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Review
. 2024 Jul 6;12(7):747.
doi: 10.3390/vaccines12070747.

Understanding COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Godspower Nwachukwu  1 , Alaa Rihan  2 , Esther Nwachukwu  3 , Ndukwe Uduma  3 , Kimberly S Elliott  4 , Yordanos M Tiruneh  2   5
Affiliations
Review

Understanding COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Godspower Nwachukwu et al. Vaccines (Basel). .

Abstract

The COVID-19 pandemic has presented the importance of vaccination as a pivotal strategy for controlling its spread. However, vaccine hesitancy poses a significant barrier to achieving widespread immunization in the United States. This systematic review utilizes the 5C model to examine the factors contributing to hesitancy, which include confidence in vaccines, complacency about disease risk, calculations of individual benefit, convenience of vaccination, and collective responsibility for the protection of others.

Methods: We conducted a comprehensive search across several relevant databases and the gray literature, identifying 544 studies that used quantitative and qualitative methods to explore COVID-19 vaccine hesitancy in the general U.S.

Results: This review identifies a complex interplay of factors affecting hesitancy, such as concerns over vaccine safety and efficacy, misinformation and conspiracy theories, demographic variables, and socioeconomic conditions. Key strategies for increasing vaccine uptake include transparent and effective communication along with proactive community engagement.

Conclusions: To effectively mitigate vaccine hesitancy, it is crucial to understand its multifaceted causes. Tailored interventions that consider socioeconomic and cultural contexts and prioritize clear communication, community involvement, and specific strategies to address unique concerns can enhance vaccine acceptance.

Keywords: COVID-19 pandemic; United States; misinformation; mistrust; vaccination; vaccine acceptance; vaccine hesitancy; vaccine perceptions; vaccine safety; vaccine uptake.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic representation of the 5C model illustrating the interplay between confidence, complacency, convenience, calculation, and collective responsibility in shaping vaccine hesitancy.
Figure 2
Figure 2
PRISMA (preferred reporting items for systematic reviews and meta-analyses) flow diagram showing the selection process for studies included in the systematic review.
Figure 3
Figure 3
Geographic distribution of vaccine hesitancy studies across the United States.
See this image and copyright information in PMC

References

    1. World Health Organization WHO Coronavirus (COVID-19) Dashboard|WHO Coronavirus (COVID-19) Dashboard with Vaccination Data. [(accessed on 9 September 2023)];2023 Available online: https://covid19.who.int/
    1. Klimek L., Novak N., Cabanillas B., Jutel M., Bousquet J., Akdis C.A. Allergenic components of the mRNA-1273 vaccine for COVID-19: Possible involvement of polyethylene glycol and IgG-mediated complement activation. Allergy. 2021;76:3307–3313. doi: 10.1111/all.14794. - DOI - PMC - PubMed
    1. Kim J.H., Hotez P., Batista C., Ergonul O., Figueroa J.P., Gilbert S., Gursel M., Hassanain M., Kang G., Lall B., et al. Operation Warp Speed: Implications for global vaccine security. Lancet Glob. Health. 2021;9:e1017–e1021. doi: 10.1016/S2214-109X(21)00140-6. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention COVID Data Tracker. U.S. Department of Health & Human Services. 9 April 2024. [(accessed on 9 April 2024)]; Available online: https://covid.cdc.gov/covid-data-tracker.
    1. Heintzelman C.A. The Tuskegee syphilis study and its implications for the 21st century. New Soc. Work. 2003;10:4–5.

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