ArticleThe Lancet. Global health2023
Global state of education-related inequality in COVID-19 vaccine coverage, structural barriers, vaccine hesitancy, and vaccine refusal: findings from the Global COVID-19 Trends and Impact Survey.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 2 of them syntheses that pooled it.
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Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors influencing vaccine hesitancy toward non-covid vaccines in South Asia: a systematic review.BMC public health · 2025Pooled it
- A Systematic Review of Factors Associated with COVID-19 Vaccine Uptake, Hesitancy, and Acceptability Among Adults with HIV: Implications for Integrating COVID-19 Immunization into HIV Care.AIDS patient care and STDs · 2024Pooled it
- Exploring the impact of reimbursement ratios on willingness to vaccinate: A mixed-effects modeling approach using panel data.Human vaccines & immunotherapeutics · 2026Article
- Determinants of seasonal influenza and COVID-19 vaccine uptake in high-risk individuals in northern Sweden.Human vaccines & immunotherapeutics · 2026Article
- Dynamic trends and determinants of COVID-19 vaccine hesitancy among adults in China during 2021-2022: A multilevel analysis based on four national cross-sectional surveys.Human vaccines & immunotherapeutics · 2026Article
- Psychosocial and Social Security Risks Linked to Vaccine Misinformation in Romania: Implications for Vaccination Acceptance and Public Policy.Behavioral sciences (Basel, Switzerland) · 2026Article
- Digital vaccines for immunization equity: an approach to strengthen vaccine delivery and public trust in low- and middle-income countries.JAMIA open · 2026Review
- Postpandemic Change in Demographic and Clinical Features of Patients With Omicron Who Were Hospitalized: Territory-Wide Retrospective Repeated Cross-Sectional Study in Hong Kong.JMIR public health and surveillance · 2026Article
- Childhood Vaccine Hesitancy and Refusal in Türkiye: A Systematic Review and Meta-Analysis.Infectious diseases & clinical microbiology · 2026Article
- HPV vaccination willingness among 3,081 secondary school parents in China's capital.Human vaccines & immunotherapeutics · 2025Article
- Uptake of COVID-19 vaccination and associated factors among patients attending oncology services at the Ocean Road Cancer Institute in Dar Es Salaam, Tanzania: insights from mixed design methods' trajectory.BMC infectious diseases · 2025Article
- Advancing Inequality Monitoring in Immunization: Reflecting on 10 Years of WHO Contributions.Vaccines · 2025Article
- Social inequalities in vaccine coverage and their effects on epidemic spreading.PLoS computational biology · 2025Article
- A Latent Class Analysis of COVID-19 Vaccine Attitudes and Beliefs: Results from a Community Survey Conducted Via the Chicagoland Community Engagement Alliance (CEAL) Program.Journal of community health · 2025Article
- Attitudes Towards the HPV Vaccine Among Oropharyngeal Cancer Patients in a Post-COVID World.Laryngoscope investigative otolaryngology · 2025Article
- Factors associated with parental hesitancy towards the human papillomavirus vaccine: a cross-sectional study.Scientific reports · 2025Article
- Global socioeconomic inequalities in vaccination coverage, supply, and confidence.NPJ vaccines · 2025Article
- The Effect of Compulsory Schooling on Vaccination Against COVID.Health economics · 2025Article
- Evaluating geographic accessibility to COVID-19 vaccination across 54 countries/regions.BMJ global health · 2025Article
- Effectiveness of Group and Individual Counselling Interventions on COVID-19 Vaccination Intention Among Industrial Employees in Romania.Patient preference and adherence · 2025Article
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8 authors.
Funding
Abstract
backgroundCOVID-19 vaccine coverage and experiences of structural and attitudinal barriers to vaccination vary across populations. Education-related inequality in COVID-19 vaccine coverage and barriers within and between countries can provide insight into the hypothesised role of education as a correlate of vaccine access and acceptability. We aimed to characterise patterns of within-country education-related inequality in COVID-19 vaccine indicators across 90 countries.
methodsThis study used data from the University of Maryland Social Data Science Center Global COVID-19 Trends and Impact Survey. Data from 90 countries (more than 14 million participants aged 18 years and older) were included in our analyses. We assessed education-related inequalities globally, across country-income groupings, and nationally for four indicators (self-reported receipt of COVID-19 vaccine, structural barriers to vaccination, vaccine hesitancy, and vaccine refusal) for the study period June 1-Dec 31, 2021. We calculated an absolute summary measure of inequality to assess the latest situation of inequality and time trends and explored the association between government vaccine availability policies and education-related inequality.
findingsNearly all countries had higher self-reported receipt of a COVID-19 vaccine among the most educated respondents than the least educated respondents. Education-related inequality in structural barriers, vaccine hesitancy, and vaccine refusal varied across countries, and was most pronounced in high-income countries, overall. Low-income and lower-middle-income countries reported widespread experiences of structural barriers and high levels of vaccine hesitancy alongside low levels of education-related inequality. Globally, vaccine hesitancy in unvaccinated people was higher among those with lower education and vaccine refusal was higher among those with higher education, especially in high-income countries. Over the study period, education-related inequalities in self-reported receipt of a COVID-19 vaccine declined, globally and across all country income groupings. Government policies expanding vaccine availability were associated with lower education-related inequality in self-reported receipt of vaccine.
interpretationThis study serves as a baseline for continued inequality monitoring and could help to inform targeted actions for the equitable uptake of vaccines.
fundingGavi, the Vaccine Alliance.
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