Exploring Factors Affecting Covid-19 Vaccine Uptake Among African University Students: A Scoping Review

Abstract

This scoping review is intended to examine and consolidate the factors that influence the uptake of COVID-19 vaccines among African university students. Gaining an understanding of these factors is crucial for developing effective public health strategies to improve vaccination rates within this demographic. An extensive search of peer-reviewed publications was carried out in databases such as Pubmed, Ebsco host, Medline as well as Google and Google Scholar. The Critical Appraisal Skilled Programme Checklist (CASP) was used to evaluate the retrieved articles and presented in the PRISMA flow diagram. Ultimately, 10 articles satisfied the inclusion and exclusion requirements. The review generated five main themes: willingness/acceptance of COVID-19 vaccine, vaccination hesitancy, factors/reasons for vaccine willingness/acceptance, reasons/barriers for vaccine hesitancy, and source of vaccine information. The acceptance rate of vaccines varied across studies and ranged from 34.2% to 69%, while vaccine hesitancy ranged from 20.8% to 50%. Several factors influenced vaccination acceptance and hesitancy including fear of side effects, the desire to protect oneself and others, doubts about vaccine efficacy, and limited access to information on vaccination. Notably, social media became the frequently utilized source of vaccination-information among university students. The synthesized studies have revealed that vaccination acceptability among the African student population is low, while hesitancy is high. Therefore, public health education should be intensified among the Africa university students to stop COVID-19 transmission, improve vaccination acceptance, achieve herd immunity, and safeguard the health and wellness of the student body and the public.

Keywords

exploring factors affecting covid-19 vaccines uptake Africa area studies humanities university students education social sciences

Introduction

Several viruses, including coronaviruses like SARS and MERS, pose significant risks to global public health (Al-Hazmi, 2016). The SARS-CoV-2 virus, which has been recognized by the World Health Organization (WHO) as a global health concern, was initially expected to have a minimal impact on Africa due to climatic factors (Martínez-álvarez et al., 2020). However, predictions of a severe impact by experts like Nagar (2021) were contradicted by lower incidence and mortality rates in the region compared to the USA and Europe (World Health Organisation [WHO], 2022). Vaccine development for SARS-CoV-2 has progressed rapidly, and WHO-approved vaccines have been distributed globally (Ndwandwe & Wiysonge, 2021). Despite the virus spreading to most African nations (Islam et al., 2021) and significant vaccination efforts, only 10% of Africa’s population was fully vaccinated by early 2022, raising concerns (Africa CDC, 2022). Public health experts advocate for vaccination to reduce virus transmission and severe outcomes (Wang et al., 2021), supported by evidence of the effectiveness of vaccines in reducing transmission and protecting against severe disease (Dagan et al., 2021; Polack et al., 2020). However, the exact vaccination rates required for herd immunity remain uncertain amid evolving variants.

While vaccination campaigns have made significant progress globally, the issue of disparities in vaccine uptake persists as a critical concern, especially in regions with low-and middle-income backgrounds like Africa (Africa CDC, 2022). According to Salerno et al. (2021), vulnerability and age have been given priority in vaccination distribution techniques, with the elderly receiving priority because of their increased risk of COVID-19-related mortality. However, it is also important to immunize adolescents and young adults to reach the threshold of “herd immunity” and decrease the worldwide cost of COVID-19 (de Bekker-Grob et al., 2018). Therefore, there is a substantial effort being made to increase the level of vaccination and the effectiveness of vaccination deployments among diverse age categories, considering that prior research demonstrates varying reactions to vaccines among population subgroups.

Among the African population, university students are considered critical due to their potential as influencers and future leaders (Lee et al., 2022). As such, they require special focus for COVID-19 immunization. University students are vulnerable to infection due to factors such as their active social lives, different living arrangements (both on-campus and off-campus), and the need to travel. To improve vaccination coverage in university students, it is important to understand the factors that influence COVID-19 vaccine uptake. University students are at a critical stage in their lives when health behaviors and attitudes are formed, which can persist into adulthood. Their choices regarding vaccination not only affect their own health but also influence their peers and family members. Achieving high vaccination rates is crucial in university environments to prevent outbreaks and ensure uninterrupted educational activities.

Despite COVID-19 vaccines being available, African university students have shown different levels of acceptance and uptake. This can be attributed to various factors, including individual, social, and structural dimensions. Individual factors include personal beliefs about vaccine safety and effectiveness, perceived susceptibility to COVID-19, and general health literacy (Aw et al., 2021). Social influences involve peer pressure, family attitudes, and cultural beliefs (Solís Arce et al., 2021), while structural factors relate to vaccine accessibility, government policies, and the role of university health services (Dzinamarira et al., 2021).

Considering the diverse range of reports on vaccine acceptability and hesitancy among African students, it is imperative to conduct a scoping review to consolidate and map studies that have investigated the factors influencing and hindering vaccination uptake among university students. The primary objective of this scoping review is to analyze and synthesize the existing literature on the determinants of COVID-19 vaccine uptake among African university students. By identifying key drivers and barriers, this review aims to provide insights that can inform the development of effective public health strategies and targeted interventions for this specific demographic. Understanding these factors is not only crucial for enhancing current vaccination rates, but also for bolstering the overall resilience of health systems in Africa in the face of future pandemics (Wiysonge et al., 2022).

Materials and Methods

Study Design

This study employed a scoping review methodology, which is widely acknowledged for its effectiveness in identifying trends, synthesizing evidence, and uncovering gaps within the existing body of literature (Westphaln et al., 2021). The review adhered to the five-stage analytical framework proposed by Arksey and O’Malley (2005), which is a well-established approach for conducting systematic reviews. The stages of this process are: defining the research questions to establish clear objectives and guide the scope of the review; conducting a comprehensive search for relevant studies across various databases and sources; selecting appropriate studies based on predetermined inclusion and exclusion criteria; organizing and analyzing the data to identify key themes, patterns, and insights; and summarizing and disseminating the findings to inform future research, policy development, and practical applications (Lisy & Porritt, 2016). By following this structured framework, the study aimed to provide a thorough exploration of the topic and generate evidence-based insights that could guide further scholarly inquiry and influence policy-making and practice within the relevant field.

