Peer-reviewed article
The impact of COVID-19 on general vaccine acceptance in low- and middle-income countries: a systematic review.
Gloria Lihemo, Madeleine Blunt, Ibrahim Dadari, Talya Underwood, Andres Esteban Ochoa Toasa et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined how the COVID-19 pandemic affected people's acceptance of routine childhood vaccines (non-COVID vaccines) in low- and middle-income countries. The review of 23 studies found that the pandemic had mostly negative or neutral effects on vaccine acceptance, affecting how people think and feel about vaccines, their motivations, practical access, and social influences. Most studies focused on healthcare workers and parents in middle-income countries. The findings show that vaccine hesitancy increased in complex ways that depend on local contexts, and the review recommends tailored strategies to rebuild vaccination coverage after pandemic losses.
Key points
- 91% of included studies reported findings on 'Thinking and Feeling' about vaccines, the most commonly reported category
- The COVID-19 pandemic had mostly negative or neutral effects on attitudes, intentions, and actions regarding vaccine acceptance across studies
- Over half of studies (61%) reported findings on motivation factors influencing vaccine acceptance
- 43% of studies examined practical issues and social processes affecting vaccination decisions
- Most studies were conducted in middle-income settings and focused on healthcare workers or parents/caregivers of children
Limitations
This is a systematic review that synthesizes findings from other studies rather than conducting original research, so it cannot directly measure vaccine hesitancy in specific populations. The review includes only studies published in English between 2020-2023, which may miss relevant research in other languages or from other time periods, and no specific countries were identified in the included studies' descriptions.
Abstract
BACKGROUND: The COVID-19 pandemic caused a major decline in childhood vaccination, especially in low- and middle-income countries (LMICs). However, its specific impact on vaccine hesitancy in the immediate post-pandemic years, particularly toward non-COVID-19 vaccines, remains unclear. Understanding the social and behavioral factors influencing vaccine acceptance following a public health emergency such as the COVID-19 pandemic is critical to improving immunization coverage. This systematic review examined the impact of the COVID-19 pandemic on general vaccine acceptance in LMICs to inform strategies to improve vaccine uptake. METHODS: This systematic review assessed people's thinking and feeling, motivations, practical issues, and social processes around vaccination, conceptualized by the World Health Organization's Behavioural and Social Drivers framework. Studies were included if they were interventional or observational in design, examined the impact of the COVID-19 pandemic on vaccine hesitancy or acceptance for non-COVID-19 vaccines, and were published in English between 2020 and 2023. RESULTS: A total of 23 studies were included in the review, with most studies conducted in middle-income settings and focused on healthcare workers or parents/caregivers of children. Findings belonging to the "Thinking and Feeling" category were the most commonly reported in 91% (n = 21/23) of studies. Over half (61%) of studies reported findings relating to the 'Motivation' construct, while 43% of studies reported outcomes related to 'Practical Issues' and 'Social Processes'. Studies reported both increases and decreases in vaccine hesitancy and intention to vaccinate due to the pandemic. Overall, studies most commonly reported that the COVID-19 pandemic had a negative or neutral effect on attitudes, intentions, and actions regarding vaccine acceptance. CONCLUSION: This systematic review illustrates how the COVID-19 pandemic influenced vaccine acceptance and decision-making in complex, context-dependent ways, impacting people's thinking and feeling, motivations, practical issues, and social processes around vaccination. The findings highlight the need to understand the specific drivers of vaccine acceptance to design more effective, targeted strategies to improve immunization uptake. The insights from this study can be used to inform evidence-based vaccination catch-up strategies to regain pandemic losses and mitigate factors that deter individuals from seeking vaccination.