The acceptance of COVID-19 vaccine at early stage of development and approval: A global systematic review and meta-analysis

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

Country of origin effects in explaining motivations for COVID-19 vaccine acceptance: A cognitive-affective-norm approach

This study aims to broaden the understanding of the motivational factors influencing vaccine acceptance framed as product country image (PCI) by exploring the role of overall country image (OCI), vaccine knowledge and information inconsistency, in addition to the three most commonly investigated constructs: vaccine efficacy, fear of vaccine and social norm. A self-administered questionnaire was distributed online to 593 Vietnamese participants to collect data on COVID-19 vaccines from four different countries: the USA, the UK, Russia and China. Structural equation modelling was employed to test the proposed model and hypotheses. The results indicated that OCI had a positive effect on vaccine acceptance for vaccines from the USA and Russia, but a non-significant effect for vaccines from the UK and a negative effect for vaccines from China. Vaccine efficacy, social norm and subjective knowledge had a positive effect for most vaccines, while fear of the vaccine and information inconsistency had negative effects for certain vaccines. The results suggest that vaccine efficacy and social norm are more stable and significant predictors of vaccine acceptance than other constructs. Moreover, OCI moderated the effects of vaccine efficacy, fear of the vaccine, information inconsistency, subjective knowledge and social norm on vaccine acceptance for certain vaccines.

Acceptance of COVID-19 vaccine booster dose among the people of Bangladesh: A cross-sectional study

Vaccine booster dose (VBD) provides a potential therapeutic alliance in preventing breakthrough infection and new variant's arrival while preserving long-lasting host immunity. This study aimed to analyze COVID-19 VBD willingness and identified the key determinants of VBD acceptance among the general people of Bangladesh. This survey-based study applied a quantitative research paradigm. A validated, anonymous, and multi-item questionnaire was adopted through a theoretical review of pertinent literature on the topic. Data were collected between August 2022─October 2022, and sampling was done randomly. A total of 704 individuals were invited via face-to-face interview approach; however, 13.8 % of them declined to give consent, which resulted in the participation of 607 potential respondents. The main outcome measure was COVID-19 VBD acceptance willingness. Binary logistic regression analysis was conducted to rationalize the study's objectives. The pooled COVID-19 booster vaccine acceptance rate was 70.0 % (95 % confidence Interval [CI]: 67─73) among Bangladeshi people. An analysis of binary logistic regression revealed that, out of 14 potential factors, "efficacy", "repeated immunity", "communication", and "trust" showed highly significant positive association (adjusted odds ratio [aOR ] = 2.151 95 % CI: 1.391─ 3.508, aOR = 2.033 95 % CI: 1.299─ 3.181, and aOR = 2.552 95 % CI: 1.557─4.183 respectively, p<0.01), and "equal safety", "risk-benefit ratio" and "community protection" had significant positive association (aOR = 1.739 95 % CI: 1.070─2.825, aOR = 1.712 95 % CI: 1.116─2.627, and aOR = 1.628 95 % CI: 1.395─0.998, p<0.05) with VBD acceptance. However, post-vaccination "side effects" showed significant negative (aOR = 0.393 95 % CI: 0.237─0.674, p<0.01) associations with VBD acceptance. The odds of accepting the COVID-19 vaccine booster was found 1.26, and it was found insignificant (p>0.05) in the Chi-squared test. Bangladeshi people expressed a moderately high level response to COVID-19 VBD acceptance. A positive attitude towards the COVID-19 VBD is an outcome of this study, regardless of the circumstances, as far as safety, efficacy, perceived health benefits, communication, trust, and community resistance are concerned. Post-vaccination side effects fear was the primary reason for booster dose skepticism as well as a barrier to administering booster shots. The confidence in COVID-19 VBD will be boosted when mass people are effectively communicated and vaccine's data become more available publicly.

