Table 1.
COVID-19 Vaccination Refusal Rates and Reasons Among Nurses (March 2020–December 2020).
| Authors and Study Period |
Country | Sample Size (n) | Refusal Rate (%) | Reasons for Refusal of COVID-19 Vaccines and Enablers of Vaccination |
|---|---|---|---|---|
| Wang et al. March 2020 [18] |
Hong Kong China | 806 | 17.1 | Reasons: Concerns about vaccine safety, efficacy, side effects; no perceived need or lack of time Enablers: Male sex, flu vaccination/chronic disease history, contact with COVID-19 patients. |
| Dror et al. March 2020 [19] |
Israel | 211 * | 39 | Reasons: Concerns about vaccine quality, efficacy, side effects; belief COVID-19 is a mild infection. Enablers: Male sex, flu vaccination history, and higher perceived COVID-19 infection risk. |
| Kwok et al. April 2020 [20] |
Hong Kong, China | 1205 | 37 | Reasons: Concerns over safety, efficacy, and duration of protection against infection from the vaccine. Enablers: Younger age, collective responsibility belief, and stronger confidence in vaccines. |
| Nzaji et al. April 2020 [21] |
Congo | 446 * | 76 | Reasons: Misinformation and rumors on social media, and use of non-authentic information sources. Enablers: Male sex, older age, occupation type, positive attitude toward the COVID vaccines. |
| Suo et al. July 2020 [22] |
China | 3844 * | 6.6 | Reasons: Concerns about vaccine safety, effectiveness, testing/evaluation process; disease history. Enablers: Male sex, flu vaccination history, higher perceived COVID-19 risk, ED/ER worker. |
| Gagneux et al. July 2020 [23] |
France | 371 * | 35.3 | Reasons: Concerns about vaccine safety, efficacy, effectiveness; and occupational category/work type. Enablers: Male sex, older age, flu vaccination history, and high perceived risk of COVID-19 infection. |
| Unroe et al. August 2020 [24] |
USA | 1602 * | 60.7 | Reasons: Concerns over vaccine side effects/effectiveness/information, religion/politics, lack of trust. Enablers: Male sex, older age, higher perceived risk/severity of COVID-19, higher work experience. |
| Manning et al. September 2020 [25] |
USA | 183 * | 14.2 | Reasons: Concerns over vaccine safety, side effects; low vaccine -related knowledge or trust. Enablers: Male sex, older age, higher perceived risk of COVID-19, willingness to protect others. |
| Kose et al. September 2020 [26] |
Turkey | 306 * | 13.7 | Reasons: Concerns about vaccine efficacy, side effects; low COVID-19 risk, self immunity trust. Enablers: Male sex, young age, flu vaccination history, trust in vaccines or pharma companies. |
| Baghdadi et al. September 2020 [27] |
Saudi Arabia | 73 * | 41.1 | Reasons: Lower perceived COVID-19 risk/severity, lower belief in vaccines, and fear of injections. Enablers: Male sex, middle-aged, lower work experience, and encouragement from family or friends. |
| AlHassan et al. October 2020 [28] |
Ghana | 376 * | 30.8 | Reasons: Concerns about vaccine safety, efficacy, side effects; low vaccine trust, no need for vaccines. Enablers: Female sex, non-Christians/no religious beliefs, higher education, occupational setting. |
| Verger et al. November 2020 [29] |
Canada | 1055 * | 11.8 | Reasons: Concerns over vaccine safety, efficacy; distrust in government; belief in natural immunity Enablers: Male sex, older age, flu vaccination history, a recommendation from others, trust in science. |
| Barry et al. November 2020 [30] |
Saudi Arabia | 757 * | 49.3 | Reasons: Concerns about vaccine side effects, efficacy, speedy development, and lack of safety data. Enablers: Male sex, flu vaccination history, high perceived COVID-19 risk, isolation unit worker. |
| Grochowska et al. November 2020 [31] |
Poland | 18 * | 27.8 | Reasons: Concerns over vaccine safety, efficacy; occupation type, and lower trust in experts/science. Enablers: Male sex, flu vaccination history, occupational status, and recommendation by doctors. |
| Eguia et al. November 2020 [32] |
Spain | 51 * | 34.6 | Reasons: Concerns about vaccine safety, efficacy, side effects; conspiracy theories or misinformation. Enablers: Older age, high general trust in vaccines, never had COVID-19, no chronic disease history. |
