Revisiting COVID-19 Vaccine Hesitancy around the World Using Data from 23 Countries in 2021

"This study confirms the importance of a positive perception of vaccine safety and efficacy for vaccine acceptance under any circumstances."

Misperceptions of COVID-19 vaccine safety, efficacy, and risks, along with mistrust in institutions responsible for vaccination campaigns, have been reported as factors contributing to vaccine hesitancy. This survey, undertaken in late June 2021, assesses vaccine uptake and the reasons for vaccine hesitancy among participants in 23 countries, which represent approximately 60% of the world's population. The researchers conducted it based on a belief that "Understanding the characteristics and degrees of hesitancy among those who believe misinformation on safety, efficacy, and risk can help health authorities, community leaders, and other trusted sources to identify priority groups for targeted information about the safety and efficacy of available COVID-19 vaccines..."

The research was carried out within the context of a year of substantial but very uneven global COVID-19 vaccine availability, administration, and acceptance. Approximately half (52.2%) of the 23,000 survey participants resided in low- and middle-income countries (LMICs), and 50.2% were female (50.2%). Data were analysed descriptively, and weighted multivariable logistic regressions were used to explore associations with vaccine hesitancy.

The results indicate that more than three-fourths (75.2%) of the 23,000 respondents report vaccine acceptance, up from 71.5% one year earlier (see Related Summaries, below). Vaccine hesitancy did not significantly correlate with a country's current COVID-19 case burden, but country vaccination rates were negatively associated with vaccine hesitancy (r = -0.45, p = 0.034). The results indicate low vaccination uptake and relatively high hesitancy in countries in Africa compared with the rest of the sample. Low hesitancy was observed in countries with vaccine uptake of greater than 40% of the population, with the exception of Poland, France, and the United States (US), which had higher hesitancy. In all countries, hesitancy to vaccinate one's children was greater among parents who themselves were hesitant.

Across all countries, vaccine hesitancy is associated with a lack of trust in COVID-19 vaccine safety and science, as well as in skepticism about its efficacy. Vaccine hesitancy was significantly lower among respondents who reported they trust their central and/or local government in all countries except Brazil, China, Ecuador, and Peru. Vaccine-hesitant respondents are also highly resistant to required proof of vaccination; 31.7%, 20%, 15%, and 14.8% approve requiring it for access to international travel, indoor activities, employment, and public schools, respectively. Recommendations by a doctor, or to a lesser extent by an employer, may impact a respondent's views on vaccination in some countries.

Based on the findings, the researchers suggest that, for ongoing COVID-19 vaccination campaigns to succeed in improving coverage going forward, "substantial challenges remain to be overcome. These include increasing vaccination among those reporting a lower vaccine confidence or who have difficulties in accessing vaccination services, in addition to expanding vaccine access to low- and middle-income countries....Ongoing vaccination requirements and active vaccine promotion are not without the risk of hardening opposition to COVID-19 vaccination, but the alternative is to risk future surges from new variants and the continuation of the pandemic as a public health threat. Further, misinformation continues to spread and can impact COVID-19 vaccine acceptance."

In conclusion: "We still need accurate COVID-19 vaccine communication delivered by trusted sources to clearly explain vaccine safety and benefits to individuals, families, and society at large."