COVID Vaccine Review 2023

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Journal of Infection and Public Health 16 (2023) 441–466
Contents lists available at ScienceDirect
Journal of Infection and Public Health

journal homepage: www.elsevier.com/locate/jiph
Review
Implications for COVID-19 vaccine uptake: A systematic review

Peter Adu a,1,⁎ a
, Tosin Popoola , Oleg N. Medvedev , Sunny Collings , James Mbinta , b a a
]]
]]]]]]
]]
Clive Aspin a, Colin R. Simpson a

a
School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
b
University of Waikato, New Zealand
a r t i cl e i nfo a bstr ac t
Article history: Background: Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major
Received 4 September 2022 public health concern in the face of high rates of COVID-19 hesitancy among the general population. We
Received in revised form 21 January 2023 must understand the impact of the determinants of COVID-19 vaccine uptake when designing national
Accepted 26 January 2023
vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and
the demographic, psychological, and social predictors of COVID-19 vaccination uptake.
Keywords:
Methods: We systematically searched seven databases between July 2021 and March 2022 to retrieve re
Vaccine uptake
COVID-19 levant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the
Vaccination 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included
Hesitancy in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first
Infodemics COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).
Results: Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns
about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and
uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA
approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate
information about vaccines were the main determinants of COVID-19 vaccine hesitancy.
Conclusion: Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as pro
viding adequate information about vaccines and the impacts of pandemics, should be considered before
implementation of any vaccination programme. Reassuring people about the safety of medical vacci
nation and using alternative procedures such as needle-free vaccination may help further increase
vaccination uptake.
© 2023 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health
Sciences. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/
4.0/).
Contents
. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
. Search terms and strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
. Inclusion and exclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
. Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
. Data extraction and quality assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
. Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
. Characteristics of the selected studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
⁎
Correspondence to: Victoria University of Wellington, P. O. Box 600, Wellington 6140, New Zealand.
E-mail addresses: adupe@staff.vuw.ac.nz (P. Adu), tosin.popoola@vuw.ac.nz (T. Poopola), oleg.medvedev@waikato.ac.nz (O.N. Medvedev),
sunny.collings@vuw.ac.nz (S. Collings), james.mbinta@vuw.ac.nz (J. Mbinta), clive.aspin@vuw.ac.nz (C. Aspin), colin.simpson@vuw.ac.nz (C.R. Simpson).
1
ORCID: 0000-0002-1931-147X;
https://doi.org/10.1016/j.jiph.2023.01.020
1876-0341/© 2023 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY
license (http://creativecommons.org/licenses/by/4.0/).
P. Adu, T. Poopola, O.N. Medvedev et al. Journal of Infection and Public Health 16 (2023) 441–466
. COVID-19 vaccine uptake/hesitancy rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461

. Demographic determinants of COVID-19 vaccine uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
. Psychological predictors of COVID-19 uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
. Social predictors of COVID-19 vaccine uptake. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
. COVID-19 Infodemic predictors of COVID-19 vaccine uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
. Research in context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Declaration of interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
Introduction behaviours (e.g. vaccine uptake determinants and attitudes) and to

determine whether these change over time [25–28].
The COVID-19 pandemic has negatively affected communities
worldwide, triggering public health interventions aimed at eradi Methods
cating or reducing the transmission of COVID-19 [1]. The societal
impacts of COVID-19 have been economic, social, and psychological We conducted a systematic review to investigate attitudes towards
[2,3]. By the end of August 2022, the World Health Organization COVID-19 vaccine acceptance and its determinants during the roll-out of
(WHO) had recorded approximately 600 million confirmed cases global COVID-19 vaccination programmes. A previously registered pro
and 6.5 million deaths due to COVID-19 worldwide [4]. tocol on PROSPERO (#CRD42021281769) guided this review. The review
Scientists have developed vaccines to prevent the spread of was conducted using the Preferred Reporting Items for Systematic
COVID-19 and reduce serious adverse events such as hospitalisation Reviews and Meta-Analyses (PRISMA) guidelines [29]. We wished to
and death. As of November 2022, 50 COVID-19 vaccines had been understand temporal changes and therefore, for the purpose of this
approved for global use. In addition, approximately 850 COVID-19 systematic review, Time 1 represents ‘before the first roll-out of the
vaccine candidates were undergoing clinical trials [5]. COVID-19 COVID-19 vaccine’ (prior to FDA approval: 11 December 2020), while
vaccines have been effective in reducing the spread of infection, Time 2 represents ‘after the first roll-out of the COVID-19 vaccine’.
severity of symptoms, and death [6,7]. A high population uptake of
vaccines can result in the achievement of a herd immunity
threshold. A high uptake of effective vaccines, such as that for Search terms and strategies
COVID-19, can lead to substantial reductions in infections [8,9]. It is
estimated that a COVID-19 vaccine with 95% and 80% efficacy will Seven databases were searched: PubMed, Medline and Embase (via
require 63% and 75% of the population, respectively, to be immune to Ovid), Scopus, PsycINFO, Web of Science, and CINAHL. Search strategies
achieve herd immunity against the infection [9,10]. However, COVID- for the review were aligned to each database according to indexing
19 vaccine hesitancy has been reported among various populations terms, in addition to Medical Subject Headings (MeSH), truncations,
[11–13], including low- and middle-income countries where COVID- and Boolean operators. Terms describing the concept of COVID-19 were
19 vaccine hesitancy tends to be higher [14]. Globally, by 17 October used in each database, and phrases denoting vaccine uptake and in
2022, 4.98 billion people have received at least one dose of a COVID- tentions were also used in each database. A preliminary literature
19 vaccine, accounting for 64% of the eligible vaccination population. search began on 12 July 2021 and all searches were completed on 18
Among them, 28.3% were from low-income countries [4]. Thus, given March 2022. Searches were not limited to any specific geographical
the benefits of vaccines and the COVID-19 vaccination prevalence location but were limited to human studies only. The search included
rate, there is a need to investigate COVID-19 vaccine uptake and its studies published since the emergence of COVID-19 in 2019. See
associated determinants to increase the success rates of vaccinations Appendix 1 for the specific search terms used for each database.
globally.
Previous systematic reviews conducted before the start of the Inclusion and exclusion criteria
COVID-19 vaccination program found that factors related to COVID-
19 vaccine hesitancy included distrust in institutions, lower educa Studies that explored the determinants of COVID-19 vaccine
tional levels, age, female sex, being a healthcare worker, African- uptake based on quantitative nationwide surveys were included in
American ethnicity in the US, low-income levels, and the use of this review. Thus, the included studies surveyed national popula
social media for sourcing COVID-19 information [15–23]. There is tions (i.e. either representative or non-representative sample sizes)
also some evidence that there have been gradual attitudinal changes of at least 100 participants aged 18 years and over. The included
towards vaccine hesitancy in the general population [13,24]. Fur studies were required to report the reliability of the non-binary
thermore, no systematic reviews of before-and-after studies (e.g. scales used in the study. Only English-language publications were
from the first roll-out of a COVID-19 vaccination program) have been included in this analysis.
conducted. Therefore, a review of the empirical literature is needed Exclusion criteria were applied to cross-national comparison
to shed light on the relevant patterns of COVID-19 vaccine-uptake studies (i.e., between-country studies), as we intended to provide
intentions. We carried out a systematic review to explore health country-specific evidence. Studies that used only a defined popula
tion characteristic (e.g. health workers or students only) and studies
442
Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the systematic review.
that provided only descriptive findings of COVID-19 vaccine uptake by screening of abstracts and sample/method sections based on the
rates were also excluded. No gray literature (such as reports, spee study design and nationwide studies. The full texts of the articles
ches, and newsletters) was added to the selected papers. identified at this stage were screened independently by two authors (PA
and JM) to determine their eligibility based on the inclusion criteria of
Screening the review (Fig. 1). Disagreements between the two authors (PA and JM)
on a paper [30] were resolved by a third investigator (CS).
Papers containing search words were extracted from seven databases
and imported into Endnote version 20, and duplicates were removed Data extraction and quality assessment
(Fig. 1). The initial data screening was performed by the first author (PA).
The titles of the articles were first screened to identify those relevant to Data from the studies used in the current review were extracted
the determinants of COVID-19 vaccine uptake (Fig. 1). This was followed independently by two authors (PA and JM). Data were extracted under
443
Table 1
Summary of included nationwide studies for before-and-after the approval of COVI-19 vaccine by FDA.
BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)
No Author (s) Aim of study Study design / Main outcome of the study Measures & Reliabilities/
Name/Country Participants’ Quality assessment
recruitment scores
method/ Sample
size/ Study date.
Domains
Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

