Table 1. Cognitive determinants of COVID-19 vaccine hesitancy .
| Author(s) | Population & country | Hesitancy rate | Results | Author(s) | Population & country | Hesitancy rate | Results |
|---|---|---|---|---|---|---|---|
| Abedin, 202121 | 3646 adults from Bangladesh |
8.5 % reluctant | Confidence in the country’s healthcare system | Al-Sanafi & Sallam 202122 |
1019 HCWs from Kuwait | 9.0% | The belief that the virus had a human-made origin |
| Adane et al, 202223 | 404 HCWs from Ethiopia | 36.0% refused | Anti-vaccine attitudes Poor knowledge and perception |
Al-Mistarehi et al, 2021 24 |
2208 individuals from Jordan | - | Lack of trust in the vaccine and their companies Lack of enough information Fear of side effects Concerns about safety and effectiveness Anti-vaccine attitudes |
| Adigwe, 202125 | 1767 individuals from Nigeria | - | Concerns about side effects | Alrajeh, et al, 202126 | 401 adults from KSA | - | Perceived susceptibility Perceived benefits Perceived barriers Concerns about effectiveness, safety, false vaccination, and side effects |
| Aemro et al, 202127 | 440 HCWs from Ethiopia | 45.9% hesitate | Unclear information provided by public health authorities Low perceived threat Concerns about side effects |
Alzubaidi, 202128 | 669 students from UAE | 31.8% hesitant |
Risks perception versus vaccine benefits Concerns about safety and effectiveness Attitudes about the disease and its consequences Knowledge and awareness about the vaccine Personal, family, and community experience with vaccination and feelings of solidarity Perception of the pharmaceutical industry Lack of confidence in government policies |
| Afzal et al, 202229 | 3759 HCWs from the US | - | Concerns about rushed vaccine development Fear of side effects Lack of trust in the people advocating for the vaccines Anti-vaccine attitudes |
An et al, 202130 | 854 students from Vietnam | - | Concerns about side effects, safety, effectiveness, and rushed vaccine development Fear of needles Low perceived susceptibility Lack of confidence in government |
| Aguilar Ticona et al, 202131 | 985 non-pregnant participants from Brazil | 26.1% were hesitant and 7.9% unsure |
Concerns about effectiveness and side effects | Ashok et al, 202132 | 264 HCW from India | - | Concerns about rushed vaccine development Lack of enough information |
| Al-Ayyadhi et al, 202120 | 6943 adults from Kuwait | 74.3% hesitant | Concerns about safety and side effects Believing conspiracy theories |
Badr et al, 202133 | 1208 adults from the US | 526 people were hesitant | Low perceived susceptibility Perceived the vaccination process as being more convenient |
| Baccolini et al, 202134 | 5369 students from Italy | 22% to 29% hesitancy ranged | Low perceived susceptibility and severity Concerns about safety and effectiveness Concern for the emergency |
Chaudhary et al, 202135 | 410 patients and their attendants from Pakistan | 47.3% were hesitant | Lack of knowledge Understanding the way vaccines work Concerns about vaccine efficacy, safety, and comfort in the vaccine administration |
| Balan et al, 202136 | 1581 students from Italy | 8% undecided group | Rushed vaccine development Vaccine barriers outweigh benefits Belief in natural immunity Lack of trust in the vaccine Lack of trust in the local and medical authorities |
Costantino et al, 20215 | 346 patients from Italy | 25.2% were hesitant | Fear of adverse events Concerns about rushed vaccine development Not afraid of COVID-19 Uncertain of vaccine efficacy |
| Blanchi et al, 202114 | 417 patients from Europe, France, and Italy | 18.9% were hesitant | Confidence in getting the vaccine easily Concerns about side effects and efficacy Lack of trust in scientists and the healthcare system |
de Sousa Á et al, 202137 | 6843 individuals from Portugal | 21.1% were hesitant | Perceived high stress Afraid of future repercussions of the disease Vaccine Conspiracy Beliefs and misinformation |
| Bolatov et al, 202138 | 888 students from Kazakhstan | 70.7%-75.5% | Trust in the opinions of close relatives Concerns about side effects, safety, effectiveness, and quality Belief in natural immunity |
Du et al, 202139 | 3011 reproductive women from China | 8.44% children and 3,011 reproductive women were hesitant | Low perceived susceptibility Lower perceived benefit High perceived barriers |
