ArticleNature medicine2021
COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries.
Article in Nature medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 640 papers, 8 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
640 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- SARS-CoV-2 infection rates and associated risk factors in healthcare workers: systematic review and meta-analysis.Scientific reports · 2025Pooled it
- COVID-19 vaccine hesitancy in Ethiopia: a scoping review for equitable vaccine access.Frontiers in health services · 2025Pooled it
- Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries.Human vaccines & immunotherapeutics · 2024Pooled it
- Acceptance-Hesitancy of COVID-19 Vaccination and Factors Affecting It in Adults: Systematic Review Study.Immunity, inflammation and disease · 2024Pooled it
- Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis.BMC women's health · 2024Pooled it
- Influence of government policies on handwashing and vaccine uptake in Kenya, Uganda, and Tanzania to prevent and control COVID-19: a systematic review.Frontiers in public health · 2024Pooled it
- Enablers and barriers to vaccine uptake and handwashing practices to prevent and control COVID-19 in Kenya, Uganda, and Tanzania: a systematic review.Frontiers in public health · 2024Pooled it
- Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries.The Lancet. Global health · 2024Pooled it
- An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection.Scientific reports · 2024Trial
- Trial
- Uptake of COVID-19 Vaccines and Intention to Vaccinate in the Democratic Republic of the Congo: A Cross-Sectional Survey.Health science reports · 2026Article
- Review
- Review
- Article
- Community-level COVID-19 vaccination promotion capacity and its association with vaccination dose per capita in China: an entropy-weighted TOPSIS and multilevel analysis.BMC public health · 2026Article
- Uncovering COVID-19 vaccine acceptance and intent in 15 developing countries: a multi-level, clustered analysis of six months of repeated, cross-sectional data.BMC infectious diseases · 2026Article
- Intent to Accept a Valley Fever Vaccine for Humans and Dogs and Factors Influencing Intended Uptake: A Cross-Sectional Survey in Two Endemic Regions.Journal of fungi (Basel, Switzerland) · 2026Article
- Perspectives of senior health managers on COVID-19 response and challenges, lessons learned and opportunities against future outbreaks in Gauteng province, South Africa.BMC health services research · 2026Article
- Conspiracy Beliefs, Institutional Mistrust, and Health-Related Behaviours During the COVID-19 Pandemic in Burkina Faso: A Mediation Analysis.The International journal of health planning and management · 2026Article
- A poorly reactogenic lipid nanoparticle-mRNA vaccine unveils an innate immune pathway for adverse reactions.NPJ vaccines · 2026Article
580 more citing papers are in PubMed but not listed here.
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74 authors.
Funding
Abstract
Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.