P. Adu, T. Poopola, O.N. Medvedev et al.
Predictors
1 Abu et al. (2021) To evaluate the -Online cross- -Religiosity -Desire for natural -Lack of information on All measures (α = 0.88)
Jordan perception and hesitant sectional survey supplements, COVID-19 COVID-19 5point: Satisfactory
attitudes towards COVID- using convenience vaccine adverse side -Financial cost related to
19 vaccine and the sampling technique effect, and previous the access of COVID-19
reasons associated with Between July and experience with vaccine
such hesitancies. August 2020 COVID-19.
-Sample size: 1287
2 Al Halabi et al. To assess the intent to -Cross-sectional -40.9% hesitancy -Gender, marital -Self-developed vaccine
(2021) receive the COVID-19 survey using Self- rate status predicted hesitancy questions
Lebanon vaccine and factors administered -37.7% were COVID-19 vaccine (α = 0.84), fear of COVID-19
associated with vaccine questionnaire neutral, and 21.4% uptake. scale (α = 0.87),
refusal. through acceptance rate. knowledge on COVID-19
Snowballing (α = 0.90), attitudes towards
sampling was COVID-19 (α = 0.83),
conducted from practice about COVID-19
November to (α = 0.89).
444
December 2020. 3ponts: Unsatisfactory
-Sample size: 579
3 Alawadhi et al. -To evaluate the -Online cross- -67% agreed to - Gender, age - Knowledge of COVID- -Engaging in protective -Knowledge question on
(2021) determinants of COVID-19 sectional survey take COVID-19 educational levels, 19 self-protection measures, informing treatment, transmission,
Kuwait vaccine acceptance using convenience vaccine. income levels, perception, following oneself about COVID-19, transmission route,
among both citizens and sampling technique marital status, and recommendation from incubation, and immunity
non-citizens from May to being a health authorities, being able to (α = 0.6), correct preventive
September 2020. worker. correctly recognize measures questions
-Sample size: 724. COVID-19 protective (α = 0.7).
measures, previous -Taking preventive
experience with COVID- measures (α = 0.80), panic
19 and influenza vaccine, (α = 0.70), and fear (α = 0.70)
and risk perception 5points: Satisfactory
towards influenza
infections, confidence in
the media, doctors,
hospitals, or the ministry
of health, trust in
government policies,
engaging in more panic
behaviours, and
expression of fear and
worries.
(continued on next page)
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
4 Ansari- Identify predictors of -Web-based cross- Perceived severity, -Perceived susceptibility

Moghaddam COVID-19 vaccine sectional survey perceived self-efficacy, (α = 0.93), perceived
et al. (2021) intentions using using convenience and perceived response severity (α = 0.77), and
Iran protection motivational sampling technique efficacy. perceived response efficacy
theory. during the month of (α = 0.85)
June 2020. 3points:
-Sample size: 265 Unsatisfactory.
5 Baeza-Rivera To assess predictors of -Online cross- -Greater belief about Beliefs about vaccine
et al. (2021) COVID-19 vaccination sectional survey vaccine effectiveness, effectiveness (a=0.86),
Chile intent. using convenience and injunctive norms conspiracy belief about
sampling technique regarding self-care COVID-19 (a=0.89), and
in December 2020 measures injunctive norms (a=0.88)
-Sample size: 1033 5points:
Satisfactory
6 Cerda et al. To identify refusal and -Online cross- -77% acceptance Gender, younger age, - Side effects of COVID- Health believed model
(2021) hesitancy factors sectional survey rate 28% were and education 19 vaccine, risk components questionnaire
Chile regarding COVID-19 through snowball undecisive. perception regarding (a=0.757).
445
vaccine. and convenience - 28% acceptance COVID-19, lack of 5points: Satisfactory
sampling rate when side knowledge of COVID-19
techniques was effects were vaccines, preferences for
conducted during unknown, and others to be vaccinated
August and 44% first, COVID-19 vaccine
September 2020. rejection rate. effectiveness concerns,
-Sample size: 370 perception protection of
COVID-19 of oneself and
others, perceived benefit
of COVID-19 vaccine,
increase perception of
the severity of COVID-19,
and previous experience
of COVID-19.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
7 Chu and Liu -To examine five set of Online cross- -Fear of COVID-19, -Perceived susceptibility to
(2021) heath behaviour theories sectional survey perceived community COVID-19 (a=0.74),
USA variables, how these using a convenience benefit and positive perceived severity of
variables influence sampling technique attitudes towards COVID-19 (a=0.92, fear of
individuals’ intentions to during late COVID-19, stronger COVID-19 (a=0.96),
receive COVID-19 vaccine. September 2020. safety concerns, beliefs attitudes towards COVID-19
Sample size: 934 about COVID-19 vaccine vaccines (a=0.98), perceived
and barriers to getting individual benefits of
COVID-19 vaccine, COVID-19 vaccines (a=0.91),
positive attitudes perceived community
towards COVID-19, and benefit of COVID-19
having had previous vaccines (a=0.85), perceived
vaccination barriers to getting COVID-19
vaccine (a=0.88, self-
efficacy (a=0.77, vaccine
hesitancy (a=0.98, COVID-
19 vaccine intentions
446
(a=0.98).
7points: Good
8 Earnshaw et al. To explore the Online cross- -Women and less -Believed in -Compliance to public
(2020) relationship between sectional survey educated individuals conspiracies health recommendation
USA COVID-19 conspiracy using convenience were less likely to (a=0.84) support for COVID-
beliefs and intentions to sampling technique receive COVID-19 19 public policies (a=0.93),
receive COVID-19 vaccine. during April 2020. vaccine. medical mistrust (a=0.88).
Sample size: 845 5points: Satisfactory
9 El-Elimat et al. -To assess COVID-19 Online cross- -37.4% acceptance -Age, employment Trust in COVID-19 -Believe that Self-developed attitudes
(2021) vaccine acceptability and sectional survey rate, 36.3% status, and gender information and COVID-19 toward COVID-19 vaccines
Jordán. attitudes predictive using convenience hesitancy rate, vaccines, having taken pandemic is a scale (a=0.6).
factors. sampling technique and 26.3% influenza vaccine before, conspiracy 6points: Satisfactory
through uncertainty rate. trust in the safety of
snowballing, COVID-19 vaccine,
conducted in willingness to pay for
November 2020. COVID-19 vaccine
Sample Size: 3100
10 Graffigna et al. To investigate the role of -Cross-sectional -58.6% -General attitudes Health engagement scale
(2020) health engagement, survey using acceptance rate towards COVID-19 ((a=0.75).
Italy perceived COVID-19 random and vaccine, perceived 4points: Unsatisfactory.
susceptibility and stratified sampling severity and perceived
severity, and the general techniques susceptibility and health
attitudes towards somewhere in May engagement.
vaccines on willingness to 2020).
accept COVID-19 vaccine. -Sample size: 1004
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
11 Guillon and To examine the -Online survey 60.6% hesitancy -Male gender, and -Previous vaccination -COVID-19 perceived threat
Kergall (2021) relationship between using quota rate and smokers history, COVID-19 (α = 0.67), perceived
France COVID-19 sampling technique, 25% vaccine concerns about benefits of COVID-19
and COVID-19 vaccination conducted in acceptance rate. safety, perceived good vaccination (α = 0.92).
intention. November 2020. health, COVID-19 risk perceived barriers to
-Sample Size: 1146 perception, perceived COVID-19 vaccination
vaccine efficacy, trust in (α = 0.81), trust in
institutions, and institutions (α = 0.78).
willingness to take risk conspiracy beliefs (α = 0.84),
in the health domain. risk preferences (α = 0.71).
5 points: Satisfactory
12 Head et al. To address public -Online cross- Education, -Low-commitment Behavioural intention items
(2020) intention to accept sectional survey employment in altruism, perceived (a=0.91), altruism scale:
USA COVID-19 vaccine using convenience healthcare sector, threat to physical health, high commitment
and determine the factors sampling technique political orientation belief in the problematic altruism((a=0.83), low
associated COVID-19 in the month of May nature of COVID-19 in commitment altruism
vaccine uptake. 2020. community worry had (a=0.81), COVID-19 related
447
-Sample size: 3159 positive relation with an worry (a=0.82), perceived
intent to vaccinate severity of COVID-19
against COVID-19. (a=0.706).
5points: Satisfactory.
13 Irfan et al. To investigate factors Face-to-face cross- -Attitudes towards -Vaccine cost and -Attitudes about COVID-19
(2022) responsible for public sectional survey COVID-19, risk unavailability of vaccine (a=0.90), environmental
Pakistan intention to get COVID-19 using perception of the negatively impacted impact of COVID-19
vaccine, and how these random sampling pandemic, and perceived COVID-19 vaccination (a=0.80), Cost of COVID-19
factors shape intentions sampling technique benefits of COVID-19 intentions. (a=0.89), risk perception of
to get COVID-19 vaccine. was conducted in vaccine positively related COVID-19 (a=0.9), perceived
November and with intentions to get vaccine benefits (a=0.94),
December 2020. COVID-19 vaccine. unavailability of vaccine
Sample size: 900 (a=0.92,), intention to get
COVID-19 (a=0.82).
6points: Satisfactory
14 Jackson et al. To examine attitudes Online cross- Types of smokers -Mistrust of vaccine benefit
(2021) towards vaccination in sectional survey (α = 0.96), worries about
UK general and the using convenience unforeseen future effects
relationship between sampling technique, (α = 0.77), concerns about
smoking status and conducted in commercial profiteering
intention to vaccinate September and (α = 87), preference for
against COVID-19 October 2020. natural immunity (α = 0.89).
pandemic. Sample Size: 29148 6points: Satisfactory.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
15 Kourlaba et al. -To determine the -Mix method study -57.7% acceptance -Age, marital status, -Correct knowledge -Sources of information. -Disbelieve in Knowledge about COVID-19
(2021) association of socio- design was rate, 26.0% employment status, regarding transmission conspiracy about (a=0.58).
Greece demographic factors, conducted using unwillingness belonging to a of COVID-19 routes and COVID-19, believing 6points: Satisfactory.
clinical factors, as well as random sampling rate, and 16.3% vulnerable group or appropriate control and that COVID-19 is a
knowledge, attitudes, and and stratified were unsure. having a family prevention measures, biological weapon,
practices and COVID-19 sampling member belonging believe in the contagious
vaccine uptake. techniques during to a vulnerable nature of COVID-19 and
the months of April group, having no the importance of herd
and May 2020. children. immunity, previous
-Sample size: 1004 experience with flu
vaccination.
16 Latkin et al. To assess the impact of -Online longitudinal -59.1% acceptance - Black race, - No prior experience -Observance of COVID-19 -COVID-19 scepticism
(2021) social norms on COVID-19 survey using rate, 16.7% educational level, with influenza vaccine, preventive (a=0.85), descriptive social
USA vaccine intention. convenience neutral and 24.2% more political COVID-19 scepticism, norms of perception of
sampling technique unwillingness conservative perceived social norms peers` concern about
from March to July rate. ideology, gender. of preventive behaviours, COVID-19(a=0.77).
2020. less trust in information 5points: Satisfactory.
448
-Sample size: 592 from CDC, trust in
information from white
house, perception of
contracting COVID-19
-
17 Malik et al. -To assess determinants of -Online cross- -67% reported -Gender, age, race, - Previous experience Perceived risk scale
(2020) COVID-19 vaccine sectional survey willingness to education, with influenza vaccine (a=0.72).
USA acceptance willingness. recruiting accept COVID-19 employment status, uptake related with 6points: Satisfactory.
participants through vaccine. and lower intentions to
Cloud Research geographic location. accept COVID-19 vaccine.
platform. The study
was conducted in
May 2020.
-Sample size: 672
18 Marchlewska Study 1: To examine the -Online survey Study 1: -Gender Study 1: Study 1: Study 1:
et al. (2022) relationship between recruiting 51% -National narcissism, -Conspiracy belief -National narcissism
Poland different national identity participants through acceptance rate. and national Study 2: (α = 0.92, national
and COVID-19 vaccination random sampling identification. -Conspiracy belief identification (α = 0.90),
attitudes. Study 2: technique. The Study 2: COVID-19 Conspiracy belief
replicate study 1 and to study was -National narcissism, (α = 0.93)
assess the effect of conducted in March national identification, Study 2:
identification with all 2020. and Identification with -National narcissism
humanity and COVID-19 -Sample size: 432 all humanity. (α = 0.95), national
vaccine uptake. (study1) identification (α = 0.93),
-Sample size: COVID-19 vaccine
807(study2) conspiracy beliefs (α = 0.92),
dentification with all
humanity (α = 0.94)
6points: Satisfactory.

Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
19 Mercadante To access the impact of Online cross- -Age, race, and -Knowledge on the -5 C scale (a=0.749). and
et al. (2020) COVID-19 pandemic on sectional survey education. importance of flu CoBQ (a=0.636), and scales
USA flu vaccine intention, and through vaccine, and perceived Combined (a=0.765).
assess vaccine intention convenience benefits vaccines. 8points: Good.
using the Health sampling technique
Behaviour Model (HBM) during the month of
October 2020.
Sample size: 525
20 Ouyang et al. To explore the prevalence Online cross- -Age, income, health -information from media, -Vaccine hesitancy scale
(2022) and factors associated sectional survey information literacy, frequency of social media (α = 0.60)
China COVID-19 vaccine through and frontline use, and diversity of social media trust (α = 0.78),
(Mainland) hesitancy. convenience workers media use health information literacy
sampling technique (α = 0.78), and lack of
during the month of confidence in COVID-19
April 2020. vaccine (α = 0.78).
Sample size: 1004 5points: Satisfactory
21 Pivetti et al. To investigate the -Online cross- - -Faith in science, and -Conspiracy belief, -Moral purity (a=0.58), faith
449
(2021) relationship between sectional survey general attitudes and COVID-19 in science (a=0.82),
Italy COVID-19 related through towards vaccines related conspiracy conspiracy belief (a=0.78),
conspiracy beliefs and convenience predicted attitudes . COVID-19-related
COVID-19 vaccine sampling technique towards COVID19 conspiracy beliefs (0.86),
acceptance behavioural was conducted vaccine uptake attitudes towards vaccines
intentions. during April-May (a=0.92), attitudes towards
2020. COVID-19 vaccine (a=0.93).
- Sample size: 590 7points: Good.
22 Prati (2020) To examine intentions to Online cross- -75.8% -Low levels of worries Institutional trust (a=0.78).
Italy receive COVID-19 vaccine. sectional survey acceptance rate, and institutional trust 4points: Unsatisfactory
-To determine factors using virtual -5.1% related with no intention
associated with vaccine snowballing unwillingness of receiving COVID-19
acceptance willingness. sampling technique rate, and 10.1% vaccine.
was conducted in were uncertain
April 2020.
Sample size: 624
23 Rahman et al. To explore COVID-19 -Online survey -Vaccine nationalism, -Vaccine demand (a=0.70),
(2021) vaccine demand, using snowballing vaccine demand, vaccine hesitancy (a=73),
Bangladesh hesitancy, and sampling technique (Prioritizing one’s vaccine nationalism
nationalism, vaccine was conducted from country for vaccination) (a=0.90).
uptake and domestic October to related COVID-19 vaccine 6points: Satisfactory
vaccine preferences. December 2020. uptake.
-Sample size: 1018
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
24 Reiter et al. To explore COVID-19 -Online cross- 69% acceptance -Income levels, -Previous experience -Recommendation of -Belief that COVID- Stigma associated with
(2020) vaccine acceptability sectional survey rate, and 31% having private health with COVID-19, COVID-19 vaccine by 19 vaccine is COVID-19 (a=0.75).
USA related variables. using convenience hesitancy rate. insurance, liberal perceived risk of getting health provider. harmful. 5points: Satisfactory.
sampling technique political learners, COVID-19 in the future,
was conducted and gender perceive severity of
during the month of COVID-19, and perceived
May 2020. effectiveness of COVID-
- Sample size: 2006 19 vaccine.
25 Roberts at al. To identify the role of -Online cross- -Age, income, -COVID-19 related stress/ -Higher approval of -Anti-vax scale (a=0.79),
(2022) political attitudes, sectional survey gender, ethnicity, worry, and experience of President Trump job, and extraversion (a=0.71),
USA personality, mental using convenience education, and fewer negative impact of adherence to COVID-19 agreeableness (a=0.76),
health, and substance use sampling technique political orientation COVID-19. safety behaviours. conscientiousness (a=0.78),
on anti-vax attitudes and was conducted negative emotionality
vaccine hesitancy. during the month of (a=0.85), open-mindedness
September and (a=0.68), mental health
October 2020. (a=0.93), problematic social
- Sample size: 1004 media use (a=0.88), liberal
450
and conservative social
attitudes (a=0.92), COVID-
19 related safety behaviours
(a=0.81), COVID-19 Stress/
worry (a=0.92).
4points: Unsatisfactory
26 Sethi et al. To identify factors Cross sectional 79.3% acceptance -Education gender, -Overall, vaccine -Overall questionnaire was
(2021) associated with COVID-19 online survey rate. 13.86% were age, ethnicity, and hesitancy increases as (a=0.91)
UK vaccine uptake. through unsure, and 6.9% smokers the perceived vaccine 5points: satisfactory.
convenience hesitancy rate. effectiveness decreases.
sampling technique
was conducted in
Septeigmber and
October 2020.
-Sample size: 4884
27 Shih et al. To estimate differences in -Online cross- -Baby Boomers -Increase perceived risk -Vaccine hesitancy scale
(2021) COVID-19 vaccine sectional survey generation, was also associated with (a=0.89).
USA hesitancy and acceptance using Convenience millennials decrease COVID-19 6points: Satisfactory
by generation. sampling technique generation, race/ vaccine rejection, this
was conducted in ethnicity, income, association was more
March 2020. political affiliation. significant among Baby
-Sample size: 713 Boomers generation
compared to Millennials
generation.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
28 Shmueli (2021) To identify attitudes and Web-based survey -80% were willing Gender, and -Having received -Perceived susceptibility to
Israel beliefs relating to COVID- through to accept COVID- education influenza vaccine COVID-19 (a=0.83).
19 vaccine. To determine convenience 19 vaccine. previously, perceived perceived severity of
factors, motivators and sampling technique benefits, cues to action, COVID-19 (a=0.73),
barriers resulting in was carried out perceived severity, perceived benefits of
decisions to receive during the months subjective norms, and COVID-19 vaccines (a=0.87),
COVID-19 vaccination. of May and June self-efficacy, cues to action (a=0.79),
2020. health motivation (a=0.759,
Sample size: 398 subjective norms (a=0.86).
5points: satisfactory
29 Trzebinski et al. To investigate how -Online longitudinal Study 1: -Basic hope scale (a=0.882):
(2021) assumption about the survey through -Life satisfaction orderliness (a=0.812),
Poland world, meaning in life, convenience correlated positively positivity (a=0.807),
and life satisfaction relate sampling technique with willingness to meaning of life scale
with attitudes towards was carried out vaccinate against COVID- (a=0.887), life satisfaction
COVID-19 vaccination. during the first half 19, and assumption scale (a=0.888, and
of December 2020 about the positivity of perceived vaccination safety
451
(study1). the world increase scale (a=0.763).
-Sample size: 266 COVID-19 vaccination 3points: Unsatisfactory.
intention when
orderliness view of the
world is low.
30 Wang et al. 2021 To investigate the Web-based survey -Gender, age, low -COVID-19 prevention -COVID-19 preventive -Preventive actions
Korea moderation role of using quota education, high related self-efficacy actions, media exposure (a=0.93), vaccination
conspiracy beliefs in sampling technique income, having large negatively predicted positively predicted intention (a=0.65), belief in
health belief model and was carried out number of children, COVID-19 vaccination COVID-19 vaccination conspiracy theories
psychometric paradigm during the months conservative intention. intention. (a=0.85), perceived
and preventive actions of August 2020 ideology, and self- susceptibility (a=0.76),
and vaccination intention. Sample size: 1524 rated poor health perceived severity (a=0.78),
perceived barriers (a=0.50),
perceived benefit (a=0.56),
self-efficacy (a=0.87),
exposure to media (a=0.60),
risk perception (a=0.86),
benefit perception (a=0.81),
trust in government
(a=0.86), trust in experts
(a=0.45), trust in science
(a=0.75), and negative affect
(a=0.91), and knowledge
(a=0.84).
8points: Good
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
AFTER FIRST COVID-19 VACCINE APPROVAL (Time2)