| Bou Hamdan et al, 202140 | 800 students from Lebanon | 10% were hesitant | Concerns about vaccine safety The vaccine in agreement with their personal views Agreement with conspiracies Level of knowledge about COVID-19 disease and vaccine Disagreement with that symptomatic cases are the only carriers of SARS-CoV-2 |
Ebrahimi et al, 202141 | 4571 adults from Norwegian |
10.46% were hesitant | Perceived risk of vaccination Belief in the superiority of natural immunity Lack of confidence in government Fear of infecting significant others |
| Butter et al, 202242 | 1599 adults from the UK | 17.7% uncertain, 8.1% refuse | Low perceived susceptibility | Ehde et al, 202143 | 359 Adults from the US | 20.3% were hesitant | Low perceived susceptibility Low trust in the Centers for Disease Control and Concerns about side effects, vaccine approval process, and potential impact of the vaccine given their health conditions |
| El-Sokkary et al, 202144 | 308 HCWs from Egypt | 41.9% were hesitant | Perception for the severity of COVID-19 COVID-19 vaccine safety Anti-vaccine attitudes |
Ghaffari-Rafi et al, 202145 | 359 adult patients from US | - | Concerns about vaccine safety Self-perception of a preexisting medical condition contraindicated with vaccination |
| Fares et al, 202146 | 385 HCWs from Egypt |
51% undecided 28% refused |
Lake of enough clinical trials Fear of side effects of the vaccine |
Gomes et al, 202247 | 3232 individuals from Portugal | 11% were hesitant | Feeling agitated, sad, or anxious Low or no confidence in the health services’ response Perceived measures implemented by the government as inadequate Low perceived susceptibility Concerns about safety and effectiveness |
| Fedele et al, 202148 | 640 individuals from Italy | 50% not sure |
Concerns about side effects, safety, and effectiveness Opposition to vaccines Other non-specific reasons |
Griva et al, 202149 | 1623 adults from Singapore | 9.9% were hesitant | Concerns about side effects, safety, and rushed vaccine development. Low perceived threat Lack of trust in the vaccine Low perceived benefits Lower moral and subjective norms |
| Freeman et al, 202150 | 5114 adults from UK | 16.6% unsure 11.7% hesitant |
Beliefs about a COVID-19 vaccine Mistrust |
Hwang et al, 202151 | 13021 individuals from Korea | 39.8% were reluctant or refused | Concerns about safety and side effects Complacency toward COVID-19 Awareness of the preventive guidelines Lack of confidence in government No fear of COVID-19 |
| Genovese et al, 202252 | 4116 individuals from Italy |
17.5% were doubtful. | Lack of trust in the vaccine Low perceived susceptibility Fear of side effects |
Hossain, et al, 202153 | 1377 individuals from Bangladesh | 35.25% unsure 18.99% denied |
Concerns about side effects, safety, and efficacy Against the vaccination program Afraid of taking injections Belief in natural remedies |
| Gerretsen et al, 202115 | 7678 adults from US and Canada | The mean (SD) hesitancy 2.3/6.0 (1.6) | Low perceived seriousness Low perceived threat Low perceived susceptibility Mistrust in vaccine benefit Preference for natural immunity Lack of confidence in government Risk propensity Mistrust in others The negative impact of COVID-19 on mental health |
Hossain et al, 20216 | 1497 adults from Bangladesh | 41.1% were hesitant | Perceived susceptibility and severity Perceived benefits and barriers Anti-vaccine attitudes Subjective norm Perceived behavioral control Anticipated regret Lack of trust in the vaccine Complacent Calculative Collective responsibility |
| Jain et al, 202154 |
1068 students from India |
10.6% were hesitant | Concern about safety and efficacy Lack of awareness regarding their eligibility for vaccination Lack of trust in the government |
Li et al, 202155 | 2196 students from China | 41.2% were hesitant | Perceived severity Concerns about side effects and effectiveness |
| Kanyike et al, 202156 | 600 students from Uganda | 30.7% were hesitant | Concerns about side effects Low perceived threat Belief in acquiring immunity against COVID-19 |
Liddell et al, 202157 | 516 refugees living from Australia |
28.1% were hesitant | Trust barriers Lower logistical barriers Attitudes relating to low control The Risk posed by COVID-19 |
| Khairat et al, 202258 | 3142 adults from the US | Mean (SD) 8 (2.83) hesitant | Lack of trust in the vaccine Concerns about side effects Lack of confidence in government |
