Findings From New 23-Country Survey Can Help Policymakers Address COVID Vaccine Hesitancy

Global willingness to accept a COVID-19 vaccine increased from 75.2% in 2021 to 79.1% in 2022, according to a new survey of 23 countries that represent more than 60% of the world’s population, published today in Nature Medicine. Vaccine acceptance decreased in eight countries however, and nearly one in eight vaccinated respondents were hesitant about receiving a booster dose.

This third annual study, led by a team of researchers from the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and the Barcelona Institute for Global Health (ISGlobal), reveals a wide variability between countries and suggests a need to tailor communication strategies to effectively address vaccine hesitancy.

“The pandemic is not over, and authorities must urgently address vaccine hesitancy and resistance as part of their COVID-19 prevention and mitigation strategy,” says CUNY SPH Senior Scholar Jeffrey V. Lazarus. “But to do so effectively, policymakers need solid data on vaccine hesitancy trends and drivers.”

To provide these data, an international collaboration led by Lazarus and CUNY SPH Dean Ayman El-Mohandes performed a series of surveys starting in 2020 in 23 highly populated countries which were impacted significantly by the pandemic (Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Turkey, the United Kingdom and the United States).

Of the 23,000 respondents (1000 per country surveyed), 79.1% were willing to accept vaccination, up 5.2% from June 2021. The willingness of parents to vaccinate their children also increased slightly, from 67.6% in 2021 to 69.5% in 2022. However, eight countries saw an increase in hesitancy (from 1.0% in the U.K. to 21.1% in South Africa). Worryingly, almost one in eight (12.1%) vaccinated respondents were hesitant about booster doses, and booster hesitancy was higher among the younger age groups (18-29).

“We must remain vigilant in tracking this data, containing COVID-19 variants and addressing hesitancy, which may challenge future routine COVID-19 immunization programs,” says Dean El-Mohandes, the study’s senior author.

The survey also provides new information on COVID-19 treatments received. Globally, ivermectin was used as frequently as other approved medications, despite the fact that it is not recommended by the WHO or other agencies to prevent or treat COVID-19.

Also of note, almost 40% of respondents reported paying less attention to new COVID-19 information than before, and there was less support for vaccine mandates.

In some countries, vaccine hesitancy was associated with being female (for example in China, Poland, Russia), having no university degree (in France, Poland, South Africa, Sweden, or the U.S.), or lower income (in Canada, Germany, Turkey or the U.K.). Also, the profile of people paying less attention to the pandemic varied between countries.

“Our results show that public health strategies to enhance booster coverage will need to be more sophisticated and adaptable for each setting and target population,” says Lazarus, also head of the Health Systems Research Group at ISGlobal. “Strategies to enhance vaccine acceptance should include messages that emphasize compassion over fear and use trusted messengers, particularly healthcare workers.”

The data provided by these surveys may offer insight to policymakers and public health officials in addressing COVID-19 vaccine hesitancy. The study follows on the heels of a global consensus statement on ending COVID-19 as a public health threat that Lazarus, El-Mohandes and 364 co-authors from 112 countries published in Nature in November.

Lazarus JV, Wyka K, White TM, Picchio C, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Medicine. 2023.

Also see:

Lazarus JV, Wyka K, White TM, Picchio CA, et al. Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021. Nature Comms. 2022.

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