A Survey of COVID-19 Vaccine Acceptance across 23 Countries in 2022

"Vaccination remains a cornerstone of the COVID-19 pandemic response, but broad public support remains elusive."

Drivers of vaccine hesitancy are context-specific and include lower education, mistrust in science and governments, and misinformation. The aim of this large survey in 23 populous and heavily impacted countries, representing almost 60% of the world's population, was to track trends in global vaccine acceptance, to profile attitudes toward recently available COVID-19 boosters and pharmaceutical treatments, and to assess attitudes toward several previously studied variables that appear to contribute to ongoing vaccine hesitancy.

The global sample of 23,000 respondents included 1,000 participants from each of 23 countries surveyed (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 (UK), and the United States, or US) from June 29 to July 10 2022. Half of respondents (50.3%) were women, and 10.8% were healthcare workers; age groups were approximately equally represented. In total, 36.6% of all respondents reported COVID-19 illness (oneself or one's family) within the past year (range 0.8% in Nigeria to 60.9% in Singapore).

COVID-19 vaccine acceptance in 2022 was reported by 79.1% of the respondents, up from 75.2% 1 year earlier (see Related Summaries, below). However, vaccine hesitancy increased in 8 countries (range 1.0% in UK to 21.1% in South Africa). One-quarter (25.2%) of respondents indicated they are now less likely to get vaccinated due to perceived lesser disease severity (range 4.2% in China to 43.1% in South Korea). Booster hesitancy among those vaccinated was 12.1% (range 1.1% in China to 28.9% in Russia). Previous research shows that the same factors that influence hesitancy to accept an initial COVID-19 dose also drive booster hesitancy, such as mistrust of government/health authorities and concerns about vaccine safety/efficacy.

Vaccine hesitancy was significantly more likely to be associated with males in Nigeria and Peru (adjusted odds ratio (aOR) = 4.42-5.24) and females in China, Poland, and Russia (aOR = 0.06-0.67) and not having a university degree in France, Poland, South Africa, Sweden, and the US (aOR = 0.15-0.60). Vaccine hesitancy was not universally associated with income distribution. Belief in a vaccine's ability to prevent COVID-19 and in vaccine safety and trust in vaccine science remained strongly correlated with acceptance.

Parental willingness to vaccinate their children in the 23 countries studied increased slightly from 67.6% in 2021, when COVID-19 vaccines for children were awaiting regulatory approval, to 69.5% in 2022. However, over the past year, COVID-19 childhood vaccine hesitancy increased in 8 countries (ranging from a 2.4% increase in Poland to 56.3% in Brazil) and remained greatest among parents who themselves were hesitant.

Almost 2 in 5 (38.6%) of all respondents said they now pay less attention to new information about COVID-19 vaccines than 1 year ago (range 7.5% in India to 58.3% in Nigeria). The characteristics of those who say they pay less attention vary by country, highlighting the importance of tailored health communication. Notably, high-credibility sources of information face challenges such as pandemic fatigue and, among some communities, low trust toward such institutions. Thus, as the pandemic drags on, "it is clear that those responsible for public health programs will need to develop more effective, personalized and sophisticated strategies to regain public attention and rebuild trust....Such programs must also be designed to include monitoring and, where appropriate, to address misinformation, as well as to develop and test other novel, effective communication methods."

Having found in the 2022 survey that support for vaccination mandates decreased, the researchers argue that "Communicating the rationale for instituting or reinstituting mandates for vaccination along with promoting vaccine literacy relative to preventive behaviors, such as face-masking and physical distancing, must improve, including the clarification of criteria for their relaxation or cessation."

Strategies to improve vaccine literacy and/or uptake include conveying messages that emphasise compassion over fear, framing message to resonate with particular recipients, using trusted messengers (e.g., healthcare providers), and providing various types of incentives. The researchers urge public health communicators to regularly test factors such as message content and frequency, source (messenger), and channels of dissemination using qualitative formative research, such as focus groups, to assess approaches to current (for example, first-dose and booster vaccination) and emerging (for example, mitigation of long COVID) issues.

In conclusion, the data shared here "can be used by health system decisionmakers, practitioners, advocates and researchers to address COVID-19 vaccine hesitancy more effectively."