López-Cepero et al, 20218 | 1911 adults from the US | More than 6.5% no intent 11% unsure |
Lack of trust in the vaccine Unafraid of getting COVID-19 Not worried about getting COVID-19 Barriers to getting the vaccine Concerns about efficacy, safety, and novelty The rigor of vaccine testing Lack of confidence in government |
| Knight et al, 202159 | 762 individuals from UK | 22% were hesitant | Confidence Complacency Convenience |
Luk et al, 202160 | 1035 individual from China |
29.2% undecided 25.5% no intention |
Concerns about safety, side effects, and effectiveness Knowledge of SARS-CoV-2 transmission Perceived danger of COVID-19 |
| Kucukkarapinar et al, 202161 | 3888 adults from Turkey | 43.9%-58.9% Increased rate of vaccine hesitancy/refusal |
Conspiracy thinking Less knowledge of prevention Reduced risk perception Higher perception of media hype Trust in the Ministry of Health and medical professional organizations |
Marijanovic et al, 202162 | 364 patients from Bosnia and Herzegovina | 37.6% Not sure | Doubt about the results of clinical trials of COVID-19 vaccines |
| Kuhn et al, 202119 | 90 homelessness from the US | 48% were hesitant | Fear of side effects Rejection of all vaccines Less trust in COVID-19 information from official sources, media, and friends Perceived threat |
McCarthy et al, 20219 | 779 patients from Australia | 30.6% were hesitant | Vaccine conspiracy theory Having higher perceptions of anomie Lack of confidence in government Low perceived health threats |
| Lee & You 202263 | 1016 individual from South Korea |
53.3% were hesitant | Perceived susceptibility perceived benefits Perceived barriers Lack of confidence in government |
Moujaess et al, 202164 | 111 Patients from Lebanon | 30.6% were hesitant | Desire to know more about the consequences of the vaccine in other patients with cancer |
| Muhajarine et al, 202165 | 9252 adults from Canada | 13 % were unsure, and 11% refused | Low perceived threat Low perceived severity Not concerned about spreading the virus |
Orangi et al, 202166 | 4136 individuals from Kenya | 36.5% were hesitant | Low perceived threat Concerns about side effects and effectiveness |
| Murphy et al, 202118 | Ireland = 1041 and UK = 2025 individual | 35% hesitancy for Ireland 31% hesitancy for England |
Low trust in scientists, healthcare professionals, and the state Negative attitudes toward migrants Lower levels of altruism Higher levels of conspiratorial Lower levels of agreeableness Higher levels of internal locus of control Lower levels of the conscientiousness Higher levels of neuroticism Belief in chance Beliefs about the role of powerful others |
Patwary et al, 202167 | 543 adults from Bangladesh | 15% were hesitant | Perceived barriers Subjective norms Low perceived threat Anti-vaccine attitudes Less self-efficacy Concerns about side effects and effectiveness Lack of enough information Belief in natural immunity |
| Navarre et al, 202168 | 1964 HCWs from French |
46.6% opposition to vaccination | Lack of trust in health authorities | Park et al, 202169 | 902 individuals from South Korea | 20.8 % were hesitant | Low perceived threat Concerns about safety Affective and Cognitive risk perception of COVID-19 Perceived the government’s performance as ineffective |
| Nazlı et al, 202170 | 467 18-65 years old from Turkey | 13.2% were hesitant | Belief in conspiracy theories low fear of COVID-19 | Paschoalotto et al, 202171 | 1623 individuals from Brazil | 30% were hesitant | Concerns about side effects |
| Nery et al, 202272 | 2521 individuals from Brazil | 18.6% were hesitant | Low perceived threat | Pedersen et al, 202116 | 423 individuals from 31 countries | 4% were hesitant | Concerns about side effects, rushed vaccine development, and effectiveness Lack of enough information |
| Nguyen et al, 202173 | 651 pregnant women from Vietnam | - | Concerns about safety and effectiveness | Peirolo et al, 202174 | 776 HCWs from Switzerland | - | Low perceived threat Concerns about side effects |
| Okubo et al, 202175 | 23142 individuals from Japan | 11.3% were hesitant | Concerns about adverse reactions Doubts about the vaccine efficacy Low perceived susceptibility |
Prickett et al, 202176 | 1284 individuals from New Zealand |