| Ahmed et al. November 2020 [33] |
Saudi Arabia | 146 * | 39.5 | Reasons: Concerns over vaccine safety, efficacy; mistrust the company/ country of vaccines/pharma. Enablers: Male sex, older age, chronic disease history, allergies, trust in non-health leaders/other. |
| Shaw et al. December 2020 [34] |
USA | 1198 * | 25.2 | Reasons: Concerns about vaccine safety, side effects, efficacy, speedy development, and lack of data. Enablers: Male sex, older age, higher perceived COVID-19 risk, caring for COVID-19 patients. |
| Zürcher et al. December 2020 [35] |
Switzerland | 1690 * | 38 | Reasons: Concerns about vaccine safety, effectiveness; belief COVID-19 is mild, and PPE is enough. Enablers: Male sex, flu vaccination history, older age, trust in other vaccines and the government. |
| Fakonti et al. December 2020 [36] |
Cyprus, Greece |
403 * | 40.9 | Reasons: Concerns over vaccine side effects, speedy approval, COVID-19 is mild, natural immunity. Enablers: Male sex, older age, flu vaccination history, higher work experience, and private-sector job. |
| Browne et al. December 2020 [37] |
USA | 2936 * | 12.7 | Reasons: Concerns about vaccine side effects, efficacy, information, and mistrust in system/providers. Enablers: Male sex, younger age, higher education/work experience, clinical work setting, white race. |
| Adeniyi et al. December 2020 [38] |
South Africa | 591 * | 10.8 | Reasons: Concerns about vaccine safety, side effects, and lower trust in vaccinations in general. Enablers: Higher education or rank or perceptions of risk; and more contact with COVID-19 patients. |
| Kaplan et al. December 2020 [39] |
Turkey | 275 * | 33.5 | Reasons: Concerns over lack of scientific information, type/choice of vaccine, past COVID-19 infection. Enablers: Male sex, older age, living with family, chronic disease or vaccination compliance history. |
| Aurilio et al. December 2020 [40] |
Italy | 531 | 2.3 | Reasons: Concerns over vaccine safety, efficacy, side effects, low perceived COVID-19 severity/risk. Enablers: Male sex, flu vaccination history, younger age, family/friends affected or in bereavement. |
| Pataka et al. December 2020 [41] |
Greece | 115 * | 13.8 | Reasons: Concerns over vaccine safety, side effects; lower education and COVID-19 related knowledge. Enablers: Male sex, older age, married and having children, COVID-19 patient contact/caring for them. |
| Arora et al. December 2020 [42] |
India | 53 * | 11.4 | Reasons: Concerns over vaccine effectiveness duration; prefer other COVID-19 preventive measures. Enablers: Male sex, older age, occupation category, higher education, desire to protect other people. |
| Chew et al. December 2020 [43] |
India, China, Singapore, Indonesia, Bhutan, Vietnam | 404 * | 3.7 | Reasons: Concerns about vaccine safety, effectiveness, side effects, getting COVID from a vaccine. Enablers: Belief that pandemic is very severe, vaccines can help, less internalized stigma about the available vaccines, expressed altruism (or pro-socialness), and high trust in the healthcare authorities. |
| Aoun et al. December 2020 [44] |
Kuwait, Egypt, Saudi, Iraq, Qatar, Syria, Jordan, Bahrain, Lebanon | 391 * | 16.1 | Reasons: Concerns about vaccine side effects, lack of vaccine information, and living in crowded places. Enablers: Male sex, flu vaccination history, chronic disease history, and a desire for the COVID-19 vaccination to protect family/friends. |
| Total = 27 studies | 29 Countries | 20,037 Nurses |
23.4% (95%CI = 17.1–31.5) |
Top Refusal Reasons: Concerns about COVID-19 vaccine safety, side effects, effectiveness. Top Enablers of COVID-19 Vaccination: Male sex, flu vaccination history, older age. |
* indicates that the nurse participants were part of a larger sample of HCWs and the reasons and enablers listed are for the whole sample. Data collection months for each study have been arranged in chronological order in the table. All the studies listed in this table had females as the majority (>50%) of study participants.