No. Author(s) Aim of study Study design / Main outcome of the study Measures & Reliabilities.
Name/Country Participants’
recruitment
method/ Sample
size/ Study date.
Domains
Uptake Rates Demographic Psychological Social Predictors Infodemics
Predictors Predictors
1 Ahmed et al. To investigate adherence -Online cross- -76.8% of the Concern about vaccine belief that COVID- -Adherence scale (α = 0.67).
(2021) to COVID-19 preventive sectional survey participants being effective, fear of 19 vaccine may 3points: Unsatisfactory
Somalia measures and using convivence agreed to receive bad side effect of COVID- contain substances
acceptability of COVID-19 sampling technique COVID-19 19 vaccine, confidence in derived from pigs.
vaccine. between later vaccine. strong immune system
December to late and the notion that
January 2021 COVID-19 is over in
-Sample size: 4543 Somalia.
452
2 Alibrahim et al. To explore the prevalence -Online cross- -73.8% -Marital status, -Concerns about side -Trust of vaccine benefit
(2021) of COVID-19 vaccine sectional survey acceptance rate. gender, age, effect and safety of (a=0.93)
Kuwait hesitancy, and evaluate using convivence - residence, smoking COVID-19 vaccine, -Worries about vaccine
general attitudes towards sampling through status, and income. concern about COVID-19 effect (a=0.79)
a vaccine, and examine snowballing was vaccine efficacy, -Concerns about
predictors of COVID-19 conducted from concerns about the fast commercial profiteering
vaccine hesitancy. March to April 2021 development of COVID- (a=0.79)
-Sample size: 1147 19 vaccine COVID-19, no -Preference for natural
worries about catching immunity (a=81)
COVID-19, negative -Full scale (a=0.89).
attitudes towards 5points: Satisfactory
vaccine benefits, desire
for natural immunity,
concerns abouts
commercial profiteering
of COVID-19 vaccine,
attitudes towards
previous vaccines, and
lack of adequate
information about
COVID-19
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
3 Al-Qerem et la. To assess COVID-19 -Online cross- -88.6% of -Income, and -Concerns about side -Practice towards COVID-19
(2022) vaccine uptake variables sectional survey participants were education, effect and safety of (a=0.80), COVID-19
Iraq and reasons for COVID-19 using convivence willing to be COVID-19 vaccine related Knowledge (a=0.59)
vaccination hesitancies. sampling technique vaccinated with hesitancy attitudes 4points: unsatisfactory
between May and against COVID-19. towards COVID-19
July 2021 vaccine, perceived
-Sample size: 1765 seriousness of COVID-19
related with COVID-19
vaccine acceptance, and
lack of adequate
information about
COVID-19 vaccine and
rigor in testing the
vaccine related with
COVID-19 vaccine
hesitancy.
4 Al-Rawashdeh To examine predictors of -Online cross- -Females gender was -Perceived better health -Intention to vaccinate
453
et a. (2022) COVID-19 vaccine uptake. sectional survey unwilling to accept status compared with (a=0.94), perceived
Jordan through COVID-19 vaccine perceived poor health susceptibility and severity
Snowballing compared to males. status related negatively of COVID-19 (a=0.92),
sampling technique with COVID-19 uptake, COVID-19 knowledge
was conducted in and perceived adequate (a=0.75), and COVID-19
the month of measures of the attitudes (a=0.77).
January 2021 government regarding 3points: unsatisfactory
-Sample size: 281 controlling the
pandemic, perceived
susceptibility and
severity of COVID-19,
and attitudes towards
COVID-19 related
positively with COVID-19
vaccine uptake.
5 Alwi et al. To investigate the Online cross- -83.3% -Ethnicity, religion, -Concerns about the side - COVID-19 vaccine concern
(2021) acceptance of COVID-19 sectional survey acceptance rate, age, race, marital effects of COVID-19 questionnaire (a=0.6)
Malaysia vaccine among the through and 16.7% were status, income levels, vaccine, safety, lack of
general population. Snowballing hesitant to take current residence, information on COVID-
sampling technique COVID-19 and having chronic 19, belief in traditional
was conducted late vaccine. illness. remedies, and fear of
December 2020. - injection.
Sample size: 1411
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
6 Babicki et al. To assess the effect of -Online cross- -98.9% -Rural residence, low -Anxiety regarding -Adherance to -Generalised anxiety
(2021) vaccination on mental sectional survey participants were education, divorced, COVID-19 infection government disorder (a=0.92), quality of
Poland well-being, attitudes using convivence willing to accept non-health workers, related with willingness recommendations related life (a=0.85).
regarding adherence to sampling technique COVID-19 income levels to vaccinate against with unwillingness to 5points: Satisfactory
government between March and vaccine. predicted COVID-19 COVID-19. vaccinate against
recommendations about April 2021 vaccine hesitancy. - Previous experience COVID-19.
limiting viral -Sample size: 1677 with COVID-19 infection,
transmission, and factors previous experience with
associated with intentions COVID-19 infection
to vaccinate against related with willingness
COVID-19. to vaccinate.
7 Belsti et al. To investigate the -Population-based -31.4% of -Gender, age marital -Knowledge regarding Overall questionnaire
(2021) willingness to accept online survey using acceptance rate, status, place of the effectiveness of (a=0.70).
Ethiopia COVID-19 vaccine. Convenience and residence, private COVID-19 vaccine, 5points: Satisfactory.
sampling technique 47.32% hesitancy sector worker, supporting the idea that
through rate, and 21.31% education, non- vaccination increase
snowballing during were unsure of healthcare worker, autoimmune diseases
454
February to March receiving the affiliation to believing in the
2021. vaccine. orthodox religion. impossibility of reducing
-Sample size: 1184 incidence of COVID-19
without the help of
vaccination, believing in
the fair distribution of
COVID-19 vaccine, and
perceiving that COVID-
19 vaccine has side
effects.
8 Benis et al. To investigate attitudes Online cross- 73.8% -Males and ethnic The desire to protect Reasons to take and
(2021) towards vaccination and sectional survey acceptance rate. minority, one’s family and recommend COVID-19
USA identify attributes using convenience -higher risk group, relatives, agreeing to the vaccine (a=0.76)
affecting COVID-19 sampling technique having greater view that vaccination is a 6points: Satisfactory
vaccination. in the December number of children, civic responsibility, fear
2020 and those with of being infected with
Sample size: 1728 higher education. COVID-19, high
confidence in healthcare
systems and providers,
and pharmaceutical
industry.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
9 Castellano-Teje To explore psychological -Online cross- -27.85% hesitancy -Age, and healthcare -Self-perceived -COVID-19 fear (a=0.85)
et la. (2021) factors associated with sectional survey rate, 6.71% professionals correctness of -Anxiety (a=0.90).
Spain COVID-19 vaccine using convivence resistant, 65.44% predicted COVID-19 performing COVID-19 4points: unsatisfactory
hesitancy and resistance. sampling technique acceptance rate vaccine uptake. preventive measures,
was conducted from belief in the
January to March effectiveness of COVID-
2021 19 vaccine and security,
-Sample size: 300 belief that the vaccine
will put an end to the
pandemic, high
confidence in the
vaccine, fear of COVID-
19, previous experience
with COVID-19, and
caring for a vulnerable
individual.
10 Domnich et al. To evaluate the attitudes -Online longitudinal - 85.1% -Gender and age -Belief in vaccines as All Measures (full scale)
455
(2022) regarding COVID-19 and cross-sectional acceptance rate predicted COVID-19 being safe, crucial for (a=0.83).
Italy flu vaccines, to quantify survey using vaccine uptake. public health, and the 8points: Good
hesitancy rates and stratified random view that COVID-19
factors associated with sampling technique variants contiguous to
acceptance of these was conducted in emerge related with
vaccines. October and willingness to accept
November 2021 COVID-19 vaccine, and
-Sample size: 2463 previous vaccination
history (flu), and
willingness to pay for flu
vaccine related with
COVID-19 vaccine
uptake.
11 Fernandes et al. To examine individuals’ -Online cross- -63% -Knowledge about -Following healthcare -Perceived threat to COVID-
(2021) willingness to self- sectional survey acceptance rate, COVID-19 and COVID-19 professionals’ 19 (a=0.58)
Portugal vaccinate and their using convivence vaccine, concerns about recommendation -Trust in management of
children. sampling technique the rapid development of COVID-19 (a=0.84).
was conducted from COVID-19 vaccine, 3points: Unsatisfactory
January to March positive beliefs and
2021 attitudes, perceived risk
-Sample size: 649 of COVID-19 were the
predictors of COVID-19
vaccine uptake
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
12 Freeman et al. To test effectiveness of Online Random -66.1% -Types of information Oxford COVID-19 Vaccine
(2021) messaging by hesitancy Control Trial was acceptance rate, predicted COVID vaccine Hesitancy Scale (a=0·98),
UK level and several conducted using 15.6% of were willingness. collective importance
sociodemographic factors. quota sampling doubtful, and (a=0.88), speed of
To test mediation of any technique in the 18.4% hesitant. development- (a=0.85),
effects by beliefs about month of January self-efficacy (a=71)
COVID-19 vaccination. and February 2021. COVID-19 vaccine side
Sample size: 18841 effect (a=0.78).
9points: very Good.
13 Freeman et al. -To determine prevalence Online cross- -13.8% were -Age predicted -Fear of injection related -Oxford COVID-19 Vaccine
(2021) of blood-injection-injury sectional survey hesitant towards vaccine hesitancy with higher levels of Hesitancy Scale (a=0.97),
UK. fears and its relation with using quota COVID-19 when fear of COVID-19 vaccine specific Phobia Scale
