The Impact of National Income and Vaccine Hesitancy on Country-Level COVID-19 Vaccine Uptake
Javad Moradpour, Ali Shajarizadeh, Jasmine Carter, Ayman Chit, Paul Grootendorst
Background: The rapid development and rollout of COVID-19 vaccines helped reduce the pandemic’s mortality burden. The vaccine rollout, however, has been uneven; it is well known that vaccination rates tend to be lower in lower income countries. Vaccine uptake, however, ultimately depends on the willingness of individuals to get vaccinated. We investigated the impact on country-level COVID-19 vaccination rates of both national income and vaccine hesitancy.
Methods: We estimated linear regression models of COVID-19 vaccine uptake across 147 countries. Vaccine uptake reflects the percentage of the population that had completed their primary vaccination series. Covariates include per capita GDP, and an estimate of the percentage of country residents who strongly disagreed that vaccines are safe. We estimated this model at each of four time points: 6, 12, 18, and 24 months after the onset of global vaccine distribution. Next, we estimated these models by time point and by country income quintile (bottom 40% and top 40%) to examine whether the impact of vaccine hesitancy varies by country income.
Results: We find that GDP per capita has a pronounced impact on vaccine uptake starting at 6 months after global rollout. After controlling for hesitancy and other factors, there was a 23% difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by per capita GDP; this difference grew to 39% by 12 months. The deleterious impact of vaccine hesitancy on vaccine uptake became apparent by 12 months and then increased over time. At 24 months, there was a 20% difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by hesitancy. The income stratified models reveal that the deleterious impact of vaccine hesitancy on vaccine uptake is limited to lower income countries; hesitancy had only small effects on vaccination rates in higher income countries.
Conclusions: Our study highlights the crucial role of both national income and vaccine hesitancy in determining COVID-19 vaccine uptake globally. There is a need to increase the supply and distribution of pandemic vaccines to low-income countries, and to take measures to improve vaccine confidence in these countries.
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Paper Keywords
COVID-19, Vaccination, Global rollout, Vaccine hesitancy, Equity