Searching for Pertinent Studies

A systematic search strategy was employed to collect relevant literature from electronic databases, including PubMed, EBSCOhost, Medline, Google, and Google Scholar. Initial searches in PubMed, EBSCOhost, and Medline were conducted from April 14, 2023, to April 25, 2023. Searches were then extended to Google and Google Scholar from May 8, 2023, to May 29, 2023. The literature search inclusion criteria included: peer-reviewed articles from the selected databases; quantitative, qualitative, and mixed studies involving student groups; studies addressing the scope and principal aim of the research; original research focused on COVID-19 vaccine acceptance and hesitancy; studies conducted in Africa; publications in English; and studies published between 2020 and 2023. Exclusion criteria included: unpublished manuscripts; publications lacking required original data; studies where students were not the sample population; articles focused on non-COVID-19 vaccine hesitancy; publications other than original research; and non-English publications. To enhance search precision and ensure a focused capture of relevant literature, specific key phrases were developed for use across the databases. The key predictive items associated with vaccine hesitancy were conceptualized around COVID-19 vaccines in Africa. The search items were adapted from prior systematic analyses evaluating COVID-19 and non-COVID-19 vaccine hesitancy globally (Roy et al., 2022; Schmid et al., 2017; Truong et al., 2022). These key phrases included (“COVID-19” OR “COVID19” OR “coronavirus 2019” OR “COVID 2019”) AND (vaccine OR immunization) AND (hesitancy OR reluctance OR barriers OR acceptance OR willingness OR intentions OR motivators) AND (student OR educational sector) AND (Africa OR sub-Saharan Africa). This strategic use of keywords ensured that the search captured studies related to vaccine uptake, acceptance, hesitancy, and barriers within the context of the COVID-19 pandemic, specifically among students in Africa. The approach enabled a focused collection of data relevant to the scoping review and provided a basis for identifying trends, challenges, and opportunities in COVID-19 vaccination efforts on the continent.

Study Selection

Following the completion of a carefully screened title and abstract in the aforementioned databases, the studies underwent a screening process utilizing the Critical Appraisal Skills Programme Checklist (CASP). This tool was employed to assess the quality and relevance of the studies, ensuring that only those meeting rigorous criteria for validity, reliability, and applicability were included in the final analysis. The CASP Checklist helped identify studies with robust methodologies, clear findings, and appropriate conclusions, ensuring a high standard of evidence for the scoping review. Those studies that fell short of the research questions were deliberately omitted. Full-text studies that were most pertinent to this review were chosen using the criteria for inclusion and exclusion. The primarily concentration was on studies using mixed, qualitative, and quantitative methodologies published in English language in an academic peer-reviewed journals between the years 2020 and 2023. Gray literature, such as thesis, was also considered. On the other hand, reports, conference papers, unpublished journals, abstracts, commentaries, protocols, letters, memoranda, and other reviews were excluded from the review. Studies that centered on the general public or certain target groups like healthcare professionals and high-risk populations were also excluded.

The data for this scoping review were independently extracted by DAF and CE, and reviewed by INK and KB. Any discrepancies that arose during extraction were resolved through meetings involving all authors. Input from a review and subject expert was sought to ensure data accuracy and comprehensiveness. Finally, the authors conducted a thematic analysis to present the results.

Charting Data

To organize and summarize the data gathered, Microsoft Excel’s standardized information extraction sheet was utilized. This sheet facilitated the collation of data into themes and the synthesis of information from the studies and reports. Detailed information from the included studies was extracted under specific headings, including the authors and year of the study, country, purpose, study design, population, sample size, and study outcome. Given the diversity of the research, the narrative synthesis method, which utilizes words and texts, was employed to compile, summarize, and explain the data (Lisy & Porritt, 2016). The identified studies were classified under the following headings: information source for COVID-19, vaccination acceptance, motivation for vaccination acceptance, vaccine hesitancy for COVID-19, and barriers/reasons for vaccine hesitancy. Thematic narratives were used by the researchers to comprehensively report the data.

Reporting the Results

The preliminary search yielded a total of 131 studies from various databases: PubMed (n = 36), EBSCO Host (n = 29), MEDLINE (n = 15), Google, and Google Scholar (n = 51). After a careful review, 45 duplicate records were removed, resulting in 86 articles for screening. Among these, 66 articles were deemed unrelated to the research objectives and were excluded, remaining 20 articles for full-text evaluation. The eligibility of these 20 articles was then assessed according to the established inclusion and exclusion standards. Following the assessment, 10 journal articles were considered for the present research. The PRISMA flow diagram in Figure 1 provides a visual representation of the screening procedure and the search outcome. Table 1 provides more information about the extracted data.

Figure 1.

PRISMA flow diagram: selection of included studies.

Table 1.

Extracted Data From Included Studies.

	Author(s), Year, and Study Location	Article title	Purpose of the study	Study design	Population	Samplesize	Outcome(s) of the study
1	Tharwat et al. (2023): Egypt	Acceptance and hesitancy to receive COVID-19 vaccine among university students in Egypt: a nationwide survey	The study sought to determine Egyptian university students’ intentions to obtain the COVID-19 vaccine and their knowledge, beliefs and attitudes toward the vaccination as well as the actual vaccination rates.	Cross-sectional	Students enrolled in different Egyptian universities	1,071	The COVID-19 vaccine’s acceptance rate was 69.0%, whereas reluctance and resistance were respectively 20.8% and 10.2%. Fear of contracting an infection (53.6%) and the need to resume routine life (51.0%) were the main motivators for vaccination acceptance, whereas fear of severe adverse effects was the main barrier to vaccination.
2	Berihun et al. (2022): Ethiopia	COVID-19 vaccine acceptance and associated factors among college students in Dessie City, Northeastern Ethiopia	To determine college students’ acceptance of vaccination for COVID-19 and related determinants in Dessie City, Northeastern Ethiopia.	Cross-sectional	College students	422	There was little COVID-19 vaccination acceptability among students. The past experience of chronic illness and vaccine uptake, instruction on COVID-19 vaccine, belief in the prevention of that COVID-19, and developing herd immunity, and the severity of infection were all elements that strongly correlated with vaccine acceptability.
3	Mustapha et al. (2021): Nigeria	Factors associated with acceptance of COVID-19 vaccine among University health sciences students in Northwest Nigeria	To ascertain the elements that influence COVID-19 vaccination adoption among students of health sciences in Northwest Nigeria.	Cross-sectional	Health students enrolled in some selected universities	440	A low percentage of health sciences students (40%) accepted the COVID-19 vaccination. Vaccine acceptability was correlated with older age, institutional mandate, government trust, and readiness to purchase the vaccine.
4	Wiafe (2021): Ghana	Knowledge, attitudes, and practices of university students toward COVID-19 and COVID-19 vaccination: The case of Ghana Institute of Journalism	To find out how the Ghana Institute of Journalism students feel about the COVID-19 vaccination and their awareness of it.	Cross-sectional	Undergraduate students at the Ghana Institute of Journalism	100	The barriers to vaccination intentions included things like vaccine center unawareness, negative side effects from vaccinations, and students’ perceived self-efficacy (18.5). Additionally, the study found that participants’ attitudes toward COVID-19 and idea to vaccinate were unaffected by their religious affiliation.
5	Obi et al. (2022): Nigeria	Willingness to accept COVID-19 vaccine and associated factors among university undergraduates in Southern Nigeria	The study assessed Southern Nigerian undergraduate students’ readiness to take the vaccine for COVID-19.	Cross-sectional	Undergraduate students	540	About 51.1% were unwilling to receive the vaccination. Acceptance of the COVID-19 vaccination was significantly influenced by the faculty of students and attitude toward the vaccine.
6	Kanyike et al. (2021): Uganda	Acceptance of the coronavirus disease- 2019 vaccine among medical students in Uganda	To assess the acceptance level of COVID-19 vaccination, hesitation, and associated factors among Ugandan medical students	Cross-sectional	Medical students	600	This study found that medical students had low rates of acceptability for the vaccine, low self-perception of COVID-19 dangers, and majority depended on social media for unfavorable information.
7	Saied et al. (2021): Egypt	Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students	To investigate the degree of COVID-19 vaccination reluctance and identify the determinants and barriers that may affect a person’s vaccination decision.	Cross-sectional	Medical students	2,133	About 90% of the students understood the significance of COVID-19 vaccination, 46% expressed immunization hesitation, and 6% either firmly accepted or rejected the vaccine. The majority of the pupils (96.2%) and teachers were concerned about the vaccine’s effectiveness and negative effects. The most often cited barrier to COVID-19 vaccination was lack of knowledge regarding the vaccine’s potential (74.17%) and actual (72.76%) negative effects.
8	Kerdoun et al. (2021): Algeria	COVID-19 vaccine hesitancy among Algerian medical students: a cross-sectional study in five universities	To investigate Algerian medical students’ attitude toward vaccination against SARS-CoV-2.	Cross-sectional	Medical students	383	The COVID-19 vaccination was not yet administered to 85.37% of respondents, who were split into three groups: those who accepted the vaccine (53.51%), those who were reluctant about receiving it (22.93%), and those who refused it (23.54%).
9	Aklil et al. (2022): Ethiopia	Willingness to receive COVID-19 vaccine and associated factors among college students in Gondar City, Northwest Ethiopia	Determining college students in northwest Ethiopia’s COVID-19 vaccine acceptance readiness and the factors that affect this decision.	Cross-sectional	College students	626	About 34.2% of the student reported being ready to take the COVID-19 vaccine. The reasons associated with the willingness included being married, third-year student, male, and having ever watched TV.
10	B. T. Taye et al. (2021): Ethiopia	Coronavirus disease 2019 vaccine acceptance and perceived barriers among university students in northeast Ethiopia: A cross-sectional study	To evaluate vaccine acceptability among Ethiopian university students, as well as related factors and perceived impediments.	Cross-sectional	University students	423	The acceptability level for the COVID-19 vaccination was 69.3%. The following were factors discovered to be linked with acceptability the vaccine: knowledge, being health science student, and family practice COVID-19 preventive techniques.