COVID-19 vaccine sampling technique vaccine. injection was hesitancy when all (blood-injection-injury)
hesitancy. was conducted from controlled for. demographic factors are (a=0.94), medical fear
January-February. -Income levels were controlled, COVID-19 survey (injections and
2021. associated with vaccine hesitancy was blood) (a=0.90).
Sample size: 15014 COVID-19 vaccine associated with specific 8points: Good
456
hesitancy attitudes. phobia, medical fear, and
injection fear, blood
injection injury fear
accounted for about 10%
vaccine hesitancy among
adult population.
14 Gan et al. (2021) Investigating willingness -Online cross- -60.4% -Education and age -Trust in the safety and - Paying attention to -Knowledge about COVID-
China to receive COVID-19 and sectional survey acceptance rate, related positively effectiveness of COVID- information about COVID- 19 (a=0.41), hygiene habits
its associated factors. using convivence 7.1% were with COVID-19 19, perception of COVID- 19 predicted COVID-19 (a=0.59).
sampling technique unwilling, and vaccine uptake. 19 incidence, and vaccine intentions. 5points: Satisfactory.
was conducted in 32.5% were previous vaccination
October and unsure. history (flu) predicted
November 2021 COVID-19 vaccine
-Sample size: 1009 intentions.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
15 Hassain et al. To assess the prevalence -Face-to-face and -46.2% expressed -Religion, and place -Poor adherence to -Vaccine hesitancy scale
(2021) of COVID-19 vaccine online survey using hesitancy of residence related COVID-19 preventive (a=0.83), COVID-19
Bangladesh hesitancy and its snowball and quota attitudes towards with COVID-19 measures predicted preventive behaviours
associated factors. sampling technique COVID-19 vaccine uptake. COVID-19 vaccine (a=0.86), Knowledge about
were conducted in vaccination. hesitancy attitudes. COVID-19 vaccine (a=0.64),
February 2021 Knowledge about
-Sample size: 1497 vaccination process (a=0.77,
COVID-19 vaccine
conspiracy (a=0.72),
attitudes towards COVID-19
vaccine (a=0.74), perceived
susceptibility (a=0.66),
perceived severity (a=0.61),
perceived benefits (a=0.84),
and perceived barriers
(a=0.70).
8points: Good
457
16 Karabela et al. To investigate the -Online cross- 54% of the -As age increases -Information from -Increased -Perception of causes of
(2021) association between sectional survey acceptance rate, attitudes towards YouTube, reliance on perception of COVID-19 Scale (PCa-
Turkey perceived causes of using cluster and 16% COVID-19 vaccine WhatsApp information, conspiracies and COVID-19), conspiracy
COVID-19, attitudes sampling technique hesitancy rate, decreases information from faith factors theories (a=0.96),
towards COVID-19 vaccine was conducted and 30% were government institution, environmental factors
and levels of trust during the month of indecisive. health professionals, (a=0.85), faith factors
regarding infodemics February 2021 newspapers, television, (a=0.90)
information source - Sample size: 1216 significant others 6points: Satisfactory.
17 Khunchandani To assess the impact of -Online cross- -89% acceptance -Ethnicity, place of -Previous experience Previous experience with
et al. (2021) COVID-19 infection in sectional survey rate, and 11% not residence, education with COVID-19 COVID-19. (a=0.79).
USA social network on COVID- using convivence willing to accept marital status, associated with COVID- 7points: Good
19 vaccination sampling technique COVID-19 political orientation 19 vaccine willingness.
willingness. was conducted in vaccine. related with COVID-
June 2021 19 vaccine uptake.
-Sample size: 1602
18 Lo et al. (2021) To understand the -Online cross- Gender Sources of vaccine Belief in both Powerlessness. (a=82).
Taiwan relationship between sectional survey recommendation artificial origin of 4points: Unsatisfactory
mental models and using convivence predicted COVID-19 COVID-19 related
COVID-19 vaccine sampling technique vaccine uptake. with COVID-19
willingness. was conducted in vaccination
April 2021 intention.
-Sample size: 1100
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
19 Maciuszek et al. To investigate the relation -Online cross- -Fear of side effects, -Reason for refusal scale for
(2022) between declared sectional survey distrust for COVID-19 Time 1: (a=0.80), reason for
Poland intention to vaccinate and using convivence vaccine producing refusal scale for Time2
the actual vaccination sampling technique companies, safety (a=0.74, reason for COVID-
uptake. was conducted from concerns and 19 acceptance scale: Time 1
February to August effectiveness, the desire (a=0.91), reason for COVID-
2021 of helping to stop the 19 acceptance scale Time 2
-Sample size: 918 pandemic, the belief that (a=0.96).
vaccines are effective to 5points: Satisfactory
prevent diseases and
return to normal life, and
concern about the fast
development of COVID-
19 vaccine.
20 Patwary et al. To identify factors of -Online cross- 85% -Body size, smoking -Fear of side effect of the Possessing COVID-19 -Satisfaction with health
(2021) COVID-19 acceptance or sectional survey acceptance rate. habits, age, and vaccine, doubt about the related information authorities (a=0.72,
Bangladesh hesitancy using the using convenience schooling. effectiveness, correlated with COVID-19 perceived susceptibility
458
theory of planned sampling technique susceptibility to COVID- vaccine uptake. (a=0.92), perceived severity
behaviour and health was conducted in 19, perceived high (a=0.61), perceived benefits
behaviour model. July and August severity of COVID-19, (a=0.79), perceived barriers
2021 greater benefits of (a=0.76), cues to actions
-Sample size: 543 vaccination, possessing (a=0.72, subjective norms
high cues to actions, (a=0.89).
stating greater subjective 5points: Satisfactory.
norms, self-efficacy,
previous experience with
vaccination, greater trust
and satisfaction with
health authorities, high
levels of perceived
barriers, and preference
for natural immunity.
21 Pang et al. 2021 To explore the effect of -Online survey -Gender, and -Higher understanding Compliance with Framing messages (two
China information framing on using convenience education predicted of COVID-19 infection, government COVID-19 groups) (a= 91) and
COVID-19 vaccination sampling technique COVID-19 vaccine perceived effectiveness prevention and control (a=0.90).
intentions. was conducted from uptake of the vaccine positively measures. 3points: Unsatisfactory
March to April 2021 predicted COVID-19
-Sample size: 280 vaccination intention,
and risk disclosure had
the greatest impact
COVID-19 vaccination
intention.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
22 Santirocchi et al. To examine the rate of -Online cross- -3.6% hesitancy -Gender, marital -COVID-19 vaccine Misinformation -Intention to be vaccinated
(2022) COVID-19 vaccination; sectional survey rate, 78.5% status, age, and uptake correlated with negatively related (a=0.88, perceived Risk
Italy and the demographic and using snowballing acceptance rate education predicted perceived risk of COVID- with COVID-19 (a=0.62, fear of COVID-19
psychological factors sampling technique COVID-19 vaccine 19, pro-sociality, fear of vaccine uptake. (a=0.86), use of, preventive
associated with COVID-19 was conducted from uptake. COVID-19, use of behaviours (a=0.92).
vaccine acceptance. March to May 2021 preventive behaviours, 5points: Satisfactory
-Sample size: 971 trust in government,
trust in science, and trust
in medical professional.
23 Schmitz et al. Study1: Study1: Online Age, and levels of -Controlled motivation, Pandemic-related health
(2022) To examine which longitudinal cross- education related distrust-based concerns (a=0.66; a=0.67),
Belgium motivational factors sectional survey with intentions to amotivation, and effort- infection-related risk
contribute to individuals’ using convenience vaccinate against based amotivation, perception (a=0.63; a=0.71),
intention and actual sampling technique COVID-19 vaccine andemic-related health autonomous motivation
behaviour to take COVID- was conducted from uptake. concerns, infection- (a=0.94; a=0.71, controlled
19 vaccine. December to May related risk perception motivation (a=0.69; a=0.74),
2021 and autonomous distrust-based amotivation
459
-Sample size: 8887 motivation, distrust- (a=0.91; a=0.90), effort-
based amotivation, and based amotivation (a=0.79;
effort-based amotivation a=0.78)
5points: Satisfactory
24 Seboka et al. To assess willingness to Online cross- 46.55% -Gender, and age -Previous experience -Affordability of vaccines -Perceived susceptibility to
(2021) pay for COVID-19 vaccine, sectional survey acceptance rate, with COVID-19, correlated with higher COVID-19 (a=0.72),
Ethiopia the demand and intent to using convenience 32.7% were perceived susceptibility, levels of uncertainty and perceived severity of
vaccinate against and snowballing unsure, and concern about COVID-19 unwillingness to accept COVID-19 (a=0.84),
COVID-19. sampling 20.69% vaccine safety, and desire COVID-19 vaccine. perceived benefits of
techniques was hesitancy rate. that more people should COVID-19 vaccines (a=0.53),
conducted between be vaccinated first. perceived barriers and cues
February-March to action (a=0.71).
2021. 4points: Unsatisfactory
Sample size: 1160
25 Trzebinski et al. To investigate how -Online longitudinal Study 2: -Basic hope scale (a=0.875):
(2021) assumption about the survey through - Life satisfaction, orderliness (a=0.809),
Poland world, meaning in life, convenience orderliness assumption positivity a= 0.775),
and life satisfaction sampling technique of the world tends to life satisfaction scale
related with attitudes was carried out reduce the positive (a=0.884), perceived
towards COVID-19 during middle of impact of positivity vaccination safety scale
vaccination. January 2021 assumption on (a=0.775).
-Sample size: 266 willingness to receive 3points: Unsatisfactory
COVID-19 vaccine.
Table 1 (continued)
recruitment scores
method/ Sample
size/ Study date.
Domains

