Reasons behind COVID-19 vaccine hesitancy and efficient strategies to address it

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This article was exclusively written for The European Sting by Mr. Olivier Sibomana, an enthusiastic and highly committed medical student at University of Rwanda (UR), college of medicine and health sciences, department of general medicine and surgery. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In December 2019, a new coronavirus was found in Wuhan city, China. Coronavirus Study Group of the International Committee on Taxonomy of Virus named the new virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and later, a disease caused by the virus was named coronavirus disease 2019 (COVID-19) by World Health Organization (WHO)[1].

COVID-19 spread in almost all countries of the world causing a large number of deaths. Strict measures such as intermittent lockdowns and social distancing have been taken and applied. Great effort and a huge amount of money was invested to develop a vaccine against COVID-19 [2] as vaccines are among the safest and most effective tools in infectious diseases control [3], and it has been found that few medical interventions compete with vaccines in infectious diseases control [4].

In the early time of the pandemic, a vaccine was just a hope, but after its availability, many people showed hesitancy about it [5]. Vaccine hesitancy is a global health issue that WHO declared as top 10 global health threats [6]. WHO Strategic Advisory Group of Experts (SAGE) defines vaccine hesitancy as a “delay in acceptance or refusal of vaccination despite the availability of vaccination services “ [7].

In this article, I will explain the main reasons behind COVID-19 vaccine hesitancy; the low rate of COVID-19 vaccine acceptance, and discuss some evidence-based strategies that can be used to reduce COVID-19 vaccine hesitancy and increase herd vaccination in the population.

Determinants of vaccine hesitancy have been recently explained by using the 3C model: confidence, competence, and convenience [8]. Confidence covers all issues on the safety of the vaccine, competence focuses on healthcare systems that deliver vaccines and competence of healthcare workers, and convenience measures the availability and affordability of vaccination services.

Mistrust of health authorities and doubt about the safety and efficacy of vaccines are the main reported reasons behind COVID-19 vaccine hesitancy [1]. A recent study in France showed that people were hesitant to COVID-19 vaccine because the vaccines were manufactured in an emergency and hence their safety is doubtful [9]. 

We must not forget political factors while explaining the reasons behind COVID-19 vaccine hesitancy. Many people started thinking about this, and their fear and mistrust of the government rose after many scientists questioned the approval of COVID-19 vaccines for emergency use by the US Food and Drug Authority (FDA) [10]. Rumors and misperceptions which were distributed on social media greatly increased this fear and mistrust of the government. One of these rumors said that the COVID-19 vaccine was manufactured and is going to be injected into people to track personal data [5]. This indicates the negative effects of social media and its role in increasing hesitancy on COVID-19 vaccines.

Although there is an increase in awareness of the importance of vaccines, vaccine hesitancy is increasing due to changes in scientific, social, cultural, spiritual, and media environments [11]. Social norms have been found to at a high-level influence COVID-19 vaccine acceptance. Due to their culture and social norms, many people refuse to be vaccinated and are susceptible to the infection. Religiosity also is among the reasons for COVID-19 vaccine hesitancy [12]. Some religions do not allow their believers to be vaccinated. 

This highlights the negative role played by culture, social norms, and religiosity in vaccine hesitancy.

Other reasons behind COVID-19 vaccine hesitancy include the low level of education and experience with past vaccination [7][13]. Uneducated people and those with a low level of education are observed to show a high level of vaccine hesitancy compared to highly-educated people. A variety of people had a bad experience with past vaccination while being vaccinated against other diseases besides COVID-19. Some people got such experience with the first dose of the COVID-19 vaccine. This caused them to refuse the further doses of the vaccine and full immunization was not achieved.

After understanding the main causes of COVID-19 vaccine hesitancy and its negative effects in a battle for eradication of the disease, it is understandable that effective strategies must be used to reduce the low rate of COVID-19 vaccine acceptance. The most effective strategies that can be used include education, public campaigns on awareness of the importance of the vaccine, and the use of social media to provide truthful information about the disease and the vaccines instead of rumors that cause fear and mistrust in the population.

