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      Vaccine Hesitancy: Obstacles and Challenges

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          Abstract

          Purpose of Review

          In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions.

          Recent Findings

          There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions.

          Summary

          Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.

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          Vaccine hesitancy: Definition, scope and determinants.

          Noni MacDonald (2015)
          The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences.
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            COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

            Malik Sallam (2021)
            Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.
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              COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

              Julio Solís Arce, Shana Warren, Niccoló F. Meriggi … (2021)
              Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs. Survey data collected across ten low-income and middle-income countries (LMICs) in Asia, Africa and South America compared with surveys from Russia and the United States reveal heterogeneity in vaccine confidence in LMICs, with healthcare providers being trusted sources of information, as well as greater levels of vaccine acceptance in these countries than in Russia and the United States.
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                Author and article information

                Contributors
                Vikram Sakaleshpur Kumar:
                ORCID: http://orcid.org/0000-0002-1369-7682
                vikramskumar@yahoo.co.in
                Journal
                Journal ID (nlm-ta): Curr Pediatr Rep
                Journal ID (iso-abbrev): Curr Pediatr Rep
                Title: Current Pediatrics Reports
                Publisher: Springer US (New York )
                ISSN (Electronic): 2167-4841
                Publication date (Electronic): 8 October 2022
                Pages: 1-8
                Affiliations
                [1 ]Consultant Adolescent Health Specialist and Pediatrician Director, Bengaluru Adolescent Care and Counselling Centre, 528, 2nd Block, Rajajinagar, Bengaluru, Karnataka India
                [2 ]Professor and Head Paediatrics Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra India
                [3 ]GRID grid.465053.1, ISNI 0000 0004 1800 291X, Professor of Pediatrics Subbaiah Institute of Medical Sciences, ; Shivamogga, India
                [4 ]Consultant Pediatric Generalist, Sarji Hospital, Karnataka Shivamogga, India
                Author information
                http://orcid.org/0000-0001-9466-1130
                http://orcid.org/0000-0002-1369-7682
                Article
                Publisher ID: 278
                DOI: 10.1007/s40124-022-00278-9
                PMC ID: 9546747
                PubMed ID: 36245801
                SO-VID: 695e9148-57f0-41fa-9295-bb684ff4d1c9
                Copyright © © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date accepted : 29 September 2022
                Categories
                Subject: Technology and Pediatrics (E Eisenstein and Y Evans, Section Editors)

                Keywords: vaccine hesitancy measurement,behavioral and social drivers,multicomponent interventions,health literacy,motivational interviewing,vaccine uptake
                Data availability:
                Keywords: vaccine hesitancy measurement, behavioral and social drivers, multicomponent interventions, health literacy, motivational interviewing, vaccine uptake

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