COVID-19 vaccination intention among nursing, medical, and dental students: A systematic review and meta-regression analysis

The introduction of the COVID-19 vaccine amidst the pandemic has heralded a paradigm shift. Healthcare students in nursing, medicine, and dentistry must have positive attitudes owing to their future role in vaccine recommendations to the public and patients. This meta-regression analysis assessed the differences in COVID-19 vaccination intention (VI) of nursing, medical, and dental students. Medline/PubMed, EMBASE, CINAHL, Cochrane Library, and Korean MBASE were searched for eligible studies. Quality was assessed by the Joanna Briggs Institute's quality appraisal. Forty-one studies were included in the final analysis, and the estimation of pooled prevalence (68%) and relevant factors were assessed. Dental students were found to have the lowest VI (57%), which significantly (p = .018) differed from that of nursing students (64%). Countries in South-East Asia and those with high income levels were found to have high VI. Therefore, global vaccine programs for healthcare students should be prepared considering their geographical and economic status.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Understanding the challenges to COVID-19 vaccines and treatment options, herd immunity and probability of reinfection

Unlike pandemics in the past, the outbreak of coronavirus disease 2019 (COVID-19), which rapidly spread worldwide, was met with a different approach to control and measures implemented across affected countries. The lack of understanding of the fundamental nature of the outbreak continues to make COVID-19 challenging to manage for both healthcare practitioners and the scientific community. Challenges to vaccine development and evaluation, current therapeutic options, convalescent plasma therapy, herd immunity, and the emergence of reinfection and new variants remain the major obstacles to combating COVID-19. This review discusses these challenges in the management of COVID-19 at length and highlights the mechanisms needed to provide better understanding of this pandemic.

BNT162b2 COVID-19 Vaccines in Children, Adolescents and Young Adults with Cancer-A 1-Year Follow-Up

(1) Background: Children and young adults with cancer are poorly represented in COVID-19 vaccination studies, and long-term protection conferred by vaccination is not known. (2) Objectives: 1. To determine the adverse effects associated with BNT162B2 vaccination in children and young adults with cancer. 2. To assess its efficacy in stimulating immunological response and in preventing severe COVID-19 disease. (3) Methods: Retrospective single-center study evaluating patients aged 8 to 22 years, with cancer, who underwent vaccination from January 2021 to June 2022. ELISA serologies and serum neutralization were collected monthly from the first injection. Serologies below 26 were considered negative, while those above 264 BAU/mL were considered positive and indicative of protection. Antibodies titers were considered positive above 20. Data on adverse events and infections were collected. (4) Results: 38 patients were included (M/F = 1.7, median age 16 years), of whom 63% had a localized tumor and 76% were undergoing treatment at the time of the first vaccination. Two or three vaccine injections were administered in 90% of patients. Adverse events were mainly systemic and not severe, except for seven grade 3 toxicities. Four cancer-related deaths were reported. Median serology was negative the month following the first vaccination and became protective during the third month. At 3 and 12 months, median serology was 1778 and 6437 BAU/mL, respectively. Serum neutralization was positive in 97% of the patients. COVID-19 infection occurred despite vaccination in 18%; all were mild forms. (5) Conclusions: In children and young adults with cancer, vaccination was well tolerated and conferred effective serum neutralization. COVID-19 infections were mild, and vaccine seroconversion persisted after 12 months in most patients. The value of additional vaccination should be further established.

COVID-19 vaccine acceptance rate and its predictors in Ethiopia: A systematic review and meta-analysis

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I²), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P.

VALUE

0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P.

VALUE

0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P.

VALUE

0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Prevalence and Determinants of COVID-19 Vaccine Acceptance in South East Asia: A Systematic Review and Meta-Analysis of 1,166,275 Respondents

Despite its importance in guiding public health decisions, studies on COVID-19 vaccination acceptance and its determinants in South East Asia (SEA) are lacking. Therefore, this study aims to determine the prevalence of COVID-19 vaccine acceptance and the variables influencing the vaccine's acceptance. This review is registered under PROSPERO CRD42022352198. We included studies that reported vaccination acceptance from all SEA countries, utilising five academic databases (Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar), three Indonesian databases (the Indonesian Scientific Journal Database, Neliti, and Indonesia One Search), two pre-print databases (MedRxiv and BioRxiv), and two Thailand databases (ThaiJo and Thai-Journal Citation Index). The analysis was conducted using STATA 17.0 with metaprop commands. The prevalence for COVID-19 vaccination acceptance in SEA was 71% (95%CI 69-74; I2 99.87%, PI: 68.6-73.5). Myanmar achieved the highest COVID-19 vaccination acceptance prevalence, with 86% (95%CI 84-89), followed by Vietnam with 82% (95% CI 79-85; I2 99.04%) and Malaysia with 78% (95%CI 72-84; I2 99.88%). None of the ten determinants studied (age, sex, education, previous COVID-19 infections, smoking and marriage status, health insurance, living together, chronic diseases, and healthcare workers) were significantly associated with acceptance. This result will be useful in guiding vaccination uptake in SEA.