COVID-19 vaccination acceptance and hesitancy in health and care workers and the general population: a systematic review and policy recommendations

Abstract Introduction: The COVID-19 pandemic challenged the scientific community to find and develop a vaccine to fight the disease. However, and despite the vaccines developed thus far, problems with achieving high vaccine coverages have emerged, even among high-risk groups such as health and care workers (HCW). The lack of experience with such extensive vaccination created knowledge gaps in health policy and multisector decisions worldwide. Objective: This systematic review aims to examine factors that influence HCW's adherence to COVID-19 vaccination and national policies to vaccinate the HCW and other target groups. Methods: Searches were performed in the PubMed, Embase, Scopus, CINAHL, Web of Science, Lilacs, and WHO databases, besides Google Scholar for grey literature. The eligibility criterion for inclusion was being a member of the HCW. Vaccination was the target intervention, and the COVID-19 pandemic was the context. Qualitative synthesis used a meta-aggregation approach. Results: Nineteen articles were included in the review , with study samples varying from 48 to 5,708 participants. Most of the evidence came from cross-sectional and qualitative studies. The main findings were related to vaccine hesitancy rather than acceptance. Factors associated with HCW vaccine hesitancy included subjective feelings such as safety concerns, related to rapid vaccine development, and insufficient testing. Non-adherence to vaccination by HCW can contribute to vaccine hesitancy in the general population. Countries have adopted few public policies to address this problem, and the main concern is whether to enforce vaccination and the extent to which measures are legal. Conclusion: Despite the large number of studies identified in the review, the quality of the evidence base remains weak. Skepticism, mistrust, and hesitancy toward vaccination are global issues that can jeopardize vaccination coverage. Governments need guidance to develop gender-specific policies to inform HCW and the public about the need to adhere to vaccination in the current and future pandemic scenarios.