3.1 Study Selection
A total of 6021 short communications, and editorial articles were searched through electronic databases from PubMed/MEDLINE, Scopus/Science direct, Web of Science, Embase, CINAHL, and Google scholars. The search for the articles was done from February to March 2021 (For articles conducted in 2020) and May to June 2022 (for articles conducted in 2021). After the search for the articles, 1310 duplicate articles were excluded. Furthermore, 2201 articles were excluded after initial selection based on abstracts and titles. Furthermore, 599 articles were excluded after eligibility for full text articles (n = 601). Finally, a total of 68 articles were included in the systematic review and meta-analysis (Figure 3).
3.2 Characteristics of the included articles
In this review, a total of 143,111 study participants were included in 68 original full-text articles throughout the world and published from 2020 to 2022. The included articles were conducted in 38 countries of the world (Figure 3).
Additionally, three articles were conducted in each Malaysia [44-46] and Kuwait [28, 47]. Two articles conducted in each Qatar[48, 49], Italy[15, 50], Jordan [28, 51], Bangladesh [52, 53], Ethiopia [54, 55], Taiwan [56, 57] and Germany [58, 59]. However, only one article was conducted in each of the following countries; Republic of Congo [60], Japan [61], Poland [10], Cameroon[7], Israel [62], Mexico [63], Malta[64], Scotland[6], Indonesia [65], England [66], South Korea [67], Iran [68], Nigeria [69], Tunisia [70], Netherlands [71], Thailand [72], Vietnam [73], United Arab Emirates [74], Botswana [75], Sudan [76], Czechia [77], Uganda [78], France [79], and in Egypt [80].
The included studies were cross-sectional studies with a sample size ranging from 123 [64] to 23,582 [32] study participants. In general, the overall global acceptance rate of the COVID-19 vaccine, regardless of occupation, was 63.4% and ranged from 15.4% [7] to 95.6% [23] (Table 1).
Table 1: Overall characteristics of the articles included in the systematic review and meta-analysis, 2022.
References
|
Survey period
|
Publication year
|
Sample size
|
Acceptance rate
|
Hesitance rate
|
Occupation
|
Country
|
WHO Region
|
[2]
|
October to November 2020
|
2021
|
4080
|
36.0
|
64.0
|
Healthcare workers
|
United States
|
American Region
|
[34]
|
May 2020
|
2020
|
672
|
67.0
|
33.0
|
Adult population
|
United States
|
American Region
|
[60]
|
August to September, 2020
|
2021
|
4131
|
55.9
|
44.1
|
Adult population
|
Republic of Congo
|
African Region
|
[44]
|
April, 2020
|
2020
|
1159
|
94.3
|
5.7
|
Adult population
|
Malaysia
|
Western Pacific Region
|
[20]
|
July to August, 2020
|
2021
|
1200
|
42.2
|
57.8
|
Adult population
|
China
|
Western Pacific Region
|
[40]
|
September, 2020
|
2020
|
1138
|
68.6
|
31.4
|
Healthcare workers
|
Turkey
|
European
|
[61]
|
September 2020
|
2021
|
1100
|
65.7
|
34.3
|
Adult population
|
Japan
|
Western Pacific Region
|
[37]
|
September to October 2020
|
2020
|
5114
|
71.7
|
28.3
|
Adults population
|
United Kingdom
|
European
|
[6]
|
April, 2020
|
2020
|
527
|
86.0
|
34.0
|
Elder adults and patients
|
United Kingdom
|
European
|
[48]
|
October to November 2020
|
2021
