Vaccine Hesitancy in Low- and Middle-Income Countries: Determinants and Interventions

Irakoze Mukamana S.

School of Applied Health Sciences Kampala International University Uganda

                                                                   ABSTRACT
Vaccine hesitancy remains a significant barrier to achieving optimal immunization coverage in low- and middleincome countries (LMICs), despite the proven effectiveness of vaccines in reducing morbidity and mortality from vaccine-preventable diseases. This meta-synthesis examines the determinants of vaccine hesitancy and evaluates evidence-based interventions aimed at improving vaccine acceptance in LMIC settings. The review draws on studies published between 2011 and 2021 and identifies multi-level factors influencing vaccination decisions, including individual beliefs, sociocultural norms, health system constraints, structural barriers, and misinformation within the information environment. Key determinants include concerns about vaccine safety and side effects, distrust in health authorities, limited health literacy, poor access to vaccination services, and the influence of social networks and community perceptions. At the system level, issues such as inadequate service delivery, long waiting times, vaccine shortages, and financial or geographic barriers further exacerbate hesitancy. Misinformation, particularly through social media and informal networks, significantly undermines vaccine confidence. The synthesis also highlights intervention strategies such as community engagement, strengthening health systems, risk communication, and supportive policy frameworks. However, evidence on intervention effectiveness in LMICs remains limited and uneven. Overall, vaccine hesitancy in LMICs is a complex, contextspecific phenomenon requiring integrated, multi-sectoral approaches to improve trust, access, and communication in immunization programs.

Keywords: Vaccine hesitancy; Low and middle income countries; Immunization; Health systems strengthening; Misinformation.

CITE AS: Irakoze Mukamana S. (2026). Vaccine Hesitancy in Low- and Middle-Income Countries: Determinants and Interventions. Research Output Journal of Public Health and Medicine 6(1):107-113. https://doi.org/10.59298/ROJPHM/2026/61107113