Building Trust for Improving Vaccine Uptake: An Integrative Review of COVID-19 Vaccine Hesitancy in the Global North and South

Background: Emerging zoonotic diseases have prompted the implementation of the Global Health Security Agenda. This often involves sudden measures and ad’hoc strategies, such as Covid-19-related contacts restrictions and mass vaccination campaigns to control the disease transmission. However, vaccine hesitancy remains a significant global barrier, driven by fear and mistrust of vaccines and the health system. Vaccine hesitancy has been extensively studied, but some dimensions remain overlooked. This study highlights the lack of attention for psychological and social predictors of vaccine uptake. This Research primarily focuses on Covid-19 vaccination campaigns while considering routine immunization programs at the global scale. The aim is to develop a conceptual model that encompasses psychological and social perspectives of vaccine refusal on a global scale. Method: An integrative review was conducted using databases from multiple disciplines, including Ovid Medline, Embase.com, APA PsycInfo, IBSS, and Web of Science. A sample of articles on Covid-19 vaccine hesitancy and uptake worldwide was selected. Following PRISMA guidelines, systematic searches were performed in these databases, along with Scopus, from inception to July 17, 2024. Two independent reviewers screened titles and abstracts for eligibility, assessing methodological quality based on established criteria. Initially, 1,269 references were screened, narrowing to 699 after abstract review. From these, 70 were prioritized, resulting in 47 final inclusions. Results: Vaccine hesitancy is a global issue, exacerbated by skepticism toward vaccines and driven largely by distrust in pharmaceutical companies and government agencies. While distrust is observed in both the Global North and South, the underlying causes differ in certain ways, as well as the resulting communication crises in the health system. Conclusion: The review highlights the emotional and psychological experiences of communities shaped by collective trauma, including fear, distrust, and social capital dynamics. A conceptual model of psycho-social perspectives on vaccine refusal is proposed for policymakers and public health interventions.