Prevalence of Caregiver Hesitancy for Vaccinations in Children and Its Associated Factors: A Systematic Review and Meta-analysis

"This review showed that the overall pooled prevalence of vaccine hesitancy among caregivers across the regions is 25%[,] with vaccine safety and efficiency...identified as a major factor contribute to vaccine hesitancy among caregivers."

Vaccine hesitancy, defined as delaying accepting or refusing or declining a vaccine despite the availability of vaccination services, is complex and context-specific, varying according to time, geography, and vaccination type. This review aimed to systematically compare and pool the prevalence of all the known evidence on caregiver hesitancy and to describe the factors influencing vaccine hesitancy among caregivers worldwide.

The researchers searched articles from a few electronic databases (PubMed, CENTRAL, ProQuest, and Web of Science) from inception to August 2023 using specific keywords. The review included population-based studies that reported the prevalence of caregiver hesitancy. Various types of vaccines were also assessed, such as (i) COVID-19; (ii) human papillomavirus (HPV); (iii) influenza; (iv) measles, mumps, and rubella (MMR); (v) mixed vaccines - children who take more than one vaccine, such as COVID-19 and influenza; and (vi) other vaccines, such as hepatitis A & B, malaria, polio, diphtheria, pneumococcal, and others.

A total of 765 studies met inclusion criteria, containing data on 38,210,589 caregivers from seven regions across the globe. The overall prevalence of vaccine hesitancy among caregivers as reported across the 434 studies that reported the prevalence of vaccine hesitancy is 25.0% (95% confidence interval (CI): 0.22-0.27, I2 = 99.91%, p = 0.001). (See the paper for specific hesitancy findings for specific types of vaccines.) The prevalence across the regions varied but mostly ranged between 14% and 30%. The South America region showed the lowest prevalence (14%), compared to other regions (22%-30%). Asia had the highest prevalence of vaccine hesitancy (41.0%), with lack of knowledge and information being identified as contributing reasons.

Based on the evidence gathered, overall, vaccine hesitancy was found to be linked to religious sentiments, personal beliefs, perceived safety concerns, and a desire for more information from healthcare providers, along with factors related to availability, accessibility, affordability, and acceptability of vaccinations. Vaccine safety and efficiency have been identified as the main factor for caregiver vaccine hesitancy globally, with a prevalence of 91.4%.

The researchers suggest that, to overcome caregiver vaccine hesitancy, healthcare providers must be able to understand caregivers' primary concerns about their children's vaccinations. They can then address these concerns by, for example, providing more data, information, and details about the vaccine, including the vaccine production, potential side effects, and the importance of vaccination for children. Notably, healthcare providers must have open and honest conversations with caregivers. Doing so can help them understand the benefits of vaccination without feeling judged, criticised, or attacked for the concerns they have about their child's health.

According to the researchers, interactive, tailored, and targeted educational strategies might help to increase vaccination rates. Having a caregivers' education website, for example, may aid in the creation of appropriate and effective immunisation information. Caregivers' attitudes, perceptions of their peers, sense of self-efficacy, desire to vaccinate, and vaccination behaviour can be influenced by a well-designed educational intervention. Caregivers should be consulted during the design of pamphlets to ensure the content is comprehensible and understandable to them, which can be an essential step in combatting anti-vaccination information on the internet. Social media and public trust in the government may play a role in encouraging immunisation and preventing diseases. Furthermore, to prevent erroneous information from spreading on social media, health authorities must provide scientific data and adequate information about vaccine benefits and risks.

Full list of authors, with institutional affiliations: Nur Hasnah Maamor, Ministry of Health, Setia Alam, Malaysia; Nor Asiah Muhamad, Ministry of Health, Setia Alam, Malaysia; Nor Soleha Mohd Dali, Ministry of Health, Setia Alam, Malaysia; Fatin Norhasny Leman, Ministry of Health, Setia Alam, Malaysia; Izzah Athirah Rosli, Ministry of Health, Setia Alam, Malaysia; Tengku Puteri Nadiah Tengku Bahrudin Shah, Ministry of Health, Setia Alam, Malaysia; Nurul Hidayah Jamalluddin, Ministry of Health, Setia Alam, Malaysia; Nurul Syazwani Misnan, Ministry of Health, Setia Alam, Malaysia; Zuraifah Asrah Mohamad, Ministry of Health, Setia Alam, Malaysia; Sophia Karen Bakon, Ministry of Health, Setia Alam, Malaysia; Mohd Hatta Abdul Mutalip, Ministry of Health, Setia Alam, Malaysia; Muhammad Radzi Abu Hassan, Office of Director General Ministry of Health, Putrajaya, Malaysia; Nai Ming Lai, Taylor's University