covid vacines

This minireview provides a summary of the main findings, features, as well as limitations and gaps in the current epidemiologic research on COVID-19 vaccine hesitancy (VH) in Pakistani population. For this purpose, data on VH studies were extracted from January 2020 to October 2021, using a systematic review and meta-analysis approach. Literature review and other narrative studies were excluded. There exists a significant heterogeneity in the reported vaccine hesitancy in the population (pooled estimates from random-effects meta-analysis: 35% (95% CI, 28–43%). However, none of the co-variables included in the studies explained the observed variance/heterogeneity in the moderator analysis models. In this minireview and critical appraisal of current VH research, we conclude that an in-depth analysis of COVID-19 vaccine hesitancy in a representative sample of Pakistani population is crucial to measure the magnitude of VH as well to explore and identify the determinants of VH in Pakistani population. This is an important step toward informing intervention and policy design and to address this issue at its root cause. To this end, focused, methodologically robust and hypothesis-driven VH research is needed using a wide range of co-variables to support a detailed coverage of the individual and environmental level VH attributes.

The COVID-19 pandemic witnessed a surge in community health research (CHR) in Pakistan on a range of topics concerning the infection, its spread, and the potential implications for health policy and interventions. Early research focused on exploring knowledge, attitudes, and practices pertaining to prescribed preventive measures and estimation of the changing burden of COVID-19 infections in the population. After the arrival of COVID-19 vaccine, the discourse, however, shifted toward the uptake and hesitancy of vaccine in the Pakistani population. Vaccine hesitancy (VH), as defined by the WHO, is a complex and context-specific concept revolving around three main pillars: complacency, confidence, and convenience. VH is not a novice concept in Pakistan's healthcare landscape; therefore, considering the historic polio vaccination challenges, the number of CHR studies exploring COVID-19 vaccine hesitancy and acceptance, and the effect of the government's vaccine mandate in Pakistan has risen exceedingly.

Vaccine hesitancy-community health research bears implications on much larger levels including public health measures, future research directions, and policy design and implementation. VH-CHR serves three major goals: (1) measures the magnitude of the VH issue, (2) explores and identifies the determinants of the VH issue, and (3) offers an action-oriented narrative, cognizant of the rich context and features of VH in the population, to inform public health messaging, interventions, prospective research, policy design, and implementation (1–3). We suggest that the existing VH-CHR in Pakistan falls short of all the three goals, and despite the increasing number, the overall findings from individual VH studies remain inconclusive, especially in estimating (1) VH magnitude across different population subgroups, (2) determinants of different VH proportions across subgroups (e.g., small vs. large provinces), and (3) influential features and areas for a long-term action plan.

To capture a holistic account of the published VH-CHR in Pakistan, a total of 323 studies were extracted using the systematic review and meta-analysis approach, starting from January 2020 to October 2021. Of the 323 studies on COVID-19 vaccination, 72 were selected for abstract screening, 19 for full-text screening, yielding 10 eligible studies (i.e., original epidemiologic research articles) that addressed VH in Pakistani populations including 9 cross-sectional survey studies (4–12) and 1 quasi experiment-based study (13). One of the eligible studies did not report VH proportion as their primary outcome and was excluded from quantitative analysis. Assuming a significant level of heterogeneity across the studies, a random-effects meta-analysis (RMA) model was used to summarize the findings of the included studies.