|
7821
|
60.5
|
39.5
|
Adult population
|
Qatar
|
Eastern Mediterranean Region
|
[35]
|
May 2020
|
2020
|
2006
|
69.0
|
31.0
|
Adult population
|
United States
|
American Region
|
[21]
|
August to September 2020
|
2021
|
2047
|
34.8
|
65.2
|
Adult population
|
China
|
Western Pacific Region
|
[15]
|
September to November 2020
|
2021
|
599
|
40.8
|
59.2
|
Patients
|
Italy
|
European
|
[28]
|
December 2020
|
2021
|
154
|
31.8
|
68.2
|
Adult population
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[10]
|
June 2020
|
2021
|
1066
|
37.0
|
63.0
|
Adult population
|
Poland
|
European
|
[7]
|
May to August 2020
|
2021
|
2512
|
15.4
|
84.6
|
Adult population
|
Cameroon
|
African Region
|
[14]
|
March 2020
|
2020
|
2058
|
91.3
|
8.7
|
Adult population
|
China
|
Western Pacific Region
|
[62]
|
March to April 2020
|
2020
|
1112
|
75.0
|
25.0
|
Adult population
|
Israel
|
European
|
[38]
|
October to December 2020
|
2021
|
535
|
29.0
|
71.0
|
Adult population
|
United Kingdom
|
European
|
[63]
|
June 2020
|
2021
|
699
|
76.2
|
23.8
|
Adult population
|
Mexico
|
American Region
|
[64]
|
September 2020
|
2020
|
123
|
61.8
|
38.2
|
Healthcare workers
|
Malta
|
European
|
[6]
|
August 2020
|
2021
|
2016
|
77.5
|
22.5
|
High risk population
|
Scotland
|
European
|
[28]
|
December 2020
|
2021
|
771
|
23.6
|
76.4
|
Adult population
|
Kuwait
|
Eastern Mediterranean Region
|
[65]
|
March to April 2020
|
2020
|
1359
|
93.3
|
6.7
|
Adult population
|
Indonesia
|
South East Asian Region
|
[41]
|
June to July, 2020
|
2020
|
759
|
49.7
|
50.3
|
Adult population
|
Turkey
|
European
|
[36]
|
June, 2020
|
20021
|
1878
|
79.0
|
22.0
|
Adult population
|
United States
|
American Region
|
[22]
|
May to June 2020
|
2021
|
3195
|
83.8
|
16.2
|
Adult population
|
China
|
Western Pacific Region
|
[23]
|
March 2020
|
2021
|
2058
|
52.2
|
47.8
|
Adults population
|
China
|
Western Pacific Region
|
[81]
|
December 2020
|
2021
|
2173
|
28.4
|
71.6
|
Adults population
|
Jordan
|
Eastern Mediterranean Region
|
[66]
|
April to May 2020
|
2021
|
1252
|
55.8
|
44.2
|
Parents and guardians
|
England
|
European
|
[45]
|
December 23–29, 2020
|
2021
|
1411
|
83.3
|
16.7
|
Adult population
|
Malaysia
|
Western Pacific Region
|
[67]
|
May to June 2021
|
2021
|
710
|
70.8
|
29.2
|
Adult population
|
South Korea
|
Western Pacific Region
|
[68]
|
December 2020 to February 2021
|
2022
|
4604
|
69
|
31
|
Adult population
|
Iran
|
Eastern Mediterranean Region
|
[69]
|
March to June 2021
|
2021
|
440
|
40
|
60
|
Students
|
Nigeria
|
African Region
|
[52]
|
February 2021
|
2021
|
1497
|
42.9
|
46.2
|
Adult population
|
Bangladesh
|
South East Asian Region
|
[54]
|
2021
|
2021
|
416
|
59.4
|
40.6
|
Patients
|
Ethiopia
|
African Region
|
[47]
|
March to April 2021
|
2021
|
4147
|
73.8
|
26.2
|
Adult population
|
Kuwait
|
Eastern Mediterranean Region
|
[24]
|
January to March 2021
|
2022
|
4227
|
84.4
|
15.6
|
HCW, Students, population,
|
China
|
Western Pacific Region
|
[70]
|
February 2021
|
2021
|
200
|
35
|
65
|
patients
|
Tunisia
|
Eastern Mediterranean Region
|
[71]
|
January to April 2021
|
2022
|
160
|
69.6
|
30.4
|
Minority Ethnic Groups
|
Netherlands
|
European
|
[25]
|
November 2021
|
2022
|
1,724
|
