Coronavirus Disease 2019 Vaccine Hesitancy and Acceptance among the Indian Population: A Systematic Review and Meta-analysis

Introduction: The disastrous impact of the coronavirus disease 2019 (COVID-19) pandemic worldwide necessitated the prompt development of vaccines to combat the situation; however, vaccination drives have been challenged by vaccine hesitancy among several communities across geographies. Understanding vaccine hesitancy and acceptance can help design appropriate vaccination strategies. With this background, a systematic review and meta-analysis were conducted to estimate the prevalence and assess the factors associated with vaccine hesitancy and acceptance among the Indian population. Methods: This systematic review is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The data were extracted from May 1, 2024, to May 30, 2024, using PubMed, Scopus, and DOAJ search engines. The keywords used in the search string are "COVID-19," "vaccine hesitancy," "vaccine acceptance," and "India." Finally, 26 articles were selected, and the included articles underwent a quality assessment with the help of the JBI-Checklist for cross-sectional studies. The pooled vaccine hesitancy and acceptance prevalence was estimated at a 95% confidence interval (CI) using a random effect model assuming potential heterogeneity. Analysis used Stata Now 18 SE (Stata Corp., College Station, TX, USA). Results: Of the 26 studies, 14 studies were conducted among healthcare workers, seven studies among the general population, two studies among pregnant women and one each among school children, parents, and socioeconomically disadvantaged people. The reported highest vaccine acceptance was 92.74% and 86.3%, and hesitancy was 60.8% and 50% among healthcare workers and the general population, respectively. Between the general population and healthcare workers, the estimated pooled prevalence of vaccine acceptance is 66.1% (95% CI: 53%-78%) and 65.9% (95% CI: 57%-74%), respectively. The estimated pooled prevalence of vaccine hesitancy is 33% (95% CI: 20%-46%) among the general population and 24% (95% CI: 11%-40%) among healthcare workers. With the random effect model, high heterogeneity was observed in both acceptance (I-2 >99%) and hesitancy (I2 >98%).Conclusion: A significant variation in the acceptability of the COVID-19 vaccine has been reported across different regions of India. Hence, future research is needed to enable comparability and generalizability, as the variations may also reflect differences in study designs, demographics, and time frames.