Results

Characteristics of Included Studies

All the studies included in this review were completed after the COVID-19 immunization programme had begun in the relevant country. The studies were quantitatively cross-sectional design, and the sample size ranged between 100 and 2,133, with a mean sample of 673.8. The mean age of participants in the included studies varied between 20.24 and 24.17 years. The majority (n = 3) of the research used in this analysis was carried out in Ethiopia. Two (2) studies came from Egypt; two (2) from Nigeria; and one (1) each from Ghana, Uganda, and Algeria. Participants were made up of undergraduate students from various African educational institutions. Four (4) studies were undertaken on university students, three (3) on medical students, two (2) on college students, and one (1) on students in health sciences. Detailed characteristics of participants in each study are included in Table 2:

Table 2.

Characteristics of Participants in Each Studies.

	Author(s), Year, and Study Location	Gender	Age range	Marital status	Level of education
1	Tharwat et al. (2023): Egypt	Males – 31.8% Females – 68.2%	Mean age 20.51	Single – 98.5% Married – 1.5%	Year 1 – 17% Year 2 & 3 – 53.6% Year 4 & more – 29.4%
2	Berihun et al. (2022): Ethiopia	Males – 40.5% Females 59.5%	18–20 years – 46.3% Above 20 years – 53.7%	Single – 78.6% Married – 21.4%	Year 1 – 26.4% Year 2 – 38.6% Year 3 and more – 35%
3	Mustapha et al. (2021): Nigeria	Female – 50.9% Male – 49.1%	Below 25 – 67.3% 25 above – 32.7	Single – 88% Married – 12%	Year 1 – 16.4% Year 2 – 14.1% Year 3 – 21.8% Year 4 – 20% Year 5 & 6 – 28.2%
4	Wiafe (2021): Ghana	Female – 42% Male – 58%	18–24 – 50% 25–29 – 50%		Year 2 – 27%Year 3 – 22%Year 4 – 51%
5	Obi et al. (2022): Nigeria	Female – 41.7%Male – 58.3%	15–19 – 28.5%20–24 – 58.1%25–29 – 12.2%30–34 – 1.2%	Single – 98.7Married – 1.3%	Year 1 – 16.5%Year 2 – 36.9%Year 3 – 25.2%Year 4 – 8.7%Year 5 & 6 – 12.7%
6	Kanyike et al. (2021): Uganda	Female – 37.2%Male – 62.8%	24 and below – 61.2%Above 24 – 38.8%	Single – 87.1%Married – 12.4Separated – 0.5%	Year 1 – 15.2%Year 2 – 13.5%Year 3 – 21.8%Year 4 – 26.2%Year 5 – 23.3%
7	Saied et al. (2021): Egypt	Female – 65.2%Male – 34.8%	Mean age – 20.24		Freshmen – 23.3%Sophomore – 31.7%Junior – 13%Senior – 28.3%Graduate 3.8%
8	Kerdoun et al. (2021): Algeria	Female – 80.7%Male – 19.3	Mean age 21.02		Junior students – 67.6%Senior students – 32.4%
9	Aklil et al. (2022): Ethiopia	Female – 55.9%Male – 44.1%	18–24 – 75.4%25 and above – 24.6%	Unmarried – 79.9Married – 20.1	Year 2 – 41.0%Year 3 – 53.2%Year 4 – 5.8%
10	B. T. Taye et al. (2021): Ethiopia	Female – 33.6Male – 66.4	Less than 25 – 57.925 and above – 42.1	Single – 72.1Married – 11.3In relationship – 16.5

Acceptability and Willingness to Use the COVID-19 Vaccination

Nine (9) of the synthesized papers discussed the students’ willingness to receive the vaccination (Aklil et al., 2022; Berihun et al., 2022; Kanyike et al., 2021; Kerdoun et al., 2021; Mustapha et al., 2021; Obi et al., 2022; Saied et al., 2021; B. T. Taye et al., 2021; Tharwat et al., 2023). The overall vaccine acceptability and willingness from the study ranged between 34.2% and 69%. In Egypt, Tharwat et al. (2023) evaluated university students’ intentions to take vaccinations and found the acceptability rate to be 69.0%. Similarly, Saied et al. (2021) found the acceptability among the sample to be 34.9%. Studies from Ethiopia reported willingness to received the vaccine among the students to be 56.2%, 95% CI [51.5, 60.9%] (Berihun et al., 2022), 34.2% (95% CI [30.9, 38.1]) (Aklil et al., 2022), and 69.3% (95% CI [65, 74]) (B. T. Taye et al., 2021). Obi et al. (2022) reported that less than 50% of the students expressed a willingness to get immunized in Nigeria. Forty (40%) of the student participants in the study of Mustapha et al. (2021) accepted to be vaccinated. Studies from Uganda and Algeria reported willingness and acceptable level to be 37.3% and 53.51%, respectively (Kanyike et al., 2021; Kerdoun et al., 2021).

