Journal Article

Global spatio-temporal distribution of coronavirus disease 2019 vaccine hesitancy between 2020 and 2022: A meta-analysis

Cai, Xianming, Ao, Le, Zhang, Xiyu, Wang, Xinyu, Zhang, Sihui, Wu, Yifei, Yang, Han, Feng, Xin, Xu, Qingsong, Wang, Mingting, Zhao, Tianshuo, Wei, Tingting, Cui, Fuqiang, Jin, Shifeng, Zhao, Jiayi, Yang, Jieru

2025

Overview

Objective: Vaccine hesitancy is a major barrier to high coronavirus disease 2019 (COVID-19) vaccine coverage. To synthesize global research on COVID-19 vaccine hesitancy, a meta-analysis was conducted to provide scientific evidence for understanding its spatial and temporal variations and influencing factors. Methods: We searched the PubMed, Web of Science, and Embase databases for studies published in English between January 2020 and December 2023 and included cross-sectional and cohort studies with study populations that included the general adult population aged ≥18 years and provided quantitative data on COVID-19 vaccine acceptance or hesitancy. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis elements and guidance for abstracting and assessing data quality and validity. Two groups of investigators independently extracted the study characteristics, including the outcome variable (the vaccine hesitancy rate). Our meta-analysis used a random-effects model. The outcome of interest was COVID-19 vaccine hesitancy. The included studies were divided into two categories based on their definitions of COVID-19 vaccine hesitancy. Definition 1 combined vaccination behavior and willingness, and Definition 2 was based solely on willingness to vaccinate. Results: 855 studies were included in the final analytical dataset; 121 met Definition 1, and 734 met Definition 2. There were 277,285,178 participants in the included studies. In studies meeting Definition 1, hesitancy rates increased annually: 18.8 % in 2020, 29.1 % in 2021, and 30.8 % in 2022. However, in studies that met Definition 2, the hesitancy rates remained at 35 %. African studies reported the highest hesitancy rates globally (42.0 %), whereas European studies reported the lowest (16.5 %). Furthermore, there was a temporal association between mortality trends and COVID-19 hesitancy because the monthly cumulative death peaks coincided with lower hesitancy peaks. Conclusion: COVID-19 vaccine hesitancy increased across the continent during 2020–2022 and might be influenced by misinformation, policy changes, and public fatigue. Demographic factors like age, gender, and education also play a key role in vaccine hesitancy. The link between vaccine hesitancy and pandemic severity highlights the need for timely and effective public health responses. •Addressed heterogeneity in vaccine hesitancy definitions by identifying two primary categories.•855 studies with 277 M participants from 102 countries were included, providing a global perspective on vaccine hesitancy.•Global vaccine hesitancy rate was 28.2 % using Definition 1 and 34.8 % using Definition 2.•Hesitancy rates increased annually from 2020 to 2022, with Africa having the highest and Europe the lowest rates.•Found a pattern linking COVID-19 mortality and hesitancy, where higher disease burden leaded to lower hesitancy rates.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / adults / Allergy and Immunology / Combined vaccines / Coronaviruses / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 - psychology / COVID-19 infection / COVID-19 vaccines / COVID-19 Vaccines - administration & dosage / data quality / death / Disease transmission / education / Female / gender / Global Health / Humans / Immunization / issues and policy / Male / Meta-analysis / misinformation / mortality / pandemic / Pandemics / Patient Acceptance of Health Care / Population studies / Public health / SARS-CoV-2 - immunology / Spatial distribution / Spatio-Temporal Analysis / Spatio-temporal distribution / statistical models / Temporal distribution / Temporal variability / vaccination / Vaccination - psychology / Vaccination Hesitancy - psychology / Vaccination Hesitancy - statistics & numerical data / Vaccine hesitancy / Vaccines