METHODOLOGICAL INSIGHTS INTO VACCINE HESITANCY RESEARCH IN RESPIRATORY DISEASES IN ADULTS AT-RISK: SYSTEMATIC REVIEW
Author(s)
Farley Gonzalez, MD, MSc1, Juan M. Reyes, MSc2, Carlos Bello, MSc1, Jair A. Arciniegas, MSc2, Jhon E. Bolaños, MSc, MD1, Andreina J. Alamo, BSc2, Mónica García, MSc2, Omar Escobar, MD2, Maria Gabriela Abalos, MD3, Jorge LaRotta, MD2, Jose Oñate, MD1, Carlos F. Mendoza, PhD4;
1SURA, Medellín, Colombia, 2Pfizer SAS, Bogotá, Colombia, 3Pfizer, Buenos Aires, Argentina, 4Pfizer, Mexico City, Mexico
1SURA, Medellín, Colombia, 2Pfizer SAS, Bogotá, Colombia, 3Pfizer, Buenos Aires, Argentina, 4Pfizer, Mexico City, Mexico
OBJECTIVES: To describe frameworks for influenza, COVID-19, or pneumococcal disease vaccine hesitancy (vaccine acceptance) among moderate and high-risk adults and the main hesitancy drivers.
METHODS: We conducted a systematic literature review following PRISMA guidelines using Medline and Embase on December 12, 2025, based on the MeSH, Emtree and free-text terms for hesitancy/acceptance and on the risk factors for influenza, COVID-19, and pneumococcal disease, by extracting frameworks, number of items, sample size, and main drivers, among others. The AXIS tool was employed to assess the quality of studies. Descriptive statistics were generated to summarize key findings about hesitancy/acceptance.
RESULTS: Among the 1,490 records reviewed, 63 studies met inclusion criteria. Over half originated from Europe and the USA, with most focused-on COVID-19 (>70%) using mainly cross-sectional designs. About one third did not report on their measurement framework, while 33% used the World Health Organization SAGE (Strategic Advisory Group of Experts on Immunization) framework (three c’s: Complacency, Convenience, Confidence). Other frameworks were less common (<10% each) like the Protection Motivation Theory, Health Belief Model, Theory of Planned Behavior, Necessity Concerns Framework, or the BASNEF model. Frequently analyzed drivers included medical history, confidence, previous knowledge about vaccination, age and gender, income or socioeconomic status, perceptions about safety , educational attainment, occupational status, and region. The hesitancy/acceptance definition was heterogeneous. Fewer than 40% of studies reported psychometric properties. Notably, SAGE studies varied from 2 to 23 in the number of items.
CONCLUSIONS: The SAGE framework was the most applied, as used to investigate hesitancy/acceptance in COVID-19 vaccination. Within this framework, different numbers of items have been used to capture the phenomenon. The highly heterogeneous main drivers range from demographical and clinical characteristics to specific traits related to vaccination knowledge and beliefs. Nonetheless, SAGE framework adaptability to emerging economies must be assessed.
METHODS: We conducted a systematic literature review following PRISMA guidelines using Medline and Embase on December 12, 2025, based on the MeSH, Emtree and free-text terms for hesitancy/acceptance and on the risk factors for influenza, COVID-19, and pneumococcal disease, by extracting frameworks, number of items, sample size, and main drivers, among others. The AXIS tool was employed to assess the quality of studies. Descriptive statistics were generated to summarize key findings about hesitancy/acceptance.
RESULTS: Among the 1,490 records reviewed, 63 studies met inclusion criteria. Over half originated from Europe and the USA, with most focused-on COVID-19 (>70%) using mainly cross-sectional designs. About one third did not report on their measurement framework, while 33% used the World Health Organization SAGE (Strategic Advisory Group of Experts on Immunization) framework (three c’s: Complacency, Convenience, Confidence). Other frameworks were less common (<10% each) like the Protection Motivation Theory, Health Belief Model, Theory of Planned Behavior, Necessity Concerns Framework, or the BASNEF model. Frequently analyzed drivers included medical history, confidence, previous knowledge about vaccination, age and gender, income or socioeconomic status, perceptions about safety , educational attainment, occupational status, and region. The hesitancy/acceptance definition was heterogeneous. Fewer than 40% of studies reported psychometric properties. Notably, SAGE studies varied from 2 to 23 in the number of items.
CONCLUSIONS: The SAGE framework was the most applied, as used to investigate hesitancy/acceptance in COVID-19 vaccination. Within this framework, different numbers of items have been used to capture the phenomenon. The highly heterogeneous main drivers range from demographical and clinical characteristics to specific traits related to vaccination knowledge and beliefs. Nonetheless, SAGE framework adaptability to emerging economies must be assessed.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
SA47
Topic
Study Approaches
Topic Subcategory
Literature Review & Synthesis, Surveys & Expert Panels
Disease
STA: Vaccines