Background: The successful implementation of the COVID-19 vaccination program depends not only on the efficiency and effectiveness of the vaccine but also on public trust and acceptance among the target population. This study aims to review the factors associated with the acceptance and refusal of COVID-19 vaccination in Iranian society.
Materials and Methods: In this systematic review, the online databases Medline, EMBASE, CINAHL, Web of Science, Scopus, and the WHO database were searched for studies on the acceptance and refusal of the COVID-19 vaccine and related factors from December 1, 2019, through January 1, 2023. Two authors independently undertook the screening selection, data extraction, and quality assessment using the STROBE scale.
Results: The acceptance rate for the COVID-19 vaccine ranged from 64.2% to 83.6%. Various determinants influenced the refusal of the COVID-19 vaccine at individual, socio-cultural, and legal-managerial levels. Individual factors included fear of short-term side effects, personality traits, and distrust of vaccines and pharmaceutical companies. Socio-cultural determinants encompassed conspiracy theories, social learning, misconceptions about COVID-19, and fatalism. Legal-managerial factors involved incomplete information, difficult and irregular access to vaccination centers, a lack of restrictions or mandates for vaccination, and insufficient incentives to receive the vaccine. Additionally, higher education levels, older age, male gender, marital status, having chronic diseases or a history of severe COVID-19 infection, as well as respect for the rights of others, were associated with better acceptance of vaccination (p < 0.05).
Conclusion: Removing barriers to vaccination related to individual, social, legal-managerial, and vaccination factors, as well as informing people about its benefits, should be a priority for health providers. Factors such as older age, gender, marital status, education level, and comorbidities were associated with higher vaccine acceptance among individuals.