Predictors
26 Xiao et al. To explore psychosocial -Online cross- -44.2% reported Gender, place of - Side effects of COVID- -Protection Motivation
(2021) factors responsible for sectional survey COVID-19 residence, and age. 19 vaccine, self reported Theory constructs (a=0.80),
China COVID-19 vaccination using convenience hesitancy rate, health status, high perceived susceptibility
willingness. sampling through and response efficacy to (a=0.86), perceived Severity
460
snowballing -55.8% reported vaccination (e.g., Vaccine (a=0.80), response efficacy
technique was COVID-19 protects me and my (a=0.83),
conducted in acceptance rate. family), high self-efficacy self-efficacy (a=0.73), and
January 2021 regarding successful response cost. (a=69).
-Sample size: 2528 vaccination against 6points: Satisfactory
COVID-19 predicted
COVID-19 vaccination
intentions.
27 Zheng et al. To evaluate factors Online cross- -Education, income, -Perceived susceptibility -Perceived susceptibility
(2022) influencing COVID-19 sectional survey general health status, to COVID-19 side effect, (a=0.86), perceived severity
USA vaccination intention using quota age, and gender. and knowledge about (a=0.86), vaccination
sampling method COVID-19. intention (a=0.94), doctor-
was conducted in patient communication
February 2021 (a=0.92).
Sample size: 800 4points: Unsatisfactory
the following headings: author, year, aim, country, study period, studies found uptake rates ranging from 46.6% [38] to 98.9% [62],
sample size, study design, scales and reliabilities, number of partici and hesitancy estimates ranged from 5.6% [73] to 47.3% [34].
pants, recruitment method, and results (Table 1). Data quality was
assessed by two authors using an adapted version of the New Demographic determinants of COVID-19 vaccine uptake
castle–Ottawa scale for cohort studies (Table 1). The quality of the
studies ranged from unsatisfactory to good, with 17 (30%) of the 57 For both time periods, 17 studies that compared women vs.
studies appraised as unsatisfactory, 31 (54%) as satisfactory, and 9 (16%) men reported that men were more likely to accept the COVID-19
as good (Table 1). Major quality issues included inadequate information vaccine [40,42,45,46,51,55,60,61,64,71,73–75,80,82,84,87]; however,
on sample justification and statistical power and study results that did in four studies, women were more likely to accept the COVID-19
not adjust for relevant predictors, risk factors, or confounders. vaccine [38,74,85,92]. Older age was associated with increased
COVID-19 vaccine uptake compared to younger age
Data analysis [34,37,49,51,52,56,63,73–75,84,85,89,91,94,99], and this result was
stable across the time periods, with six studies reporting higher uptake
The features of all studies are summarised, including the de in younger age groups [38,42,46,61,64,93]. Across both periods, 18
terminants of COVID-19 vaccine uptake (Table 1). Researchers were studies found that education levels correlated positively with COVID-19
unable to conduct a meta-analysis due to the heterogeneity of the vaccine uptake [34,45,48,51,52,56,58,59,62,66,67,73,75,84,87,89,91,92].
measurement of COVID-19 vaccine determinants (i.e., some studies A negative relationship with education level was observed in studies
used dichotomous measures and others used scales); hence, data conducted in Kuwait, Korea, and China during Time 1 [42,71,85]. During
was described narratively. Predictive factors of COVID-19 vaccine Times 1 and 2, studies conducted in the US and UK found that com
uptake were grouped under four broad headings: demographic, so pared to ethnic majority groups, ethnic minorities (e.g. Black or Asian
cial, psychological, and infodemic (false or misleading information in ethnicity) were hesitant towards the COVID-19 vaccine [51,52,56,87],
digital and physical environments during the breakout of a dis but in other studies in the USA, people of Asian ethnicity were more
ease) [31]. willing to accept the COVID-19 vaccine [51,67,85,92]. These results were
observed across both the time periods. Most studies have found that
Results income is positively associated with COVID-19 vaccine uptake
[55,59,61,62,75,84,85] during both periods. Two studies conducted in
Overall, 12,502 articles were identified from seven databases. China and Kuwait reported a negative relationship between income
After removing duplicates, 10,881 articles were screened by title and and COVID-19 vaccine uptake [42,93] during Time 1. For marital status,
abstract, and 357 articles were identified. Finally, 57 articles met the results were consistent for both times, with single people (i.e. not
inclusion criteria after screening the full text of the selected articles married, widowed, or divorced) being more willing to accept the
(see flow chart for details: Fig. 1). To reiterate, the use of the COVID- COVID-19 vaccine compared to those who were married
19 vaccine uptake only reflects intentions or willingness to accept [33,34,40,42,73]. The reverse was also found in Poland and Kuwait, as
the COVID-19 vaccine. single people were more hesitant than married people about the
COVID-19 vaccine [61,62] during Time 2 (Table 1). In Bangladesh and
Characteristics of the selected studies Kuwait, non-smokers compared with smokers [61,94] were found to be
hesitant towards the COVID-19 vaccine during Time 2. In the UK,
Most (97%) of the studies included in our review employed a during Time 1, smokers, when compared with non-smokers, were
web-based recruitment method for data collection [32–85]. Only found to be hesitant towards the COVID-19 vaccine [81]. Urban re
one study used a face-to-face data collection method, and one used sidence compared with rural residence was a predictor of COVID-19
both face-to-face and web-based data collection methods [86]. In vaccine acceptance during Time 2 [34] but was associated with COVID-
terms of study design, four studies used a longitudinal survey design 19 vaccine hesitancy during Time 1 [61,62,86]. In the US, identifying as
[39,87], one used an experimental design [88], one employed a liberal was associated with the highest intent to be vaccinated against
mixed-methods study design [49], and 52 employed a cross-sec COVID-19 compared to those who were identified as moderate and
tional study design [32–85,89,90,91] (refer to Table 1). Eleven stu conservative [48,55,67,85,87] for both time periods. Self-reported
dies were undertaken in the US [44,45,48,51,52,55,67,75,84,87,92]; health was unrelated to COVID-19 vaccine uptake during both periods
four in the UK [36,56,81,88]; five in Italy [47,53,54,64,73]; four in [60,74,75,80,85]. Similarly, being in a vulnerable group or having a fa
China [66,71,74,93]; three each in Poland [39,62,69,82] and Bangla mily member belonging to a vulnerable group did not impact the
desh [86,94]; two each in Jordan [60,78], Ethiopia [34,38], Kuwait COVID-19 vaccine uptake [49,63,92]. Four studies reported religious
[42,61] and Chile [76,89]; and one each in Malaysia [33], Somalia affiliation as a significant predictor of COVID-19 vaccine hesitancy
[32], Lebanon, Turkey [37], Greece [49], India [95], Israel [58], Iraq [32–34,78]. One study found that having no children [49], and two
[59], Taiwan [68], Spain [63], Portugal [96], Pakistan [97], Belgium studies found that having children [85,92] predicted COVID-19 vaccine
[91], Iran [98], France [80] and South Korea [85]. uptake during Time 1 only. During Time 1, having private health in
After the completion of the search and screening process, it was surance [55] was associated with vaccine uptake. During Time 2,
seen that 30 of the 57 studies (40, 41, 43–59, 73, 77, 79, 81–83, 85, chronic disease, being a pensioner, or being obese was associated with
86, 93, 94, 98, and 99)were conducted during Time 1, and 27 studies a tendency to refuse the COVID-19 vaccine [33,94] (Table 1).
(33–40, 60–65, 67–70, 72, 74–76, 87, 92, 95, and 97) were under
taken during Time 2. Notably, one study [39] met the criteria for the Psychological predictors of COVID-19 uptake
both timelines (i.e., two studies were presented in a single paper:
Study 1 was conducted during Time 1 and Study 2 during Time 2); Concerns regarding the fast development, safety, negative side
hence, this study was included for both time periods. effects, commercial profiteering, and the effectiveness of the COVID-
19 vaccine were common psychological factors negatively associated
COVID-19 vaccine uptake/hesitancy rates with its vaccine uptake at Times 1 and 2 [32–34,38,42,
46–48,53,54,55,59,61,64,66,69,71,74–76,78,86,89,94,96,97,100]. Fear,
The COVID-19 vaccine uptake rates from the 31 studies for Time 1 anxiety, panic, and worries regarding COVID-19 were positively re
ranged from 21.4% [40] to 73.8% [92], whilst hesitancy rates ranged lated to vaccine uptake during both time periods [62,63,84,92].
from 5.1% [54] to 74.0% [80]. Notwithstanding, for Time 2, the 27 Another variable found to be a common positive predictor during the
461
two time periods was knowledge regarding the COVID-19 pandemic, preventive measures and required adherence to these measures
including its preventive measures and a COVID-19 vaccine [42,49,64,84,86,87]. In Jordan and Bangladesh, willingness to pay for
[34,39,42,44,63,75,85,86,89,96,101]. Trust in science, COVID-19 in the COVID-19 vaccine predicted COVID-19 vaccine uptake for both
formation sources, government institutions, preventive measures time periods [46,72,85]. Perceiving COVID-19 preventive measures
against the COVID-19 pandemic, health professionals, the Centres for as a social norm related both positively [58] and negatively [94] to