14.2% were unlikely and 15.1% unsure | Concerns about the side and future effects Thought their chances of becoming seriously ill if they caught COVID-19 were low Being protected by herd immunity |
| Rahman et al, 202177 | 850 adults from Bangladesh | 30.23% were hesitant | Afraid of side effects lack of enough information Lack of trust in the vaccine |
Schernhammer et al, 202278 | 1007 adults from Australia | 41.1% were hesitant | Optimism |
| Reno et al, 202179 | 1011 individuals from Italy | 31.1% were hesitant | Perceived threat | Shekhar et al, 202180 | 3479 HCWs from the US |
56% were hesitant | Concerns about Safety, efficacy, and rushed vaccine development |
| Roberts et al, 202281 | 1004 adults from the US | - | Anti-vax beliefs | Shen et al, 202182 | 2361 individuals from China | - | Lack of trust in the vaccine Risks perception |
| Ruggiero et al, 202183 | 427 parents from the US | 21.93% were hesitant | Concerns about side effects and safety | Soares et al, 202184 | 1943 individuals from Portugal | 56% wait and 9% refuse. | Lack of trust in the vaccine and the health service response Worse perception of government measures Perception of the information provided as inconsistent and contradictory |
| Schaal et al, 202185 | 2339 pregnant & breastfeeding from Germany | Pregnant: 28.9% unsure Breastfeeding: 28.1% unsure |
Scientific data on the COVID-19 vaccination are too preliminary Lack of enough information Being anxious because of vaccine damage to the unborn or causing pregnancy Complications |
Solak et al, 202286 | 525 adults from Turkey | - | Need for cognitive closure |
| Sharma et al, 202187 | 428 African Americans from US | 48% were hesitant | Perceived Advantages Perceived Disadvantages Participatory Dialogue Behavior Confidence |
Spinewine et al, 202188 | 1132 HCWs from Belgium |
37.1% were hesitant | Concerns about side effects, rushed vaccine development, and effectiveness Low perceived threat |
| Schwarzinger et al, 202189 | 1942 adults from France | 71.2% were hesitant | Vaccine efficacy Concerns about side effects Communication about the collective benefits of herd immunity |
Stojanovic et al, 202117 | 32028 individuals from Brazil, Canada, Colombia, France, Italy, Turkey, UK, US | 27% were hesitant. France had highest level of hesitancy (47.3%) and Brazil the lowest (9.6%) |
Fewer COVID-19 health concerns Higher personal financial concerns |
| Theis et al, 202190 | 816 Wright-Patterson Air Force Base (WPAFB) from the US | 22.7% | Concerns about side effects and effectiveness Vaccines making them feel sick Vaccine infects them COVID-19 Being worried about misinformation/political agenda |
West et al, 202191 | 360 Temporary Foreign Workers from Bangladesh | 25% were hesitant | Fear of side effects Low perceived threat Willingness to take the vaccine by more people first Lack of enough information |
| Ticona et al, 202192 | 985 individuals from Brazil | 26.1% were hesitant | Concerns about effectiveness and side effects | Wu et al, 202293 | 306 adult from the US |
33.99% were hesitant | Concerns about side effects, safety, ingredients, rushed vaccine development, and effectiveness Low perceived threat Concerns about vaccine causing MS relapse, making MS medication ineffective, and getting the COVID-19 infection Prior bad experiences with other vaccines |
| Tram et al, 20213 | 459235 households from the US | 10.2% “probably NOT” get a vaccine | Concern about side effects and safety Other people need it more than I Lack of trust in the vaccine Lack of confidence in government |
Xu et al, 202194 | 4748 parents from China | 25.2% of women, 26.1% of their spouses, and 27.3% of their children | Psychological distress Concern about safety |
| Turhan et al, 202195 | 620 individuals from Turkey | - | Lack of trust in healthcare system | Yanto et al, 202196 | 190 adults from Indonesia | 13.2% were hesitant | Agreeableness trait Neuroticism Lack of confidence in government, scientists, and HCWs |
| Wang & Zhang 202197 | 382 parents from China | - | Psychological flexibility Self-efficacy Coping style |
Zhang et al, 202198 | 1015 individuals from China | 82 Doubtful 39 Strongly Hesitancy | Conspiracy beliefs Medical mistrust Knowledge of vaccines Vaccine confidence and complacency |
| Wang et al, 202199 | 7318 adults from China | 67.6% were hesitant | Confidence Complacent Convenience |
- | - | - | - |
HCWs: health care workers.