Clinicians and health workers, in general, are thought to be the source of trusted health information. Therefore, the recommendation of the COVID-19 vaccine by the clinicians was reported to increase the rate of vaccine acceptance. In a recent study, many people declared that they would accept the vaccine if recommended by their clinicians [10]. These recommendations may build confidence in people and make them believe in the safety and efficacy of the vaccine.

Messaging systems also can be used as a strategy to reduce COVI-19 vaccine hesitancy and increase vaccine acceptance. Unified messages from medical providers [14] to individuals, especially parents, on the benefits of vaccines and the time of taking them for themselves and their children [15] can play a great role in making people understand how dreadful is COVID-19 and how important is accepting vaccines to build strong immunity against the disease.

Vaccination campaigns targeting precarious populations [16], and the public, in general, can help in increasing vaccine uptake and reducing hesitancy on the vaccine. Campaigns aiming at clarifying the social benefits of vaccination are believed to give observable good outcomes in increasing the rate of COVID-19 vaccine acceptance.

Even though social media was reported to be the source of rumors that make people fearful of vaccines and become hesitant, it can also be used to contradict these rumors and give accurate information about vaccines, especially the COVID-19 vaccine to the public. On the internet, more than 48,000 contents related to vaccines are produced every month [17]. This explains the impact of social media on increasing COVID-19 vaccine acceptance. Nowadays, many people are getting interested in getting information from the internet. Understandably, information including the importance of vaccines must be published at a high rate to satisfy the curiosity of many people who are still in a dilemma on whether to take the vaccine or not.

In conclusion, COVID-19 vaccine hesitancy is a great hindrance in implementing measures to fight against COVID-19. Lack of trust in health professionals and the government and doubt about the safety of vaccines have been the main causes of hesitancy on COVID-19 vaccines. Further research is recommended to know the real burden of vaccine hesitancy worldwide. Strategies such as education, campaigns, and publishing more information on vaccines have been found to play a great role in reducing vaccine hesitancy and increasing the rate of vaccine uptake. Deep surveys and research must be done to develop other applicable strategies that can be used to reduce COVID-19 vaccine hesitancy.  


[1]           G. Troiano and A. Nardi, “Vaccine hesitancy in the era of COVID-19,” Public Health, vol. 194. Elsevier B.V., pp. 245–251, May 01, 2021. doi: 10.1016/j.puhe.2021.02.025.

[2]           A. A. Dror et al., “Vaccine hesitancy: the next challenge in the fight against COVID-19,” European Journal of Epidemiology, vol. 35, no. 8, pp. 775–779, Aug. 2020, doi: 10.1007/s10654-020-00671-y.

[3]           B. Hickler, S. Guirguis, and R. Obregon, “Vaccine Special Issue on Vaccine Hesitancy,” Vaccine, vol. 33, no. 34. Elsevier Ltd, pp. 4155–4156, Aug. 14, 2015. doi: 10.1016/j.vaccine.2015.04.034.

[4]           A. Schuchat, “Human Vaccines and Their Importance to Public Health,” Procedia in Vaccinology, vol. 5, pp. 120–126, 2011, doi: 10.1016/j.provac.2011.10.008.

[5]           S. A. Nossier, “Vaccine hesitancy: the greatest threat to COVID-19 vaccination programs,” Journal of the Egyptian Public Health Association, vol. 96, no. 1, Dec. 2021, doi: 10.1186/s42506-021-00081-2.

[6]           C. Reno et al., “Enhancing covid-19 vaccines acceptance: results from a survey on vaccine hesitancy in northern Italy,” Vaccines (Basel), vol. 9, no. 4, Apr. 2021, doi: 10.3390/vaccines9040378.

