Refusing or Accepting the COVID -19 Vaccine in Iranian Society: A Systematic Review

Document Type : Systematic Review


1 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 MSc Student of Health Education and Promotion, Yasuj University of Medical Sciences, Yasuj, Iran.

3 Associate Professor of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.

4 Professor of Health Education and Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.



Background: The successful implementation of the vaccination program against COVID-19 is not limited to the efficiency and effectiveness of the vaccine but also requires public trust and acceptance of the target population. This study aims to review the factors associated with COVID-19 vaccination acceptance/refusal in Iranian society.
Materials and Methods: In this systematic review, online databases Medline, EMBASE, EMBASE, CINAHL, Web of Science, Scopus, and WHO database were searched for studies on the acceptance/refusal of the COVID-19 vaccine and related factors from 1 December 2019 through 1 January 2023. Two authors undertook screening selection independently, data extraction, and quality assessment (using the STROBE scale).
Results: The COVID-19 vaccine acceptance rate ranged from 64.2% to 83.6%. Various determinants at the individual (fear of short-term side effects of vaccines, personality traits, and distrust of vaccines and pharmaceutical companies), socio-cultural (conspiracy theory, social learning, misconceptions about COVID-19, and fatalism), and legal-managerial levels (incomplete information, difficult and irregular access to vaccination centers, lack of restrictions and compulsion to be vaccinated, and lack of incentives to be vaccinated) were involved in refusing the injection of the COVID-19 vaccine. Higher education level, older age, male gender, marital status, having chronic diseases or being already infected with 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 based on individual, social, legal-managerial, and vaccination factors, as well as informing people about its benefits, should be a priority for health providers. Older age, gender, marital status, education level, and comorbidities were associated with better vaccine acceptance in individuals.