88.46
|
11.54
|
child caregivers, Children
|
China
|
Western Pacific Region
|
[72]
|
March 2021 to April 2021
|
2021
|
705
|
95.6
|
4.4
|
Healthcare workers
|
Thailand
|
South East Asian Region
|
[73]
|
January to February 2021
|
2021
|
651
|
60.4
|
39.6
|
Pregnant Women
|
Vietnam
|
Western Pacific Region
|
[46]
|
December 2021
|
2021
|
1406
|
64.5
|
35.5
|
Adult population
|
Malaysia
|
Western Pacific Region
|
[74]
|
November 2020 and January 2021
|
2022
|
517
|
58
|
42
|
Healthcare workers
|
United Arab Emirates
|
Eastern Mediterranean Region
|
[75]
|
February 2021
|
2022
|
5300
|
73.4
|
26.6
|
Adult population
|
Botswana
|
African Region
|
[56]
|
June to September 2021
|
2022
|
957
|
74.9
|
25.1
|
elderly people
|
Taiwan
|
Western Pacific Region
|
[39]
|
December 2020
|
2021
|
4,535
|
85
|
15
|
Adult population
|
United Kingdom
|
European
|
[29]
|
November 2020
|
2021
|
1512
|
70
|
30
|
Healthcare workers
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[76]
|
June to July 2021
|
2022
|
217
|
55.8
|
44.2
|
Students
|
Sudan
|
Eastern Mediterranean Region
|
[53]
|
January to February 2021
|
2021
|
4175
|
60.5
|
39.5
|
Adult population
|
Bangladesh
|
South East Asian Region
|
[55]
|
June to July 2021
|
2022
|
319
|
72.73
|
27.27
|
Healthcare workers
|
Ethiopia
|
African Region
|
[77]
|
August to October 2021
|
2021
|
362
|
70.2
|
29.8
|
Pregnant and Lactating Women
|
Czechia
|
European
|
[58]
|
December 2020 to January 2021
|
2021
|
1296
|
57
|
43
|
Healthcare workers
|
Germany
|
European
|
[78]
|
March to April 2021
|
2021
|
317
|
70.1
|
29.9
|
High-risk populations
|
Uganda
|
African Region
|
[49]
|
February 2021
|
2021
|
462
|
62.6
|
37.4
|
Employees and students
|
Qatar
|
Eastern Mediterranean Region
|
[42]
|
December 2020
|
2021
|
384
|
54.7
|
45.3
|
Adult population
|
Turkey
|
European
|
[30]
|
January to February 2021
|
2021
|
862
|
22.4
|
77.6
|
Adult population
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[31]
|
January and March 2021
|
2021
|
531
|
61.8
|
38.2
|
Adult population
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[57]
|
October 2020
|
2021
|
1020
|
52.7
|
47.3
|
Adult population
|
Taiwan
|
Western Pacific Region
|
[26]
|
November 2020
|
2021
|
2126
|
89.1
|
10.9
|
Adult population
|
China
|
Western Pacific Region
|
[32]
|
October to December 2020
|
2021
|
23,582
|
64.9
|
35.1
|
Healthcare workers
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[79]
|
January 2021
|
2021
|
237
|
71.3
|
28.7
|
Patients
|
France
|
European
|
[33]
|
December 2020
|
2021
|
2137
|
48
|
52
|
Adult population
|
Saudi Arabia
|
Eastern Mediterranean Region
|
[27]
|
November 2020
|
2021
|
1392
|
77.4
|
22.6
|
Pregnant and Lactating Women
|
China
|
Western Pacific Region
|
[59]
|
February 2021
|
2021
|
4500
|
91.7
|
8.3
|
Healthcare workers
|
Germany
|
European
|
[50]
|
February to April 2021
|
2021
|
3226
|
91.9
|
8.1
|
Students
|
Italy
|
European
|
[51]
|
November 2020
|
2021
|
3,100
|
37.4
|
62.6
|
Adult population
|
Jordan
|
Eastern Mediterranean Region
|
[80]
|
January 2021
|
2021
|
2133
|
54
|
46
|
Students
|
Egypt
|
Eastern Mediterranean Region
|
[43]
|
January to February 202
|
2021
|
300
|
37
|
63
|
Pregnant and Lactating Women
|
Turkey.