Vaccination Hesitancy

Overall, the vaccination hesitancy rate from the synthesized studies varied from 20.8% to 50%. The study by Tharwat et al. (2023) in Egypt found out that 20.8% of university students had hesitated to take the COVID-19 vaccine. Nearly 43.8% (95% CI [39.1, 48.5]) of student in Ethiopia either hesitated or rejected vaccination (Berihun et al., 2022). According to Obi et al. (2022), 51.1% of the participants in Nigeria were unwilling to receive the vaccination. The majority (62.79%) of the participants in a study by Kanyike et al. (2021) concerning acceptability, reluctance, and correlated factors of COVID-19 immunization among medical students in Uganda did not consent to vaccination. Vaccine hesitant and refusal groups in a study conducted in Algeria accounted for 46.47% (Kerdoun et al., 2021).

Motivations and Determinants of COVID-19 Acceptance

Eight (8) studies reported on the variety of factors that increased vaccine uptake and willingness. Prevalent among them were fear of contracting an infection, a desire to resume normal life, and concern over spreading an infection to others (Mustapha et al., 2021; Saied et al., 2021; Tharwat et al., 2023). Additionally, herd immunity emergence, vaccination instructions, prior records of taking regular vaccines, COVID-19 severity, and belief that the virus can be prevented all had an impact on students’ inclination to obtain the COVID-19 vaccine (Berihun et al., 2022). Other factors include adequate information about the vaccine, religious/cultural belief, family support, where to get the vaccine, vaccine availability, protection of oneself and others, vaccine effectiveness, and no severe side effects (Kanyike et al., 2021; Kerdoun et al., 2021; Obi et al., 2022).

Mustapha et al. (2021) identified several factors connected to COVID-19 vaccination acceptance. These included ethnicity (OR, 1.68; 95% CI [1.13, 2.55]; p = .011), age 25 years and above (OR, 1.77; 95% CI [1.18, 2.65]; p = .006), being a student in the fourth year (OR, 2.12; 95% CI [1.10, 4.09]; p = .025) or a student in the sixth year (OR, 3.27; 95% CI [1.56, 6.87]; p = .002), report of a chronic condition (OR, 2.85; 95% CI [1.36, 5.95]; p = .005), infected with COVID-19 (OR, 4.18; 95% CI [1.71, 10.24], p = .002), readiness to get vaccinated if advised by institutional leaders (OR, 33.35; 95% CI [18.09, 61.49]; p < .001), readiness to purchase the vaccine if it’s not provided for free (OR, 23.39; 95% CI [9.83, 55.62]; p < .001), and confidence in how the government handles vaccine related concerns (OR, 50.82; 95% CI [23.62, 109.36]; p < .001).

According to Aklil et al. (2022), the alertness to receive vaccination for COVID-19 was considerably related to listening to the radio, watching TV, participants’ sex, living with family, maternal education, marital status, paternal education, knowledge and attitude. Furthermore, having knowledge (AOR: 2.43, CI [1.57, 3.77]), pursuing a degree in health science (AOR: 2.25, CI [1.43, 3.54]), and living in a household practicing COVID-19 preventive measures (AOR: 1.73, CI [1.06, 2.81]) were discovered to be elements linked to the uptake of COVID-19 vaccination (B. T. Taye et al., 2021).

Reasons/Barriers for Vaccine Hesitancy

Seven (7) of the studies discussed students’ perceived barriers to not getting the vaccine. Of these seven studies, five (5) cited fear of side effects and safety issues (Aklil et al., 2022; Kerdoun et al., 2021; Saied et al., 2021; B. T. Taye et al., 2021; Tharwat et al., 2023; Wiafe, 2021). Five (5) studies raised issues with the efficacy of vaccines and doubts about their ineffectiveness, which has resulted in widespread anxiety about receiving vaccinations (Aklil et al., 2022; Kerdoun et al., 2021; B. T. Taye et al., 2021; Tharwat et al., 2023; Wiafe, 2021). Insufficient information about vaccination safety was cited by three (3) different studies (Kerdoun et al., 2021; Saied et al., 2021; B. T. Taye et al., 2021), whereas negative information regarding the vaccine was identified in two (2) studies (Kanyike et al., 2021; Saied et al., 2021). Less common reasons were center awareness (Wiafe, 2021), concerns about safety (Kanyike et al., 2021), financial cost hindrance (Saied et al., 2021), insufficient trust in vaccine sources (Saied et al., 2021), and vaccines for only at-risk populations (B. T. Taye et al., 2021).

Source of Vaccine Information

The research explored the information sources on COVID-19 inoculation for students and discovered that five (5) of the studies reported on the information sources. Four (4) studies (Kanyike et al., 2021; Saied et al., 2021; Tharwat et al., 2023; Wiafe, 2021) highlighted the main source of information on the COVID-19 vaccine for students to be social media. Healthcare workers, the internet, and scientific websites as sources of information were identified in two studies (Saied et al., 2021; Tharwat et al., 2023). Additionally, two studies also reported that students received information from family/friends, television, and radio (Kanyike et al., 2021; Wiafe, 2021). Two other studies reported newspapers and magazines as additional sources of information for students; however, they were considered the least significant sources (Kanyike et al., 2021; Saied et al., 2021).

Discussion

Throughout history, vaccinations have proven to be the most effective means of combating rapidly spreading communicable diseases such as COVID-19 (Elhadi et al., 2021; Kaya et al., 2021). Vaccination is crucial for achieving herd immunity and controlling infectious diseases, especially COVID-19. However, in Africa, there are various challenges associated with this process, which are connected to personal, socio-cultural, economic, and political factors. The acceptance percentages in sub-Saharan African nations varied greatly, ranging from 28% in the Democratic Republic of Congo (DRC) to 92% in Ethiopia (Kanyanda et al., 2021; Oyekale, 2021). However, most studies conducted among university and school communities reported acceptance rates below 50% (Kanyike et al., 2021; Sahile et al., 2022). According to Tadele Admasu (2021) and Lamptey et al. (2021), acceptance was positively influenced by a higher perceived risk of COVID-19. Additionally, good knowledge, a positive attitude, and adherence to safe procedures were found to have a significant impact on vaccine acceptance (Abebe et al., 2021; E. B. Taye et al., 2022). Other research revealed that individuals with a previous history of COVID-19 showed a greater acceptance of vaccination (Adedeji-Adenola et al., 2022; Mustapha et al., 2021).

In developed countries, Ding et al. (2020) found that young people, such as university students, may not show symptoms or only have mild symptoms when infected with COVID-19. This could lead to a lower perception of risk and a decreased willingness to get vaccinated. Studies by Sharma et al. (2021) and Latkin et al. (2021) have shown high levels of vaccine reluctance among young adults aged 18 to 29, ranging from 47% to 60%. For example, a survey of university students in the USA found that 47.5% of respondents expressed unwillingness to get vaccinated (Sharma et al., 2021). Pastorino et al. (2021) also discovered that medical students, those who were more worried about COVID-19, and those who were more susceptible to the illness were more likely to intend to get vaccinated. Assessing the acceptance level of vaccination is important for implementing intervention and communication campaigns. This understanding is crucial for increasing public awareness, building confidence in vaccine effectiveness and safety, and ultimately reducing COVID-19 transmission (Habersaat et al., 2020; Weintraub et al., 2021). It is essential to grasp young people’s attitudes toward the COVID-19 vaccine in order to develop successful public health interventions, as they have higher rates of infection and hospitalization due to their presence in academic and social settings (Sandoval et al., 2021).

