Cited by 2,128Vaccine Coverage and HesitancySARS-CoV-2 and COVID-19 ResearchCOVID-19 and Mental Health

The DOI matches its Crossref record; 107 of the 107 references it cites were found in a registry or an index; none of the 18 sources its claims cite is checked for support yet.

COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

Open access
Sallam, Malik·2021·Vaccines

Published version of a preprint

Abstract

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 31 peer-reviewed survey studies from 33 countries found wide global variation in COVID-19 vaccine acceptance, with high rates in Ecuador, Malaysia, Indonesia, and China and low rates in Kuwait, Jordan, and several European countries. It concludes that vaccine hesitancy could be a major hindrance to pandemic control and recommends more studies in under-covered regions.

Key findings

  • Among the general public, the highest COVID-19 vaccine acceptance rates were in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%), and China (91.3%); the lowest were in Kuwait (23.6%), Jordan (28.4%), Italy (53.7%), Russia (54.9%), Poland (56.3%), the US (56.9%), and France (58.9%).
  • Among eight healthcare-worker surveys, acceptance ranged from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel; three surveys reported rates below 60%.
  • Stratified per country, 29/47 (62%) general-public surveys reported acceptance ≥70%; the review analyzed 60 surveys total: 47 among the general public, 8 among healthcare workers, 3 among parents/guardians, and 2 among university students.
  • Male sex was associated with significantly higher COVID-19 vaccine acceptance in 15 countries/studies, while age was a significant factor in 11 studies/countries.

Methods

  • PRISMA-guided systematic search of PubMed/Medline as of 25 December 2020 for English peer-reviewed survey studies evaluating COVID-19 vaccine acceptance/hesitancy; 178 records were identified, 30 articles were included, and one additional Jordan/Kuwait article was added, yielding 31 studies from 33 countries.
  • Data extracted included survey date, country/countries, target population, total respondents, and COVID-19 vaccine acceptance rate, defined as respondents answering agree/somewhat/completely agree/leaning towards yes/definitely yes.
  • Findings were synthesized descriptively, with acceptance rates stratified by country and target population.

Limitations

  • The paper states that reliance on PubMed alone may have missed relevant studies, citing the example of Head et al.; included studies were cross-sectional with different sampling strategies, so results are snapshots and cannot predict future changes in acceptance.
  • The paper states that studies used different approaches to express willingness to accept COVID-19 vaccines (e.g., binary yes/no vs. Likert-type scales), which should be considered when comparing acceptance rates.
  • Evident from the text: the review added one recently published Jordan/Kuwait article outside the systematic search, and it reports a descriptive synthesis rather than a formal meta-analysis or quality appraisal.

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Integrity signals

Registry

Crossref · 10.3390/vaccines9020160

Cites

107 of 107 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Flow chart of the study selection process.
Figure 1 Flow chart of the study selection process.CC BY · PubMed Central
Figure 2 COVID-19 vaccine acceptance rates worldwide. For countries with more than one survey study, the vaccine acceptance rate of the latest survey was used in this graph. The estimates were also based on studies from the general population, except in the following cases where no studies from the general public were found (Australia: parents/guardians; DRC: healthcare workers; Hong Kong: healthcare workers; Malta: healthcare workers).
Figure 2 COVID-19 vaccine acceptance rates worldwide. For countries with more than one survey study, the vaccine acceptance rate of the latest survey was used in this graph. The estimates were also based on studies from the general population, except in the following cases where no studies from the general public were found (Australia: parents/guardians; DRC: healthcare workers; Hong Kong: healthcare workers; Malta: healthcare workers).CC BY · PubMed Central

Verification

Claims the paper makes

12 Not checked yet · 10 Own result · 6 No basis given · 4 Own method · 4 Own interpretation

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  • Probably not a substantial claim. 4
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Metadata

Authors
Sallam, M.
Affiliations
University of Jordan (JO)
Corresponding author
Sallam, Malik
Venue
Vaccines
Publisher
MDPI AG
Published
2021-02-16
Volume
9
Issue
2
Pages
160
ISSN
2076-393X (ISSN-L)
OpenAlex
W3132264034
Cited by
2,128
References
101
Citations by year
2026: 82 · 2025: 146 · 2024: 270 · 2023: 505 · 2022: 710 · 2021: 410
FWCI
51.35
Type
journal article
Language
en
Open access
Locations
  • Vaccines (publishedVersion, cc-by)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • Preprints.org (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
COVID-19 vaccine hesitancy, COVID-19 vaccination, healthcare workers, public trust in vaccination, cross-national comparison

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