Summary Examine the factors that promote vaccine hesitancy or acceptance during pandemics, major epidemics and global outbreaks. A systematic review and thematic analysis of 28 studies on the Influenza A/H1N1 pandemic and the global spread of Ebola Virus Disease. We found seven major factors that promote vaccine hesitancy or acceptance: demographic factors influencing vaccination (ethnicity, age, sex, pregnancy, education, and employment), accessibility and cost, personal responsibility and risk perceptions, precautionary measures taken based on the decision to vaccinate, trust in health authorities and vaccines, the safety and efficacy of a new vaccine, and lack of information or vaccine misinformation. An understanding of participant experiences and perspectives toward vaccines from previous pandemics will greatly inform the development of strategies to address the present situation with the COVID-19 pandemic. We discuss the impact vaccine hesitancy might have for the introduction and effectiveness of a potential COVID-19 vaccine. In particular, we believe that skepticism toward vaccines can still exist when there are no vaccines available, which is contrary to contemporary conceptualizations of vaccine hesitancy. We recommend conducting further research assessing the relationship between the accessibility and cost of vaccines, and vaccine hesitancy.

The severe acute respiratory syndrome–coronavirus-2 pandemic has spread rapidly and has a growing impact on individuals, communities, and healthcare systems worldwide. At the core of any pandemic response is the ability of authorities and other stakeholders to react appropriately by promoting hygiene and social distancing behaviors. Successfully reaching this goal requires both individual and collective efforts to drastically modify daily routines and activities. There is a need to clarify how knowledge and awareness of disease influence risk perception, and subsequent behavior in the context of pandemics and global outbreaks. We conducted a scoping review of 149 studies spanning different regions and populations to examine the relationships between knowledge, risk perceptions, and behavior change. We analyzed studies on five major pandemics or outbreaks in the twenty-first century: severe acute respiratory syndrome, influenza A/H1N1, Middle East respiratory syndrome, Ebola virus disease, and coronavirus disease 2019.

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