The reviewed studies primarily focused on university students due to the expectation that they would possess better information about COVID-19 and be ready to receive vaccination. In spite of this expectation, low vaccination acceptance rates were seen in this group in the studies reviewed. This is similar to a study conducted in Europe among first-degree nursing students (Patelarou et al., 2021). The synthesized results differed across research and populations. These findings are similar to Reiter et al. (2020), who discovered that 69% of the adult population in America accepted the vaccine, while 31% rejected inoculation. Again, research was carried out by Barello et al. (2020) among university students and 86.1% of the students were vaccine accepters; likewise in France, 35% of adults were categorized as vaccine hesitant (Detoc et al., 2020). A cross-sectional study conducted in the United Arab Emirates revealed the vaccination acceptance level to be 56.3% (Shahwan et al., 2022). Meanwhile, in Jordan, 30.4% of the respondents stated that their acceptance of vaccines is dependent on its availability (Al-Mistarehi et al., 2021). These discrepancies in vaccination acceptance and reluctance rates among the studies are likely caused by variations in geographical spread, demographic characteristics, distinct study periods, data gathering techniques, and cultural inequalities. Geographical spread is crucial in determining vaccination rates due to differences in healthcare accessibility, infrastructure, and governmental support (Wiysonge et al., 2022). The timing of studies can influence findings, as public perception and knowledge about vaccines can rapidly change due to new information, public health campaigns, or changes in the pandemic’s status. Early studies during the COVID-19 pandemic showed higher vaccine hesitancy, while later studies demonstrated increased acceptance as more information became available and vaccines proved effective (Lazarus et al., 2021). These variations impact individual health outcomes, public health strategies, healthcare systems, and societal health metrics. They hinder achieving herd immunity, increase the risk of outbreaks, strain healthcare resources, complicate public health campaigns, and affect mental health and academic performance. Addressing these variations through targeted interventions, equitable access, and effective communication strategies is crucial to improving vaccination rates and protecting public health.

Most commonly cited reasons for vaccination acceptance were the need to safeguard oneself, prevent transmission to others, adverse effects, resume normal life, trust and the conviction that vaccination is the greatest method of defense against COVID-19 spread and its associated complications. These findings align with a study by Manning et al. (2021). Other scientific research has recognized safety as a strong predictor of vaccination reluctance, along with the seriousness of the disease, cultural factors, and contextual influences (Sweileh, 2023). For both the general public and healthcare experts, safety and side effects were top priorities when choosing a vaccine (Yaqub et al., 2014). According to Karafillakis and Larson (2017), vaccine efficacy and safety were major determinants in decisions regarding vaccination among various nations. Risk perception of COVID-19 can directly influence an individual’s decision to receive vaccination (Kanyike et al., 2021). Public health experts can strengthen their campaign for vaccination acceptance among students by addressing concerns about vaccine safety and potential side effects. Acceptance of COVID-19 vaccines among university students in Africa has important clinical implications. It can reduce transmission rates, contribute to herd immunity, ensure academic continuity, and ease the burden on healthcare systems. It also offers psychosocial benefits, influences future health behaviors, and has positive economic impacts. By reducing hospitalization rates, it allows healthcare providers to focus on other critical health issues and maintain healthcare quality, which is particularly important in African countries with strained healthcare infrastructure. Promoting vaccine acceptance among this demographic is crucial for safeguarding public health and ensuring the resilience of educational and healthcare infrastructures.

According to Larson et al. (2014), inoculation rejection is not a constant occurrence, but instead a flexible, heterogeneous idea shaped by various socio-psychological, societal, and behavioral factors. The main reasons for vaccine reluctance in the current review included fear of adverse reactions, doubts about the effectiveness and safety of vaccines, suspicion, and limited information about the vaccine, and this was also confirmed in the findings of Guljaš et al. (2021) Additional research also revealed similar concerns by participants (Dror et al., 2020; Patelarou et al., 2021). Lucia et al. (2021) reported similar proportions of hesitation, with 89.2% expressing concern about adverse effects and 83.8% doubting the vaccine’s efficacy. It can be challenging to guarantee equal vaccine coverage across different demographic groups due to shifting public attitudes toward immunization over time and in reaction to disease outbreaks (Xiao et al., 2022). In 2021, Manning et al. reported a decreased percentage (7.1%) of hesitation to take vaccination among students, indicating a pressing need to address poor knowledge and misconceptions about the vaccine promptly. Vaccine reluctance poses a severe obstacle to the battle against COVID-19 (Rodríguez-Blanco et al., 2021). The pandemic’s high mortality rates make vaccination hesitancy a primary public health concern (Bedford et al., 2018). The study’s findings demonstrate that the bulk of those who refused to be vaccinated must be included in the widespread immunization process; otherwise, global attempts to provide free vaccines might not successfully stop the spread and mobility of COVID-19. Therefore, synthesizing and summarizing vaccine hesitancy among student populations can aid in formulating measures to reduce vaccination hesitation and create mass vaccination programmes. Healthcare providers should prioritize clear communication about vaccine safety, potential side effects, and the overall risk-benefit profile of COVID-19 vaccines. This will enhance public confidence and alleviate fears.

Unreliable sources of information can significantly impact students’ vaccination decisions and this can lead to higher transmission rates of COVID-19. Health-related information, including vaccine-related content, obtained from various sources, especially social media, has the potential to fuel vaccine indecision. Social media is identified as a key resource for accessing COVID-19 information (Abdelhafiz et al., 2020; Saqlain et al., 2020). Social media platforms allow users to publish news quickly and internationally without editorial control, which could result in the spread of false information. Through the use of vivid narratives and powerful imagery, social media can further amplify the dissemination of inaccurate information. According to Puri et al. (2020), the vast reach and quick information-sharing capabilities of social media contribute to its potential to influence large audiences. Continuous exposure to alarming and false narratives about vaccines can cause anxiety, stress, and confusion among university students. This psychological impact can negatively affect mental well-being, leading to decreased academic performance and overall quality of life (Zhou et al., 2020). Health institutions and public health professionals must ensure that information shared on future pandemics via various platforms is very informative to help reduce misconceptions regarding the uptake of vaccines. It is important to address misinformation through targeted public health communication, improved health literacy, and increased trust in healthcare systems. These actions are necessary to mitigate negative outcomes and promote a healthier future.

Conclusion

This scoping review highlights the factors that influence COVID-19 vaccine uptake among university students in Africa. It shows that vaccine acceptance and hesitancy are influenced by various determinants, including individual beliefs and knowledge, social influences, structural barriers, and cultural contexts. Understanding these factors is crucial for developing targeted public health interventions. Such interventions should include educational campaigns to combat misinformation, promote vaccine literacy, and involve trusted community leaders and peer influencers to build trust and acceptance. Future research should delve further into these determinants, using rigorous methodologies to capture the experiences of university students. By addressing barriers and leveraging facilitators, stakeholders can increase COVID-19 vaccination coverage among this demographic, contributing to broader public health goals and strengthening health systems in Africa against future pandemics. This review emphasizes the importance of adopting a comprehensive and inclusive approach to public health, considering the unique challenges and opportunities within African university settings that can help the health system.

