COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries

Abstract

Vaccine hesitancy forms a critical barrier to the uptake of COVID-19 vaccine in high-income countries or regions. This review aims to summarize rates of COVID-19 hesitancy and its determinants in high-income countries or regions. A scoping review was conducted in Medline^®, Embase^®, CINAHL^®, and Scopus^® and was reported in accordance with the PRISMA-SCr checklist. The search was current as of March 2021. Studies which evaluated COVID-19 vaccine hesitancy and its determinants in high-income countries (US$12,536 or more GNI per capita in 2019) were included. Studies conducted in low, lower-middle, and upper-middle income countries or regions were excluded. Factors associated with vaccine hesitancy were grouped into four themes (vaccine specific, individual, group, or contextual related factors). Of 2237 articles retrieved, 97 articles were included in this review. Most studies were conducted in U.S. (n = 39) and Italy (n = 9). The rates of vaccine hesitancy across high-income countries or regions ranged from 7-77.9%. 46 studies (47.4%) had rates of 30% and more. Younger age, females, not being of white ethnicity and lower education were common contextual factors associated with increased vaccine hesitancy. Lack of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19, lesser fear of COVID-19, believing that COVID-19 is not severe and not having chronic medical conditions were most frequently studied individual/group factors associated with increased vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine hesitancy included beliefs that vaccine are not safe/effective and increased concerns about rapid development of COVID-19 vaccines. Given the heterogeneity in vaccine hesitancy definitions used across studies, there is a need for standardization in its assessment. This review has summarized COVID-19 vaccine hesitancy determinants that national policymakers can use when formulating health policies related to COVID-19 vaccination.

Keywords: 2019 novel coronavirus disease; COVID-19 pandemic; COVID-19 vaccines; SARS-CoV-2 infection; coronavirus disease-19 (COVID-19); scoping review; vaccine acceptance; vaccine hesitancy; vaccines.

Figure 1

Flowchart for retrieval of articles. ^a Records excluded: Did not evaluate COVID-19 related vaccine hesitancy (n = 1425); Evaluated vaccine hesitancy in non-high-income countries (n = 34); non-English articles (n = 23); irrelevant systematic reviews/meta-analyses (n = 3); ^b Records excluded: Studies included countries other than high-income countries (n = 14); studies are editorials, commentaries, news article and/or opinions without original data (n = 132); Study looked at willingness of guardians enrolling children in vaccine trials (n = 1); studies retracted (n = 3).

Figure 2

Studies on vaccine hesitancy and its corresponding rates among high income countries. * Only studies with reported vaccine hesitancy rates were included in Figure 2. # 4 studies performed in multi-continents not included to prevent double counting. Abbreviations: U.S.—United States; UAE—United Arab Emirates.

Figure 3

Framework diagram summarizing key determinants of vaccine hesitancy in high-income countries or regions.