Disease Control and Prevention, and the media were found to cor COVID-19 vaccine uptake in Israel and Bangladesh, respectively, for
relate positively with COVID-19 vaccine uptake for both time periods both time periods. Notwithstanding, five studies reported that bar
[42,46,53,54,60,73,80,87,92,94]. However, in China, media trust ne riers to vaccine access (e.g. cost) were directly linked to COVID-19
gatively predicted COVID-19 uptake at Time 1 [93]. Researchers have vaccine hesitancy [44,85,86,94,97].
found that perception of the severity of COVID-19 infection Seven studies indicated that inadequate information regarding
[42,47,55,58–60,85,94,102] and perceived susceptibility to the the COVID-19 pandemic and vaccine negatively predicted COVID-19
pandemic [38,47,48,55,60,61,85,94,102] were positive predictors vaccine uptake [32,33,59,61,69,71,94]. However, in an experimental
of vaccine uptake for both periods. Overall, risk perception study, hesitant participants exposed to collective information on
towards COVID-19 infection and influenza infections COVID-19 by researchers tended to be willing to accept COVID-19
[42,73,80,85,87,91,96,97] and perceived benefits of COVID-19 vaccine vaccine [88]. Notably, these findings were peculiar to the Time 2
[42,52,58,94,97] were notable variables found to be directly linked period. Finally, altruistic behaviours were linked directly with
with vaccine uptake for both periods. COVID-19 vaccine uptake for Time 1 [48] (Table 1).
Additionally, the following factors were common positive pre
dictors of COVID-19 vaccine uptake for both Times 1 and 2: self- COVID-19 Infodemic predictors of COVID-19 vaccine uptake
efficacy, confidence in receiving the COVID-19 vaccine without any
side effects [58,74,78,85]; life satisfaction and a positive view of the Common infodemics, specifically the belief that COVID-19 is a
world [39]; health engagement; belief in the importance of herd biological weapon or a myth, correlated negatively with COVID-19
immunity [47,49]; and concerns about the safety of relatives and vaccine uptake at both Times 1 and 2 [32,37,45,46,50,73,82]. In one
friends; and society [69,73,74,92]. However, less self-efficacy in study, the reverse of this relationship was reported at Time 2 [37].
preventing the infection negatively predicted COVID-19 vaccine Belief that the COVID-19 pandemic is a strategy for big pharma to
uptake in a study conducted in Bangladesh during Time 2 [94]. make money, caused by 5 G mobile networks, and that the COVID-19
During both times, desire for natural immunity, confidence in having vaccine is harmful predicted less willingness to be vaccinated for
a strong immune system, and belief in traditional remedies as a cure COVID-19. These factors were notable at Time 1 (46, 47, 54, 55, and
for COVID-19 were found to be associated with COVID-19 vaccine 88). Nonetheless, during Time 2, not believing in the existence of
hesitancy [32,33], including the desire for others to be vaccinated COVID-19 and the belief that the COVID-19 vaccine contained sub
first [38,42]. stances derived from animals such as pigs was related to COVID-19
During both periods, previous experience of COVID-19 infection vaccine hesitancy [32]. Paradoxically, religious faith factors, such as
was positively associated with COVID-19 vaccine uptake ‘the pandemic is humanity’s destiny, were related to positive in
[38,55,61–63,67,89]. Likewise, 10 studies reported that intention to tentions to accept the COVID-19 vaccine [37]. (see Fig. 2 for a sum
vaccinate against COVID-19 was higher among participants with mary of all the identified predictors in this review).
previous experience with vaccination, including influenza vaccina
tion, compared to those with no or minimal vaccination history Discussion
[44,46,49,51,52,58,64,66,87,94]. Fear of medical procedures (e.g.
blood injury and injection phobia) [33,88], ‘assuming that the world We found that there tended to be more COVID-19 vaccine hesi
is in order’ [39], and lower perception of COVID-19 incidence [66] tancy prior to the first FDA approval of a COVID-19 vaccine (Time 1)
were found to predict COVID-19 hesitancy during Time 2. Positive than after (Time 2). Attitudes aligning with acceptance of the COVID-
predictors of COVID-19 vaccine uptake also included the view that 19 vaccine also increased over time, representing a positive move
vaccination is a civic responsibility, COVID-19 pandemic-related towards vaccination. We found that people were concerned about
health concerns, national identification with all humanity, and vac the rapid development of the COVID-19 vaccine, its safety, side ef
cine nationalism (i.e. prioritising one’s country for vaccination), fects, and its effectiveness. These factors were reported consistently
while national narcissism, controlled motivation, distrust-based across both time periods by 27 studies conducted across five con
amotivation, and effort-based amotivation negatively predicted tinents (Africa, Asia, North and South America, and Europe) and
COVID-19 vaccine uptake [72,91,92]. were found to be negatively related to COVID-19 vaccine uptake
during both time periods.
Social predictors of COVID-19 vaccine uptake Our findings were similar to those of previous studies on influ
enza vaccine uptake [89,104,105]. Previous studies found higher le
Information from the mass media, official national websites, vels of anxiety, fear, and worry to be positive predictors of influenza
government institutions, health professionals, newspapers, national vaccine uptake [106]. In agreement with other studies (e.g.[104, 107,
television, YouTube, and significant others (e.g. family and friends) 108], perception of the risk of COVID-19 infection and perceived
positively predicted COVID-19 vaccine uptake [49,85,103] for both benefit of COVID-19 vaccine were found to correlate positively with
time periods. However, in China, the frequency of social media use, COVID-19 vaccine uptake. Likewise, COVID-19 information from
reliance on information from WhatsApp, and using different social health professionals, government institutions, and other social
media were negatively correlated with COVID-19 vaccine uptake at media (e.g. national websites) was related to COVID vaccine uptake
Time 1 [93,103]. In the US, information from the White House during for both time periods. These findings were similar to those of studies
2019–2021 and higher approval of President Trump were associated on influenza vaccines and other pandemic vaccine uptake studies
with COVID-19 vaccine hesitancy during Time 1 [84,87] (Table 1). conducted in the US [105,109]. Our review found evidence that
Moreover, calls to action, such as recommendations from gov previous experience with vaccination predicts the willingness to
ernment authorities and health professionals, were directly related accept a vaccine [107]. Specifically, previous experiences of both
to COVID-19 vaccine uptake during the two timelines COVID-19 infection and influenza vaccination were positively related
[42,55,58,62,71,96]. Another common positive predictor of COVID-19 to COVID-19 vaccine uptake. Cues to action (e.g. recommendations
vaccine uptake for both periods was being informed about from professionals), being informed about COVID-19 preventive
462
Fig. 2. A pictorial representation of the determinants of COVID-19 vaccine uptake for before-and-after the first approval of COVID-19 vaccine by FDA.
measures, and adherence to these measures were positively asso relationships in terms of predicting COVID-19 vaccine uptake be
ciated with COVID-19 vaccine uptake. That is, respondents who cause religious affiliation negatively predicted COVID-19 vaccine
followed such health behaviours might have positive attitudes to uptake in Jordan, Somalia, Malaysia, and Ethiopia, which is con
wards health behaviours in general, including vaccination [110]. sistent with previous literature [113]. In terms of sex, the majority of
Studies of influenza vaccine uptake intentions have reported self- the studies reviewed supported previous studies suggesting that
efficacy as one of the determinants of influenza vaccine uptake [110], males were more likely to accept a vaccine than females [114].
and our review of COVID-19 vaccine uptake provided additional To the best of our knowledge, this systematic review is the first to
evidence to support such a relationship. explore the determinants of COVID-19 vaccine uptake across two time
Infodemics have been reported to impede vaccine uptake in periods. This timely exploration of differences in the trends of COVID-
different populations globally [111]. The COVID-19 infodemics 19 vaccine uptake determinants provides an overview to stakeholders
identified in this review were also negatively associated with the about attitudinal changes occurring over time since the emergence of
COVID-19 vaccine uptake. Paradoxically, religious faith in COVID-19 COVID-19. Again, the selection of studies that were assessed for quality
infodemics was positively correlated with COVID-19 vaccine uptake. ensured an adequate level of accuracy and confidence in our findings.
A possible reason for this could be that religious bodies sensitised However, our review has the following limitations. Most of the studies
individuals to the need to be vaccinated against COVID-19 to facil were cross-sectional surveys. Caution concerning the interpretation of
itate their ritual activities as the pandemic halted many religious our results should be taken, as we were unable to determine causation