Recommendation

It is essential to encourage students’ immunization against COVID-19, and this can be achieved through effective vaccination campaigns and health education initiatives. Medical professionals play a pivotal role in continuously raising awareness of the significance, vaccine efficiency and safety, particularly targeting groups who are more likely to get the disease. Health education among university students should include courses on vaccinations and preventive behaviors. Public health specialists should put in place organized efforts targeted at lowering vaccination resistance and promoting greater vaccination rates among students. They must increase public confidence and trust in health services in order to successfully lower COVID-19 vaccination resistance. By combining these efforts, a more informed and proactive approach can be created to combat the pandemic and protect the health of both students and the wider community. Thus, health professionals must implement vaccination policies and launch programs to raise public awareness of the advantages of vaccination. It is important for healthcare agencies to formulate targeted and efficient methods to increase overall vaccine acceptance and ensure equitable vaccine coverage among students. Furthermore, government websites and health organizations should increase their social media presence. Establishing collaborations with social networking sites can be a powerful tool to rapidly promote evidence-based public health strategies. Moreover, it is essential to ensure that mass media channels disseminate factual information in a manner consistent with procedures established by the WHO.

Limitation and Suggestion for Further Studies

Limited studies were included in the current study due to the limited databases searched and search strategies. Therefore, future studies should advance the searches into more databases to enable the discovery of many studies. Again, background characteristics like age, education, gender and socio-economics status were not analyzed in this scoping review due to its limited reportage across the studies. Future studies should focus on the background characteristics that could influence willingness and acceptability of vaccination. Since all of the studies were cross-sectional and quantitative, additional research should focus on qualitative investigations to acquire a deeper appreciation of the factors affecting students’ willingness and reluctance toward COVID-19 vaccination.

Footnotes

ORCID iD

Daniel Adom-Fynn

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, Daniel Adom-Fynn, upon reasonable request. To protect the confidentiality and privacy of participants, the data are not publicly available.

References

Abdelhafiz

A. S.

Mohammed

Ibrahim

M. E.

Ziady

H. H.

Alorabi

Ayyad

Sultan

E. A.

(2020). Knowledge, perceptions, and attitude of Egyptians towards the novel coronavirus disease (COVID-19). Journal of Community Health, 45, 881–890.

Abebe

Shitu

Mose

(2021). Understanding of COVID-19 vaccine knowledge, attitude, acceptance, and determinates of COVID-19 vaccine acceptance among adult population in Ethiopia. Infection and Drug Resistance, 14, 2015–2025.

Adedeji-Adenola

Olugbake

O. A.

Adeosun

S. A.

(2022). Factors influencing COVID-19 vaccine uptake among adults in Nigeria. PLoS One, 17(2), e0264371.

Africa CDC. (2022). COVID-19 vaccination updates. Africa CDC: https://africacdc.org/speech/talking-points-weekly-press-briefing-on-covid-19-in-africa-13-january-2022/

Aklil

M. B.

Temesgan

W. Z.

Gessesse

D. N.

Kassa

B. G.

Tiguh

A. E.

Kebede

A. A.

Ayalew

M. D.

Yismaw

A. E.

(2022). Willingness to receive COVID-19 vaccine and associated factors among college students in Gondar City, Northwest Ethiopia. Frontiers in Education, 7, 799301.

Al-Hazmi

(2016). Challenges presented by MERS coronavirus and SARS coronavirus to global health. Saudi Journal of Biological Sciences, 23(4), 507–511. https://doi.org/10.1016/j.sjbs.2016.02.019

Al-Mistarehi

A. H.

Kheirallah

K. A.

Yassin

Alomari

Aledrisi

M. K.

Bani Ata

E. M.

Hammad

N. H.

Khanfar

A. N.

Ibnian

A. M.

Khassawneh

B. Y.

(2021). Determinants of the willingness of the general population to get vaccinated against COVID-19 in a developing country. Clinical and Experimental Vaccine Research, 10(2), 171.

Arksey

O’Malley

. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32.

Seng

J. J. B.

Seah

S. S. Y.

Low

L. L.

(2021). COVID-19 vaccine hesitancy – a scoping review of literature in high-income countries. Vaccines, 9(8), 900.

10.

Barello

Nania

Dellafiore

Graffigna

Caruso

(2020). ‘Vaccine hesitancy’among university students in Italy during the COVID-19 pandemic. European Journal of Epidemiology, 35, 781–783.

11.

Bedford

Attwell

Danchin

Marshall

Corben

Leask

(2018). Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine, 36(44), 6556–6558.

12.

Berihun

Walle

Teshome

Berhanu

Derso

(2022). COVID-19 vaccine acceptance and associated factors among college students in Dessie city, northeastern Ethiopia. Journal of Multidisciplinary Healthcare, 15, 1735–1746.

13.

Dagan

Barda

Kepten

Miron

Perchik

Katz

M. A.

Hernán

M. A.

Lipsitch

Reis

Balicer

R. D.

(2021). BNT162b2 mRNA covid-19 vaccine in a nationwide mass vaccination setting. New England Journal of Medicine, 384(15), 1412–1423.

14.

de Bekker-Grob

E. W.

Veldwijk

Jonker

Donkers

Huisman

Buis

Swait

Lancsar

Witteman

C. L. M.

Bonsel

Bindels

. (2018). The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment. Vaccine, 36(11), 1467–1476.

15.

Detoc

Bruel

Frappe

Tardy

Botelho-Nevers

Gagneux-Brunon

(2020). Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine, 38(45), 7002–7006.

16.

Ding

del Pozo Cruz

Green

M. A.

Bauman

A. E.

(2020). Is the COVID-19 lockdown nudging people to be more active: A big data analysis. British Journal of Sports Medicine, 54(20), 1183–1184.

17.

Dror

A. A.

Eisenbach

Taiber

Morozov

N. G.

Mizrachi

Zigron

Srouji

Sela

(2020). Vaccine hesitancy: The next challenge in the fight against COVID-19. European Journal of Epidemiology, 35, 775–779.

18.

Dzinamarira

Nachipo

Phiri

Musuka

(2021). COVID-19 vaccine roll-out in South Africa and Zimbabwe: Urgent need to address community preparedness, fears and hesitancy. Vaccines, 9(3), 250.

19.

Elhadi

Alsoufi

Alhadi

Hmeida

Alshareea

Dokali

Abodabos

Alsadiq

Abdelkabir

Ashini

Shaban

Mohammed

Alghudban

Bureziza

Najah

Abdulrahman

Mshareb

Derwish

Shnfier

… Msherghi

(2021). Knowledge, attitude, and acceptance of healthcare workers and the public regarding the COVID-19 vaccine: A cross-sectional study. BMC Public Health, 21(1), 955.

20.

