The impact of national income and vaccine hesitancy on country-level COVID-19 vaccine uptake

Abstract

Background The rapid development and rollout of COVID-19 vaccines helped reduce the pandemic’s mortality burden. The vaccine rollout, however, has been uneven; it is well known that vaccination rates tend to be lower in lower income countries. Vaccine uptake, however, ultimately depends on the willingness of individuals to get vaccinated. If vaccine confidence is low, then uptake will be low, regardless of country income level. We investigated the impact on country-level COVID-19 vaccination rates of both national income and vaccine hesitancy. Methods We estimated a linear regression model of COVID-19 vaccine uptake across 145 countries; this cross-sectional model was estimated at each of four time points: 6, 12, 18, and 24 months after the onset of global vaccine distribution. Vaccine uptake reflects the percentage of the population that had completed their primary vaccination series at the time point. Covariates include per capita GDP, an estimate of the percentage of country residents who strongly disagreed that vaccines are safe, and a variety of control variables. Next, we estimated these models of vaccine uptake by country income (countries below, and above the international median per capita GDP) to examine whether the impact of vaccine hesitancy varies by country income. Results We find that GDP per capita has a pronounced impact on vaccine uptake at 6 months after global rollout. After controlling for other factors, there was a 22 percentage point difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by per capita GDP; this difference grew to 38% by 12 months. The deleterious impact of distrust of vaccine safety on vaccine uptake became apparent by 12 months and then increased over time. At 24 months, there was a 17% difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by distrust. The income stratified models reveal that the deleterious impact of vaccine distrust on vaccine uptake at 12 and 24 months is particularly evident in lower income countries. Conclusions Our study highlights the important role of both national income and vaccine hesitancy in determining COVID-19 vaccine uptake globally. There is a need to increase the supply and distribution of pandemic vaccines to lower-income countries, and to take measures to improve vaccine confidence in these countries.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

“…Several studies have looked at the impact of GDP on COVID-19 vaccination uptake [ 180 , 181 , 182 , 183 ] but none have looked at the impact of GDP on vaccine acceptance or hesitancy. Here we present the first study, to the best of our knowledge, that showed that WB income level was associated with VA and VH, but that percentage GDP spent on vaccine procurement was not associated with VA and VH.…”

Worldwide Child Routine Vaccination Hesitancy Rate among Parents of Children Aged 0–6 Years: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

“…This may lead to greater heterogeneity in decisions about childhood vaccinations, which in turn may affect the level of hesitancy among parents. However, the presence of these factors, in varying proportions, may be individual for each country or society [ 53 , 54 ].…”