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Background <p>COVID-19 vaccination hesitancy is antithetical to preventing communicable disease. The study’s aim was to determine social ecological factors associated with vaccination acceptance / intent in select developing countries.</p> Methods <p>To examine vaccine acceptance / intent in fifteen developing countries, data was sourced from the Global COVID-19 Trends and Impacts Survey and analyzed with a multi-level, clustered, cross-sectional design. Weighted Generalized Additive Modeling (GAM) with 1,000 stratified cluster bootstraps mitigated intra-cluster correlation and temporal dependencies.</p> Results <p>Statistically significant linear variables included those age 55 + (OR = 1.204, 95% CI [1.095, 1.324], <i>p</i> &lt; 0.001) and identification as female (OR = 1.538, 95% CI [1.448, 1.630], <i>p</i> &lt; 0.001), which were responsible for increased odds of vaccine acceptance / intent. Percent Fear of Vaccine Side Effects (EDF = 2.50, <i>p</i> &lt; 0.001) demonstrated a nonlinear decline in vaccine acceptance / intent. Time (Month) (EDF = 1.94, <i>p</i> &lt; 0.001) was associated with a concave parabolic trend. Cultural Principal Components (PCs) 1–3, respectively, (EDF = 3.97, <i>p</i> &lt; 0.001). EDF = 4.87, <i>p</i> &lt; 0.001), and (EDF = 4.95, <i>p</i> &lt; 0.001) demonstrated oscillating patterns of vaccine acceptance / intent depending upon cultural score direction and magnitude. All PCs demonstrated lower levels of vaccination acceptance / intent with no definitive cultural leaning. There was, however, a push-pull effect among all three dimensions, demonstrating PCs either drove or suppressed vaccination acceptance / intent.</p> Conclusions <p>Vaccine decision-making complexities are associated with cultural and individual influences. Such findings could inform future vaccine campaign strategies.</p>

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Uncovering COVID-19 vaccine acceptance and intent in 15 developing countries: a multi-level, clustered analysis of six months of repeated, cross-sectional data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月19日

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  • Cristina A. Smith,
  • Daniel Handysides,
  • Alan Cupino,
  • Anna Nelson,
  • W. Lawrence Beeson

摘要

Background

COVID-19 vaccination hesitancy is antithetical to preventing communicable disease. The study’s aim was to determine social ecological factors associated with vaccination acceptance / intent in select developing countries.

Methods

To examine vaccine acceptance / intent in fifteen developing countries, data was sourced from the Global COVID-19 Trends and Impacts Survey and analyzed with a multi-level, clustered, cross-sectional design. Weighted Generalized Additive Modeling (GAM) with 1,000 stratified cluster bootstraps mitigated intra-cluster correlation and temporal dependencies.

Results

Statistically significant linear variables included those age 55 + (OR = 1.204, 95% CI [1.095, 1.324], p < 0.001) and identification as female (OR = 1.538, 95% CI [1.448, 1.630], p < 0.001), which were responsible for increased odds of vaccine acceptance / intent. Percent Fear of Vaccine Side Effects (EDF = 2.50, p < 0.001) demonstrated a nonlinear decline in vaccine acceptance / intent. Time (Month) (EDF = 1.94, p < 0.001) was associated with a concave parabolic trend. Cultural Principal Components (PCs) 1–3, respectively, (EDF = 3.97, p < 0.001). EDF = 4.87, p < 0.001), and (EDF = 4.95, p < 0.001) demonstrated oscillating patterns of vaccine acceptance / intent depending upon cultural score direction and magnitude. All PCs demonstrated lower levels of vaccination acceptance / intent with no definitive cultural leaning. There was, however, a push-pull effect among all three dimensions, demonstrating PCs either drove or suppressed vaccination acceptance / intent.

Conclusions

Vaccine decision-making complexities are associated with cultural and individual influences. Such findings could inform future vaccine campaign strategies.