Predictors of COVID-19 vaccination uptake and reasons for decline of vaccination: a systematic review

  1. Petros Galanis
  2. Irene Vraka
  3. Olga Siskou
  4. Olympia Konstantakopoulou
  5. Aglaia Katsiroumpa
  6. Daphne Kaitelidou

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Abstract

Background

Various COVID-19 vaccines with proven safety and effectiveness are available now but vaccine hesitancy remains a public threat. COVID-19 vaccines uptake appears to have an essential role in the successful control of the COVID-19 pandemic.

Objective

To examine predictors of COVID-19 vaccination uptake and reasons for decline of vaccination.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review. We searched Medline, PubMed, Web of Science, Scopus, ProQuest, CINAHL, and a pre-print service (medRxiv) from inception to July 12, 2021. We used the following key-words: vaccin*, COVID-19, and uptake. We included all types of studies (quantitative, qualitative, and mixed methods) reporting COVID-19 vaccination uptake. The review protocol was registered with PROSPERO (CRD42021267460).

Results

Twelve studies met the inclusion and exclusion criteria. COVID-19 vaccination uptake ranged from 28.6% to 98% in the general population, while among healthcare workers ranged from 33.3% to 94.5%, and among patients ranged from 36% to 80%. The main predictors of COVID-19 vaccination uptake were male gender, white race, older age, higher socioeconomic status, higher self-perceived COVID-19 vulnerability, increased information about COVID-19 vaccines, and chronic illness. The most important reasons for decline of vaccination were concerns about the safety and effectiveness of vaccines, illness, medication, pregnancy, fertility, breastfeeding, religious reasons, ethical reasons, previous COVID-19 diagnosis, self-estimation that COVID-19 is not a severe disease, and limited knowledge about the vaccines.

Conclusions

Several factors affect COVID-19 vaccination uptake, while various reasons affect people’s decision to refuse to take a COVID-19 vaccine. These findings are essential to further enhance our understanding of COVID-19 vaccination uptake and design specific interventions. Given the high prevalence of COVID-19 vaccine hesitancy, our findings have major implications for the delivery of COVID-19 vaccination programmes in the public with special attention to people who are undecided or unlikely to take a COVID-19 vaccine.

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  1. ScreenIT

    SciScore for 10.1101/2021.07.28.21261261: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched Medline, PubMed, Web of Science, Scopus, ProQuest, CINAHL, and a pre-print service (medRxiv) from inception to July 12, 2021.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    ProQuest
    suggested: (ProQuest, RRID:SCR_006093)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our systematic review is subject to several limitations. Firstly, five out of 12 studies was of poor or moderate quality, while more than the half of studies was published in pre-print services without a peer-review process. Secondly, studies were conducted mainly in the USA and United Kingdom and thus the results could not be generalized. Thirdly, data collection time among studies ranged from December 2020 to May 2021. Availability of COVID-19 vaccines and knowledge regarding these vaccines are increasing significantly on an ongoing basis and people’s attitudes towards COVID-19 vaccination could be changed. Moreover, all studies in our review were cross-sectional and thus causal inferences are impossible. Also, only nine studies investigated predictors of COVID-19 vaccination uptake and five studies investigated reasons for decline of COVID-19 vaccination. Additional research is needed to understand as soon as possible the factors that influence people’s decision to take a COVID-19 vaccine. For instance, no study until now has investigated psychological factors that could affect people’s attitudes towards COVID-19 vaccination uptake. Moreover, we should examine whether additional sociodemographic, infection-related and social media variables are related with COVID-19 vaccination uptake. Conclusions: Several factors affect COVID-19 vaccination uptake, while there are various reasons for decline of vaccination. For instance, males, older and white people take mor...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.07.28.21261261v1 on medRxiv