Table 2.
COVID-19 Vaccination Refusal Rates and Reasons Among Nurses (January 2021–May 2021).
| Authors and Study Period |
Country | Sample Size (n) | Refusal Rate (%) | Reasons for Refusal of COVID-19 Vaccines and Enablers of Vaccination |
|---|---|---|---|---|
| Rabi et al. January 2021 [45] |
Palestine | 639 | 18 | Reasons: Concerns about vaccine side effects; natural immunity preference; media misinformation. Enablers: Older age, no fear of injections; believing in vaccine efficacy; take to protect others. |
| Hara et. al. January 2021 [46] |
Japan | 369 * | 18.4 | Reasons: Concerns about vaccine side effects, effectiveness, newness, vaccine immunity duration. Enablers: Male sex, flu vaccination history, older age, current smoking, local area epidemic situation. |
| Fares et al. January 2021 [47] |
Egypt | 89 * | 32.6 | Reasons: Concerns over vaccine safety, side effects, efficacy; low trust or a lack of information. Enablers: Male sex, COVID-19 patient care, past vaccination history, recommendations from others. |
| Spinewine et al. January 2021 [48] |
Belgium | 319 * | 5.3 | Reasons: Concerns over vaccine side effects and efficacy on variants, low perceived COVID-19 risk. Enablers: Male sex, older age, flu vaccination history, to protect others and to stop the pandemic. |
| Maraqa et al. January 2021 [49] |
Palestine | 483 * | 75.6 | Reasons: Concerns over vaccine side effects, efficacy, could get COVID-19 infection from a vaccine. Enablers: Male sex, flu vaccination history, younger age, higher knowledge/risk of COVID. |
| Desveaux et al. January 2021 [50] |
Canada | 1556 * |
18.8 | Reasons: Concerns about vaccine safety/speedy approval; belief that vaccines are it is not required, lower confidence in vaccines. Enablers: Older age, higher education, trust in public health websites/providers, paid sick days at job. |
| Mena et al. January 2021 [51] |
Spain | 234 * | 12.8 | Reasons: Concerns about vaccine effectiveness; lower education and income; COVID-19 patient care. Enablers: Male sex, flu vaccination history, older age, and high perceived risk of COVID-19 infection. |
| Schrading et al. January 2021 [52] |
USA | 345 * | 22.3 | Reasons: Concern over vaccine safety, efficacy, religious/ethical/personal reason, and lack of time Enablers: Male sex, older age, white race, chronic disease history, and easier logistics to get vaccines. |
| Patelarou et al. January 2021 [53] |
Albania, Cyprus, Spain, Greece, Kosovo | 1135 | 4.8 | Reasons: Concerns about vaccine safety, efficacy, effectiveness; previous COVID-19 infection, lower perceived risk or severity of COVID-19 infection. Enablers: Male sex, flu vaccination history, greater knowledge of COVID-19 vaccines, trust in experts and the government, and living in an area of high mortality from COVID-19 infections. |
| Holzmann-Littig et al. February 2021 [54] | Germany | 466 * | 9 | Reasons: Concerns over vaccine side effects, safety; lack of trust in authorities/pharma companies. Enablers: Older age, trust in other vaccines, high perceived risk or knowledge about COVID-19. |
| Baniak et al. February 2021 [55] |
USA | 276 | 5.1 | Reasons: Concerns about vaccine side effects, efficacy; and lack of information to make a decision. Enablers: Confidence in vaccine safety, development process, and higher work experience years. |
| AlKetbi et al. February 2021 [56] |
UAE | 1402 * | 11.3 | Reasons: Concern about vaccine side effects, lack of information, belief the vaccines may not work. Enablers: Male sex, older age, trust in vaccine producers/distributors, belief vaccines are effective. |
| Agyekum et al. February 2021 [57] |
