Prevalence of COVID-19 vaccine hesitancy in students: A global systematic review

Background: Examining the prevalence of coronavirus disease (COVID-19) vaccine hesitancy and understanding what motivates students to accept or reject a newly promoted vaccine has the potential in preventing rapid spread of infection and optimizing country-wide mass vaccination programs. This systematic review aimed to examine global COVID-19 vaccine hesitancy among students, and to identify an up-to-date and concise assessment of most common factors influencing vaccine acceptance and hesitancy around the world. Methods: A systematic search of peer-reviewed literatures indexed in reputable databases was performed. After obtaining the results via screening using PRISMA flow diagram, a total of 35 articles met the inclusion criteria and formed the basic structure of the study objectives. Results: The results revealed that, the worldwide pooled COVID-19 vaccine hesitancy rate was (x?%)=29.8% (95% CI 23.37–36.23) among students. According to the country count assessment, the pooled vaccine hesitancy has been found to be ups and downs across the countries around the world such as (x?%)=32% (95% CI 20.04–43.97) in Asia, (x?%)=(28.11%, 95% CI 18.83–37.40) in the United States, (x?%)=15.59% (95% CI 8.23–22.95) in Europe, (x?%)=55.93% (95% CI 40.31–71.55) in Africa, (x?%)=20.4% in North America, and (x?%)=22.5% in multi-ethnic areas in the reported student’s COVID-19 vaccine hesitancy. In total, 10 key factors were identified. Side effect” 45.41% (95% CI 29.68–61.14), safety” 42.27% (95% CI 27.50–57.04), and trust” 44.95%, (95% CI 26.51–63.39) were the overarching concerns in making students' vaccination decisions. Conclusions: The prevalence of COVID-19 vaccine hesitancy varied among the students; however, vaccine acceptance or refusal relies on several socio-psychological, societal, and vaccine related factors. This study helps the vaccine policy-makers and health stakeholders gain a better understanding of COVID-19 vaccination drive and design the vaccine promotion strategies. Health educational interventions could be the most preferred approach to improve student’s adherence and knowledge about the COVID-19 vaccination consequences.