Guljaš

Bosnić

Salha

Berecki

Krivdić Dupan

Rudan

Majnarić Trtica

(2021). Lack of informations about COVID-19 vaccine: From implications to intervention for supporting public health communications in COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(11), 6141.

21.

Habersaat

K. B.

Betsch

Danchin

Sunstein

C. R.

Böhm

Falk

Brewer

N. T.

Omer

S. B.

Scherzer

Sah

Fischer

E. F.

Scheel

A. E.

Fancourt

Kitayama

Dubé

Leask

Dutta

MacDonald

N. E.

Temkina

… Butler

(2020). Ten considerations for effectively managing the COVID-19 transition. Nature Human Behaviour, 4(7), 677–687.

22.

Islam

M. S.

Kamal

A.-H. M.

Kabir

Southern

D. L.

Khan

S. H.

Hasan

S. M. M.

Sarkar

Sharif

M. O.

Pakpour

A. H.

Seale

(2021). COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PLOS ONE, 16(5), e0251605. https://doi.org/10.1371/journal.pone.0251605

23.

Kanyanda

Markhof

Wollburg

Zezza

(2021). Acceptance of COVID-19 vaccines in sub-Saharan Africa: Evidence from six national phone surveys. BMJ Open, 11(12), e055159.

24.

Kanyike

A. M.

Olum

Kajjimu

Ojilong

Akech

G. M.

Nassozi

D. R.

Agira

Wamala

N. K.

Asiimwe

Matovu

Nakimuli

A. B.

Lyavala

Kulwenza

Kiwumulo

Bongomin

(2021). Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda. Tropical Medicine and Health, 49(1), 37–11.

25.

Karafillakis

Larson

H. J.

(2017). The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations. Vaccine, 35(37), 4840–4850.

26.

Kaya

M. O.

Yakar

Pamukçu

Önalan

Akkoç

R. F.

Pi̇ri̇nçci̇

Gürsu

M. F.

(2021). Acceptability of a COVID-19 vaccine and role of knowledge, attitudes and beliefs on vaccination willingness among medical students. European Research Journal, 7(4), 417–424.

27.

Kerdoun

M. A.

Henni

A. H.

Yamoun

Rahmani

Kerdoun

R. M.

Elouar

(2021). COVID-19 vaccine hesitancy among Algerian medical students: A cross-sectional study in five universities. medRxiv.

28.

Lamptey

Serwaa

Appiah

A. B.

(2021). A nationwide survey of the potential acceptance and determinants of COVID-19 vaccines in Ghana. Clinical and Experimental Vaccine Research, 10(2), 183–190.

29.

Larson

H. J.

Jarrett

Eckersberger

Smith

D. M.

Paterson

(2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150–2159.

30.

Latkin

C. A.

Dayton

Konstantopoulos

Boodram

(2021). Trust in a COVID-19 vaccine in the US: A social-ecological perspective. Social Science & Medicine, 270, 113684.

31.

Lazarus

J. V.

Ratzan

S. C.

Palayew

Gostin

L. O.

Larson

H. J.

Rabin

Kimball

El-Mohandes

(2021). A global survey of potential acceptance of a COVID-19 vaccine. Natural Medicines, 27(2), 225–228.

32.

Lee

Rundle-Thiele

Wut

T. M.

(2022). Increasing seasonal influenza vaccination among university students: A systematic review of programs using a social marketing perspective. International Journal of Environmental Research and Public Health, 19(12), 7138.

33.

Lisy

Porritt

(2016). Narrative synthesis: Considerations and challenges. JBI Evidence Implementation, 14(4), 201.

34.

Lucia

V. C.

Kelekar

Afonso

N. M.

(2021). COVID-19 vaccine hesitancy among medical students. Journal of Public Health, 43(3), 445–449.

35.

Manning

M. L.

Gerolamo

A. M.

Marino

M. A.

Hanson-Zalot

M. E.

Pogorzelska-Maziarz

(2021). COVID-19 vaccination readiness among nurse faculty and student nurses. Nursing Outlook, 69(4), 565–573.

36.

Martínez-álvarez

Asencio-Cortés

Torres

J. F.

Gutiérrez-Avilés

Melgar-García

Pérez-Chacón

Rubio-Escudero

Riquelme

J. C.

Troncoso

(2020). Coronavirus optimization algorithm: A bioinspired metaheuristic based on the COVID-19 propagation model. Big Data, 8(4), 308–322.

37.

Mustapha

Lawal

B. K.

Sha’aban

Jatau

A. I.

Wada

A. S.

Bala

A. A.

Mustapha

Haruna

Musa

Ahmad

M. H.

Iliyasu

Muhammad

Mohammed

F. Z.

Ahmed

A. D.

Zainal

(2021). Factors associated with acceptance of COVID-19 vaccine among University health sciences students in Northwest Nigeria. PLoS One, 16(11), e0260672.

38.

Nagar

(2021). West Africa and Covid-19: a model for effective mitigation with limited resources. Harvard International Review. https://hir.harvard.edu/west-africa-and-covid-19-effective-mitigation-with-limited-resources/

39.

Ndwandwe

Wiysonge

C. S.

(2021). COVID-19 vaccines. Current Opinion in Immunology, 71, 111–116.

40.

Obi

A. I.

Nwankaegho

Ehinze

E. S.

Obadia

Tobin

Okoli

Enato

Osa

Obi

B., R. U

., (2022). Willingness to accept COVID-19 vaccine and associated factors among university undergraduates in Southern Nigeria. Journal of Infectious Diseases and Epidemiology, 8, 23333928221106269. https://doi.org/10.23937/2474-3658/1510278

41.

Oyekale

A. S.

(2021). Compliance indicators of COVID-19 prevention and vaccines hesitancy in Kenya: A random-effects endogenous probit model. Vaccines, 9(11), 1359.

42.

Pastorino

Villani

Mariani

Ricciardi

Graffigna

Boccia

(2021). Impact of COVID-19 pandemic on flu and COVID-19 vaccination intentions among university students. Vaccines, 9(2), 70.

43.

Patelarou

Galanis

Mechili

E. A.

Argyriadi

Argyriadis

Asimakopoulou

Brokaj

Bucaj

Carmona-Torres

J. M.

Cobo-Cuenca

A. I.

Doležel

Finotto

Jarošová

Kalokairinou

Mecugni

Pulomenaj

Saliaj

Sopjani

Zahaj

… Patelarou

(2021). Factors influencing nursing students’ intention to accept COVID-19 vaccination: A pooled analysis of seven European countries. Nurse Education Today, 104, 105010.

44.

Polack

F. P.

Thomas

S. J.

Kitchin

Absalon

Gurtman

Lockhart

Gruber

W. C.

(2020). Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine. New England Journal of Medicine, 383(27), 1577–2615.

45.

Puri

Coomes

E. A.

Haghbayan

Gunaratne

(2020). Social media and vaccine hesitancy: New updates for the era of COVID-19 and globalized infectious diseases. Human Vaccines & Immunotherapeutics, 16(11), 2586–2593.

46.

Reiter

P. L.

Pennell

M. L.

Katz

M. L.

(2020). Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine, 38(42), 6500–6507.