[7]           S. Lane, N. E. MacDonald, M. Marti, and L. Dumolard, “Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017,” Vaccine, vol. 36, no. 26, pp. 3861–3867, Jun. 2018, doi: 10.1016/j.vaccine.2018.03.063.

[8]           E. O. Oduwole, E. D. Pienaar, H. Mahomed, and C. S. Wiysonge, “Current tools available for investigating vaccine hesitancy: A scoping review protocol,” BMJ Open, vol. 9, no. 12. BMJ Publishing Group, Dec. 11, 2019. doi: 10.1136/bmjopen-2019-033245.

[9]           V. C. Lucia, A. Kelekar, and N. M. Afonso, “COVID-19 vaccine hesitancy among medical students,” Journal of Public Health (United Kingdom), vol. 43, no. 3, pp. 445–449, Sep. 2021, doi: 10.1093/pubmed/fdaa230.

[10]        L. J. Finney Rutten et al., “Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy,” Mayo Clinic Proceedings, vol. 96, no. 3. Elsevier Ltd, pp. 699–707, Mar. 01, 2021. doi: 10.1016/j.mayocp.2020.12.024.

[11]        D. Kumar, R. Chandra, M. Mathur, S. Samdariya, and N. Kapoor, “Vaccine hesitancy: Understanding better to address better,” Israel Journal of Health Policy Research, vol. 5, no. 1, Feb. 2016, doi: 10.1186/s13584-016-0062-y.

[12]        M. Sallam, “Covid-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates,” Vaccines, vol. 9, no. 2. MDPI AG, pp. 1–15, Feb. 01, 2021. doi: 10.3390/vaccines9020160.

[13]        C. Jarrett et al., “Strategies for addressing vaccine hesitancy – A systematic review,” Vaccine, vol. 33, no. 34. Elsevier Ltd, pp. 4180–4190, Aug. 14, 2015. doi: 10.1016/j.vaccine.2015.04.040.

[14]        D. Callender, “Vaccine hesitancy: More than a movement,” Human Vaccines and Immunotherapeutics, vol. 12, no. 9. Taylor and Francis Inc., pp. 2464–2468, Sep. 01, 2016. doi: 10.1080/21645515.2016.1178434.

[15]        M. Siddiqui, D. A. Salmon, and S. B. Omer, “Epidemiology of vaccine hesitancy in the United States,” Human Vaccines and Immunotherapeutics, vol. 9, no. 12. pp. 2643–2648, Dec. 2013. doi: 10.4161/hv.27243.

[16]        C. Fokoun, “Strategies implemented to address vaccine hesitancy in France: A review article,” Human Vaccines and Immunotherapeutics, vol. 14, no. 7. Taylor and Francis Inc., pp. 1580–1590, Jul. 03, 2018. doi: 10.1080/21645515.2018.1458807.

[17]        N. E. MacDonald et al., “Vaccine hesitancy: Definition, scope and determinants,” Vaccine, vol. 33, no. 34, pp. 4161–4164, Aug. 2015, doi: 10.1016/j.vaccine.2015.04.036.

About the author

Olivier SIBOMANA is an enthusiastic and highly committed medical student at University of Rwanda (UR), college of medicine and health sciences, department of general medicine and surgery. He is a Rwandan active member of Medical Students’ Association of Rwanda (MEDSAR), serving in the standing committee on public health (SCOPH). Olivier is interested in medicine and global health, makes advocacy on public health issues, and does research that focus on infectious and tropical diseases.


  1. IZERE Josiane says:

    True indeed!

  2. MUNYUZANGABO Ephurem says:

    Thoughtfully prepared!
    Of course doing more surveys and research would be one of the ways to know about Covid-19 hesitance, as well as giving the best strategies to handle the case. Thanks dear colleague.

  3. MBONIMANA Justin says:

    Be courageous Dr Olivier. Your deeds will not only make positive changes but also brings great influence in advanced health services.


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