The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 Countries: A multicenter cross-sectional study

Mehrdad Askarian, Aleksandr Semenov, Ferran Llopis, Francesca Rubulotta, Gorana Dragovac, Natalia Pshenichnaya, Ojan Assadian, Yvon Ruch, Zahra Shayan, Cristobal Padilla Fortunatti, Daniel Lucey, Abdullah Almohaizeie, Abu Hena Mostafa Kamal, Adenike Ogunshe, Aidos Konkayev, Asim Beg, Enzo Primerano, Fatma Amer, Hema Prakash Kumari Pilli, Ivan HungFolusakin Ayoade, Jean Yves Lefrant, Joanna Zajkowska, Jordi Rello, Momin Kazi, Mohammad Hossein Taghrir, Stijn Blot, Stephen Leib, Parisa Hosseinpour, Hamidreza Hosseinpour, Amirhossein Erfani, Roham Borazjani, Hossein Akbarialiabad, Masoud Najafi, Ardalan Askarian, Hakan Erdem

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19 Citations (Scopus)


The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While ‘Perceived benefits of the COVID-19 vaccination’ (OR: 3.82, p-value<0.001) and ‘Prosocial norms’ (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, ‘The vaccine safety/cost concerns’ with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine.
Original languageEnglish
Pages (from-to)93-103
Number of pages11
JournalEXCLI Journal
Publication statusPublished - 3 Jan 2022


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