47.

Rodríguez-Blanco

Montero-Navarro

Botella-Rico

J. M.

Felipe-Gómez

A. J.

Sánchez-Más

Tuells

(2021). Willingness to be vaccinated against COVID-19 in Spain before the start of vaccination: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(10), 5272.

48.

Roy

D. N.

Hossen

M. M.

Biswas

Islam

Azam

M. S.

(2022). Prevalence of COVID-19 vaccine hesitancy in students: A global systematic review. F1000Research, 11, 928.

49.

Sahile

A. T.

Gizaw

G. D.

Mgutshini

Gebremariam

Z. M.

Bekele

G. E.

(2022). COVID-19 vaccine acceptance level in Ethiopia: A systematic review and meta-analysis. Canadian Journal of Infectious Diseases and Medical Microbiology, 2022, 2313367.

50.

Saied

S. M.

Saied

E. M.

Kabbash

I. A.

Abdo

S. A. E.

(2021). Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. Journal of Medical Virology, 93(7), 4280–4291.

51.

Salerno

Zhao

Prabhu Sankar

Salvatore

Fritsche

L. G.

Lee

Lisabeth

L. D.

Valley

T. S.

Mukherjee

(2021). Patterns of repeated diagnostic testing for COVID-19 in relation to patient characteristics and outcomes. Journal of internal medicine, 289(5), 726–737.

52.

Sandoval

Nguyen

D. T.

Vahidy

F. S.

Graviss

E. A.

(2021). Risk factors for severity of COVID-19 in hospital patients age 18–29 years. PLoS One, 16(7), e0255544.

53.

Saqlain

Munir

M. M.

Rehman

S. U.

Gulzar

Naz

Ahmed

Tahir

A. H.

Mashhood

(2020). Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: A cross-sectional survey from Pakistan. Journal of Hospital Infection, 105(3), 419–423.

54.

Schmid

Rauber

Betsch

Lidolt

Denker

M. L.

(2017). Barriers of influenza vaccination intention and behavior–a systematic review of influenza vaccine hesitancy, 2005–2016. PLoS One, 12(1), e0170550.

55.

Shahwan

Suliman

Abdulrahman Jairoun

Alkhoujah

Al-Hemyari

S. S.

Al-Tamimi

S. K.

Godman

Mothana

R. A.

(2022). Prevalence, knowledge and potential determinants of COVID-19 vaccine acceptability among university students in the United Arab Emirates: Findings and implications. Journal of Multidisciplinary Healthcare, 15, 81–92.

56.

Sharma

Batra

(2021). A theory-based analysis of COVID-19 vaccine hesitancy among African Americans in the United States: A recent evidence. Healthcare, 9(10), 1273.

57.

Solís Arce

J. S.

Warren

S. S.

Meriggi

N. F.

Scacco

McMurry

Voors

Syunyaev

Malik

A. A.

Aboutajdine

Adeojo

Anigo

Armand

Asad

Atyera

Augsburg

Awasthi

Ayesiga

G. E.

Bancalari

Björkman Nyqvist

Omer

S. B

. (2021). COVID-19 vaccine acceptance and hesitancy in low-and middle-income countries. Natural Medicines, 27(8), 1385–1394.

58.

Sweileh

(2023). Analyzing research trends and patterns on COVID-19 vaccine hesitancy: A bibliometric study from 2021 to 2022. Electronic Journal of General Medicine, 20(4), em500.

59.

Tadele Admasu

. (2021). Knowledge and proportion of COVID-19 vaccination and associated factors among cancer patients attending public hospitals of Addis Ababa, Ethiopia, 2021: A multicenter study. Infection and Drug Resistance, 14, 4865–4876.

60.

Taye

B. T.

Amogne

F. K.

Demisse

T. L.

Zerihun

M. S.

Kitaw

T. M.

Tiguh

A. E.

Mihret

M. S.

Kebede

A. A.

(2021). Coronavirus disease 2019 vaccine acceptance and perceived barriers among university students in northeast Ethiopia: A cross-sectional study. Clinical Epidemiology and Global Health, 12, 100848.

61.

Taye

E. B.

Taye

Z. W.

Muche

H. A.

Tsega

N. T.

Haile

T. T.

Tiguh

A. E.

(2022). COVID-19 vaccine acceptance and associated factors among women attending antenatal and postnatal cares in central Gondar Zone public hospitals, Northwest Ethiopia. Clinical Epidemiology and Global Health, 14, 100993.

62.

Tharwat

Saad

A. M.

Nassar

M. K.

Nassar

D. K.

(2023). Acceptance and hesitancy to receive COVID-19 vaccine among university students in Egypt: A nationwide survey. Tropical Medicine and Health, 51(1), 16.

63.

Truong

Bakshi

Wasim

Ahmad

Majid

(2022). What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis. Health Promotion International, 37(1), daab105.

64.

Wang

Jing

Lai

Zhang

Lyu

Knoll

M. D.

Fang

(2021). Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines, 9(3), 170. https://doi.org/10.3390/vaccines9030170

65.

Weintraub

R. L.

Subramanian

Karlage

Ahmad

Rosenberg

(2021). COVID-19 vaccine to vaccination: Why leaders must invest in delivery strategies now: Analysis describe lessons learned from past pandemics and vaccine campaigns about the path to successful vaccine delivery for COVID-19. Health Affairs, 40(1), 33–41.

66.

Westphaln

K. K.

Regoeczi

Masotya

Vazquez-Westphaln

Lounsbury

McDavid

Lee

Johnson

Ronis

S. D.

(2021). From Arksey and O’Malley and Beyond: Customizations to enhance a team-based, mixed approach to scoping review methodology. MethodsX, 8, 101375.

67.

Wiafe

(2021). Knowledge, attitudes, and practices of university students towards covid-19 and covid-19 vaccination: The case of Ghana Institute of Journalism [Doctoral dissertation, Ghana Institute of Journalism].

68.

Wiysonge

C. S.

Coulson

Pillay

Cooper

Groenewald

Essack

Parker

Houston

Simmonds

Jaca

Mutemwa

Katoto

P. D.

Rooyen

H. V.

(2022). Community-based case studies of vaccine hesitancy and the COVID-19 response in South Africa-study protocol. F1000Research, 11, 1514.

69.

World Health Organisation. (2022). Covid-19 transmission and protective measures. Retrieved February 4, 2023, from https://www.who.int/westernpacific/emergencies/covid-19/information/transmission-protective-measures

70.

Xiao

Cheung

J. K.

M. Y.

Cowling

B. J.

Liao

(2022). Temporal changes in factors associated with COVID-19 vaccine hesitancy and uptake among adults in Hong Kong: Serial cross-sectional surveys. The Lancet Regional Health–Western Pacific, 23, 100441.

71.

Yaqub

Castle-Clarke

Sevdalis

Chataway

(2014). Attitudes to vaccination: A critical review. Social Science & Medicine, 112, 1–11.

72.

Zhou

Liu

Xue

Yang

Tang

(2020). Mental health response to the COVID-19 outbreak in China. American Journal of Psychiatry, 177(7), 574–575.