Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review

Abstract

Although the COVID-19 pandemic has caused the need for the largest mass vaccination campaign ever undertaken to date, African, Caribbean, and Black (ACB) populations have shown both a disproportionately high degree of negative impacts from the pandemic and the lowest willingness to become vaccinated. This scoping review aims to investigate low vaccine uptake in ACB populations relative to public health in high-income countries. A search was conducted in MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), the Cochrane Central Register of Controlled Trials (OvidSP), the Cochrane Database of Systematic Reviews (OvidSP), the Allied and Complimentary Medicine Database (Ovid SP), and the Web of Science following the Joanna Briggs Institute (JBI) framework for scoping reviews, supplemented by PRISMA-ScR. Theoretical underpinnings of the intersectionality approach were also used to help interpret the complexities of health inequities in the ACB population. The eligibility criteria were based on the population, concept, context (PCC) framework, and publications from 2020-19 July 2022 which discussed vaccine uptake amongst ACB people in high-income countries were included. Analysis was carried out through thematic mapping and produced four main themes: (1) racism and inequities, (2) sentiments and behaviors, (3) knowledge and communication, and (4) engagement and influence. This study has contributed to the identification and definition of the issue of low vaccine uptake in ACB populations and has illustrated the complexity of the problems, as vaccine access is hampered by knowledge, psychological, socioeconomic, and organizational barriers at the individual, organizational, and systemic levels, leading to structural inequities that have manifested as low vaccine uptake.

Keywords: African; Black and Caribbean; COVID-19 vaccination; high-income countries; vaccine hesitancy; vaccine uptake.

Figure 2

Thematic mapping. This diagram from Etowa et al. [49] illustrates the steps in thematic mapping. These steps were followed in our study except for the qualitative appraisal which is not required in a scoping review [32].

Figure 3

Results of the thematic mapping. This shows the range of subthemes within each main theme as well as the composition of different types (qualitative, quantitative, mixed methods, and commentaries) of articles relating to each theme and subtheme, to help define concepts and their boundaries.

Figure 1

Prisma diagram. * This Prisma diagram shows the selection process from the initial retrieved articles from 8 databases to the resultant 60 articles selected to incorporate into this scoping review, with reasons for articles not being included [50].