A rapid review of evidence on the determinants of and strategies for COVID-19 vaccine acceptance in low- and middle-income countries

Abstract

Background Vaccine acceptance and hesitancy among the general population and health care workers play an important role in successfully controlling the Coronavirus Disease (COVID)-19 pandemic. While there is evidence for vaccine hesitancy across the globe, wide variation in factors influencing vaccine acceptance has been reported, mainly from High-Income Countries (HIC). However, the evidence from Low- and Middle-Income Countries (LMICs) remains unclear. The objective of this review was to describe the determinants of vaccine acceptance and strategies to address those in an LMIC context. Methods The World Health Organization’s (WHO) Measuring Behavioral and Social Drivers of Vaccination (BeSD) Increasing Vaccination Model was employed to identify factors that influenced vaccine acceptance. All evidence related to supply-side and demand-side determinants and social and health system processes were examined. A comprehensive search for published literature was conducted in three databases and grey literature in relevant websites of government, multinational agencies, and COVID-19 resource aggregators, followed by a narrative synthesis. Results Overall, the results showed that the vaccine acceptance rates differed across LMICs, with a wide variety of reasons cited for vaccine hesitancy. Vaccine acceptance was reportedly greater among males, those with higher education, elevated socio-economic status, the unmarried, those employed as health care workers. Evidence suggested that exposure to misinformation about COVID-19 vaccines and public concerns over the safety of vaccines may contribute to lower acceptance rates. Strategies to increase vaccine acceptance rates included direct engagement with communities through influencers, including community leaders and health experts; clear and transparent communication about COVID-19 vaccines, financial and non-financial incentives; and strong endorsement from health care workers. Trust in government was identified as a significant enabler of vaccine acceptance. Conclusions There is a need for measures to address public acceptability, trust and concern over the safety and benefit of approved vaccines. Local context is essential to consider while developing programs to promote vaccine uptake. The governments worldwide also need to strategize to develop plans to address the anxiety and vaccine related concerns of community regarding vaccine hesitancy. There is a need for further research to evaluate strategies to address vaccine hesitancy in LMIC.

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

“…Trust in vaccines and vaccine messaging: Accurate and reliable information on the safety and effectiveness of COVID-19 vaccines will need to be made available to populations in these countries through a variety of trusted channels and leaders to increase COVID-19vaccine acceptance [40][41][42]. A lack of trust in COVID-19 vaccines was common among Non-acceptors in all five countries where it was assessed (Bangladesh, Kenya, Myanmar, the DRC, and Tanzania).…”

“…Information will need to be disseminated to counter (but not repeat) common myths about the vaccines' safety and effectiveness, such as beliefs in the DRC and Myanmar that the vaccines have negative and potentially deadly side effects and beliefs about the vaccines causing impotence in Tanzania. Perceived safety and trust in COVID-19 vaccines and in those promoting the vaccines (e.g., health workers and government workers) have been found to be important determinants of COVID-19 vaccination in other countries [42].…”

Adults’ Acceptance of COVID-19 Vaccine for Children in Selected Lower- and Middle-Income Countries

“…A recent review about the reasons for vaccine hesitancy in LMICs showed that exposure to misinformation about COVID-19 vaccines, public concerns over the safety of vaccines, and distrust in the government, were the main contributing factors to low vaccine acceptance rates [18]. Therefore, to decrease vaccine hesitancy, direct engagement with communities through influencers, including community leaders and health experts, is needed.…”

“…Compared to a very large number of studies addressing COVID-19 vaccine acceptance among adults [18], there is a limited number of studies examining COVID-19 vaccine acceptance for children especially among low-and middle-income countries (LMICs) [19][20][21]. Given the feasibility of vaccinating children in LMICs with the COVID-19 vaccine in the near future, our research questions were: (1) What are the COVID-19 vaccine acceptance rates for children at 50%, 75%, and 95% effectiveness levels, and (2) What are the factors affecting vaccine acceptance for children?…”

COVID-19 Vaccine Acceptance among Low- and Lower-Middle-Income Countries: A Rapid Systematic Review and Meta-Analysis

“…However, we are unaware of comprehensive categorizations and confirmations of these factors and their effects. Earlier reviews have focused on summarizing global vaccine hesitancy rates [ 13 ], calculating global vaccine acceptance rates [ 23 ], pooling vaccine acceptance rates and their predictors [ 5 ], describing vaccine acceptance rates among LMICs in a qualitative fashion [ 24 ], scoping vaccine acceptance rates in higher-income countries [ 25 ], or scoping vaccine hesitancy rates and their predictors [ 26 ]. A systematic review with a meta-analysis of vaccine acceptance and hesitancy rates and their associated factors in LMICs has not yet been explored.…”