|
European
|
Keys: HCWs: Healthcare Workers
3.3 COVID-19 Vaccine Acceptance
The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) Version 3 statistical software determine the global pooled prevalence / acceptance rate and the hesitancy rate of the COVID-19 vaccine.
3.3.1 The Overall Pooled Prevalence /Rate of COVID-19 Vaccine Acceptance
The pooled prevalence rate for the acceptance of the COVID-19 vaccine was found to be 64.9% [95% CI of 60.5 to 69.0%]; I2 = 99.57% with a p-value of <0.001 (Figure 4).
3.3.2 Subgroup analysis of the pooled prevalence rate of COVID-19 vaccine acceptance
Based on the subgroup analysis that was employed based on the World Health Organization Region, the overall pooled prevalence rate of acceptance of the COVID-19 vaccine was 60.8% [95% CI: 56.3, 65.2%]. The lowest prevalence of acceptance rate was reported in the Eastern Mediterranean Region accounting for 60.8% [95% CI: 43.4, 57.2%], whereas the highest prevalence was reported in South East Asian Region which accounted for 81.0% [95% CI: 59.9, 92.4%] (Figure 5).
Based on the countries where the study was conducted, the lowest prevalence of COVID-19 vaccine acceptance rate was reported in Cameroon [15.4% (95% CI: 14.0, 16.9] followed by the highest prevalence [95.6% (95% CI: 93.8, 96.9%] of COVID-19 vaccine acceptance was reported in Thailand followed by Indonesia [93.3% (95% CI: 91.8, 94.5%] (Figure 6).
Based on the study participants, the highest COVID-19 vaccine acceptance rate was reported among the healthcare workers prevalence [71.4% (95% CI: 59.9, 80.7%] followed by students 64.7% (95% CI: 32.6, 89.2%]. The lowest prevalence of COVID-19 vaccine acceptance rate was reported among patients [51.8% (95% CI: 36.8, 66.6%] (Table 7)
Based on the survey period, the pooled prevalence of the COVID-19 vaccine acceptance rate was 64.5% [95% CI: 60.3, 68.5%]. Relatively, the lowest prevalence [57.9% (95% CI: 49.2, 66.2%] of vaccine acceptance was reported from September to November 2020, followed by [60.1% (95% CI: 40.5, 76.9%], whereas the highest prevalence [81.0% (95% CI: 57.3, 93.1%] was reported between September to November 2021 (Figure 8).
3.4 Publication bias
3.4.1 Sensitivity analysis
Sensitivity analysis was performed by removing low outcome, high outcome, and small sample size. However, the sensitivity analysis did not show a substantial change in the prevalence of COVID- 19 acceptance compared to the pooled prevalence without sensitivity analysis [61.1% (95% CI 53.8 to 67.9%)] (Table 2).
Table 2: Results of sensitivity analysis for COVID-19 vaccine acceptance rate, 2022.
Criteria used
|
Prevalence
|
Heterogeneity
|
95% Confidence interval
|
P-value
|
Upper limit
|
Lower limit
|
|
After removing three articles with small sample size
|
65.2%
|
|
60.8
|
69.3
|
<0.001
|
After removing on article with small sample size
|
64.85
|
|
60.0
|
69.3
|
|
After removing one article with low outcome
|
65.5%
|
|
61.5
|
69.4
|
<0.001
|
After removing four articles with high prevalence rate
|
62.0%
|
|
57.8
|
66.1
|
<0.001
|
After removing one article with low and four articles with high prevalence rate
|
65.8%
|
|
58.8
|
66.6
|
<0.001
|