gatherings worldwide. between the variables. Qualitative studies and studies published in
Another unique factor found to predict COVID-19 vaccine hesi languages other than English were excluded from the review because
tancy after FDA approval was fear of medical procedures (e.g. in of the time and cost involved.
jection), which is in line with findings from general vaccination The global aim of achieving high uptake of a COVID-19 vaccine
programs in India [112]. An underestimated perception of COVID-19 could be achieved if specific concerns associated with vaccine
incidence, that is, participants might have lost focus on the pan hesitancy, such as safety, effectiveness, potential side effects, and
demic, perhaps due to lack of or ignoring information available from benefits related to COVID-19 vaccines, including disbeliefs and
different media, could have lessened the desire or urgency to vac adequate information about the pandemic, are clearly commu
cinate against the pandemic. Studies also indicated that inadequate nicated and understood. Addressing the difference in pre- and
information regarding both COVID-19 infection and the vaccine re post-first FDA approval of COVID-19 vaccine determinants is
lated to COVID-19 vaccine hesitancy. This finding will be of interest important for policymakers to understand the factors that em
to relevant stakeholders, especially as it occurred after the first roll- phasise current COVID-19 vaccination programs. Infodemics
out of the COVID-19 vaccine. In addition, nationalism (e.g. national were additional factors in this regard which were associated with
narcissism) and certain types of motivation have been found to hesitancy attitudes. A strategy found to help address mis
predict COVID-19 vaccine hesitancy. information is psychological inoculation (i.e. exposing in
Common demographic factors linked to COVID-19 vaccine uptake dividuals to a version of already known information, which they
included sex, marital status, age, education, area of residence, and can refute) [115]. Again, since phobia of medical procedures was
religious affiliation. Religious affiliation was found to show specific found to contribute to COVID-19 vaccine hesitancy after FDA
463
approval, clinicians may consider dealing with medical proce are an effective means of reducing the spread of infection and pre
dure phobias by considering different administration routes of venting diseases, for example, by achieving the herd immunity
COVID-19 vaccines, for example, needleless injection procedures threshold. However, COVID-19 vaccine hesitancy has been reported
to increase COVID-19 vaccine coverage. This seems to be an im among various populations globally, particularly in resource-poor
portant predictor given that 69% of participants (participating in countries.
an influenza survey) opted for a needleless route of administra To understand this phenomenon, we reviewed materials pub
tion [116]. Finally, a standardised method of measuring COVID-19 lished between July 2021 and March 2022. We searched PubMed,
vaccine uptake will help ensure precision in the future, as most MEDLINE(Ovid), Web of Science, Embase (Ovid), Scopus, PsycINFO,
of the studies measured uptake dichotomously, which limits CINAHL, and dimensions for systematic reviews and meta-analyses
accuracy and makes it difficult to compare studies on COVID-19 of studies relevant to COVID-19 vaccine uptake intentions published
uptake; hence, measuring COVID-19 vaccine uptake using a well- in English since COVID-19 was reported on 31 December 2019 in
validated scale may help increase the measurement precision of Wuhan, China.
COVID-19 uptake. This novel review explores the determinants of COVID-19 vaccine
Our study identified 30 [39,42–58,72,76,78,80–82,84,85,92,93, uptake since the emergence of COVID-19. We distilled the evidence
97,98] and 27 studies [32–39,59,60–64,66,67–69,71,73–75,86,91,92, with regard to demographic, psychological, social, and infodemic
94,96] for Time 1 and Time 2 respectively. Over time, our review determinants of COVID-19 vaccine uptake, focusing on studies in
found that COVID-19 uptake rates tended to increase, with COVID-19 volving national populations in different countries. We identified
vaccine concerns, sources of information, and cues to actions being common COVID-19 vaccine hesitancy determinants, such as con
common predictors of COVID-19 vaccine uptake. Specifically, na cerns regarding COVID-19 vaccine safety, negative side effects, fast
tionalism and inadequate information about COVID-19 were unique development of COVID-19 vaccine, and uncertainty about vaccine
predictors of COVID-19 vaccine uptake prior to FDA approval. After effectiveness, as well as country-specific predictors. We also as
FDA approval, phobia of medical procedures, such as fear of injec sessed real-world evidence of factors associated with COVID-19
tion, was one of the main determinants of COVID-19 vaccine hesi vaccine hesitancy both before and after FDA approval, such as phobia
tancy. Future national research studies should investigate other of medical procedures and inadequate information about vaccines
predictors of health behaviour, such as the COVID-19 vaccine uptake and the pandemic.
literature, which is limited. Future studies should explore certain
psychological factors, such as mindfulness, self-compassion, and
Implications
affective symptoms (e.g. anxiety) as potential predictors of COVID-19
vaccine uptake. It is possible that intentions or willingness may not
This review informs clinicians and stakeholders about the most
lead to actual behaviours; therefore, investigation of the factors that
relevant predictors of COVID-19 vaccine uptake that should be
lead to COVID-19 vaccine uptake behaviours may help increase
considered to enhance vaccination success. Specifically, campaigns
COVID-19 uptake. Finally, studies focusing on regions known to have
should consider concerns surrounding COVID-19 vaccine such as
high vaccine hesitancies, such as Sub-Saharan Africa, are limited.
information about vaccines and pandemics and safety of vaccination
procedures to increase COVID-19 vaccination coverage.
Research in context
By the end of August 2022, the World Health Organization Declaration of interests
(WHO) had recorded approximately 600 million cases of COVID-19
infections and 6.5 million consequent deaths worldwide. Vaccines We declare no competing interests.
Appendix 1
Database Search terms
Web of science (TS=( COVID-19 OR SARS-CoV-2)) OR TS= ( Severe acute respiratory syndrome coronavirus 2)) AND TS= ( 2019nCoV*)) OR TS= (HCoV-19)) OR
TS= (Coronavirus Disease 2019 Virus)) OR TS= (2019 Novel Coronavirus*)) AND TS= (Vaccine* uptake)) OR TS= (vaccination acceptance)) OR
TS= (vaccination willingness)) OR TS= (vaccin* inoculation)) OR TS= (vaccin* intention)) OR TS= (vaccine* hesitan*)) OR TS= (vaccine* refusal);
Medline & Embase (vaccination acceptance OR willingness to vaccine$ OR intention to vaccine$ OR vaccine hesitancy$ OR vaccine$ refusal OR vaccine$ innoculat$ AND
COVID-19 OR SARS-CoV-2 OR Severe acute respiratory syndrome coronavirus 2 OR 2019nCoV OR HCoV-19 OR Coronavirus Disease 2019 Virus Vaccine$
OR 2019 Novel Coronavirus vaccine$);
CINAHL and PsycI (Vaccine* uptake OR vaccination acceptance OR willingness to vaccin* OR intention to vaccin* OR vaccine hesitancy* OR vaccine* refusal OR vaccine*
NFO inoculate* AND COVID-19 OR SARS-CoV-2 OR Severe acute respiratory syndrome coronavirus 2 OR 2019nCoV OR HCoV-19 OR Coronavirus Disease 2019
Virus Vaccine* OR 2019 Novel Coronavirus vaccine* AND vaccine uptake OR vaccination acceptance OR vaccination willingness OR inoculation OR
vaccine intention OR vaccine hesitation OR vaccine refusal);
Scopus (COVID-19 OR SARS-CoV-2 OR Severe acute respiratory syndrome coronavirus 2 OR 2019nCoV OR HCoV-19 OR Coronavirus Disease 2019 Virus Vaccine*
OR 2019 Novel Coronavirus vaccine* AND Vaccine* uptake OR vaccination acceptance OR vaccination willingness OR vaccine* inoculation OR vaccine*
intention OR vaccine* hesitation OR vaccine* refusal).
PubMed COVID-19 OR SARS-CoV-2 OR Severe acute respiratory syndrome coronavirus 2 OR 2019nCoV OR HCoV-19 OR Coronavirus Disease 2019 Virus
Vaccine* OR 2019 Novel Coronavirus vaccine* AND Vaccine* uptake OR vaccination acceptance OR vaccination willingness OR vaccine* innoculation OR
vaccine* intention OR vaccine* hesitation OR vaccine* refusal
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free information in English and Mandarin on the novel coronavirus COVID-

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Contents lists available at ScienceDirect

Journal of Infection and Public Health

Implications for COVID-19 vaccine uptake: A systematic review

Clive Aspin a, Colin R. Simpson a

. COVID-19 vaccine uptake/hesitancy rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461

Introduction behaviours (e.g. vaccine uptake determinants and attitudes) and to

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

4 Ansari- Identify predictors of -Web-based cross- Perceived severity, -Perceived susceptibility

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

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BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

AFTER FIRST COVID-19 VACCINE APPROVAL (Time2)

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

BEFORE FIRST COVID-19 VACCINE APPROVAL (Time 1)

Uptake Rates Demographic Psychological Predictors Social Predictors Infodemics

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