Ghana | 151 * | 64.9 | Reasons: Concerns about vaccine safety, side effects; had COVID-19 or low perceived risk of disease. Enablers: Male sex, occupation type, family/friends had COVID-19, and higher trust in government. |
| Huynh et al. Feb 2021 [58] |
Vietnam | 146 * | 16.4 | Reason: Concerns about vaccine efficacy, side effects, fear, doubt; low perceived vaccine benefits. Enablers: High perceived risk or knowledge about COVID-19; reliable sources of information. |
| Paris et al. February 2021 [59] |
France β | 563 * | 3 | Reasons: Concerns about vaccine safety, efficacy; controversies about the existing vaccine side effects. Enablers: Older age, flu vaccination history, no comorbidities or allergies, past COVID-19 infection. |
| Janssen et al. March 2021 [60] |
France | 821 * | 15.5 | Reasons: Concerns about vaccine side effects, efficacy, immunity duration; mistrust in pharma group Enablers: Male sex, older age, flu vaccine or chronic disease history, higher COVID-19 infection risk |
| Angelo et al. March 2021 [61] |
Ethiopia β | 242 * | 55.4 | Reasons: Concerns about vaccine side effects; misinformation; negative attitude toward prevention. Enablers: Chronic disease history; high knowledge of COVID-19/ vaccines, higher COVID-19 risk. |
| Al-Sanafi et al. March 2021 [62] |
Kuwait | 127 * | 17.3 | Reasons: Concerns about vaccine side effects, influence of conspiracy theories or social media stories. Enablers: Male sex, higher education and COVID-19 vaccine confidence, job in public health sector. |
| Vignier et al. March 2021 [63] |
France | 200 * | 35.5 | Reasons: Concerns about vaccine side effects, benefits, efficacy, and low trust in pharma/authorities. Enablers: Male sex, older age, vaccination history, COVID-19 patient care, higher COVID-19 risk. |
| Branson et al. April 2021 [64] |
USA | 311 | 12.2 | Reasons: Concerns over vaccine safety, side effects, speedy approval, previous COVID diagnosis. Enablers: Older age, white race, higher education/work experience/designation or perceived risk. |
| Kozak et al. April 2021 [65] |
Germany | 908 * | 9.9 | Reasons: Concerns about vaccine safety/efficacy, side effects/fertility; low confidence/social pressure. Enablers: Middle age, flu vaccination history, COVID-19 patient contact, desire to protect others. |
| Do et al. April 2021 [66] |
USA | 275 * | 47.6 | Reasons: Concerns about vaccine side effects, efficacy, newness; mistrust; past COVID-19 diagnosis. Enablers: Male sex, older age, flu vaccination history, chronic disease history, COVID-19 patient care. |
| Toth-M, et al. May 2021 [67] |
USA | 303 * | 20.5 | Reasons: Concerns over lack of information/evidence on vaccines, side effects; racial minorities. Enablers: Male sex, older age, liberal, chronic disease in the family, recommendation of others. |
| King et al. May 2021 [68] |
USA β | 9701 * | 11.6 | Reasons: Concerns about vaccine side effects, efficacy, vaccine not needed, low trust in government. Enablers: Favorable attitudes toward vaccines/vaccination overall, and recommendation from others. |
| Total = 24 studies | 18 Countries | 21,061 Nurses |
18.3% (95%CI = 14.4–24.7) |
Top Refusal Reasons: Concerns about vaccine side effects, efficacy, and misinformation/mistrust. Top Enablers of COVID-19 Vaccination: Male sex, flu vaccination history, older age. |
| Grand Total = Tables 1 + 2 = 51 Studies, 36 Countries, 41,098 Nurses. COVID-19 vaccine refusal rate from March 2020–May 2021 = 20.7% (95% CI = 16.5–27.0) | ||||
∗ 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. β indicates studies without the majority of the study participants being females (rest had a majority of females). The overall prevalence of vaccine refusal among nurses was estimated from the included studies with 95% confidence intervals using random-effects modeling.