Prevalence of COVID-19 vaccine hesitancy in South Asia: a systematic review and meta-analysis

Vaccine uptake and coverage in susceptible populations are needed through effective vaccination campaigns to address the COVID-19 pandemic in South Asian countries. We aimed to measure the pooled proportion of COVID-19 vaccine hesitancy in this regard. Research articles published between January 1, 2020, to December 31, 2021, were searched through Medline, PubMed, Cochrane, Google Scholar, and the WHO COVID-19 database. The Joanna Briggs Institute (2014) tool for prevalence studies was used to assess data quality. We performed a meta-regression test and a sensitive analysis among the studies and used the DerSimonian and Laird random-effects model to measure the pooled effect estimates. Subgroup analyses were performed concerning vaccine hesitancy, countries, study population, study level, and the time since the first outbreak of the pandemic. A total of 43 studies out of 598 published articles across the eight countries in South Asia were included. The pooled proportion of COVID-19 vaccine hesitancy was 26.5% (95% CI [22, 31], I2 = 99.59%). Vaccine hesitancy was higher in Afghanistan (37%), Pakistan (33%), and Bangladesh (28.9%); among the general population (29%); at community levels (27.9%); and the duration of time of 1–12 months since the first outbreak in each country (27.5%). Vaccine hesitancy exists in South Asia with different rates among countries, population sub-groups, communities, study-levels, duration of time since the first outbreak, and study population. Therefore, enhancing public awareness of vaccination and vaccine hesitancy is required to prevent future pandemics.