Determinants of Malaria Vaccine Acceptance: A Systematic Review and Meta-Analysis of Awareness, Acceptance, Hesitancy, and Willingness to Pay.

Abhishek Sharma, Eman Alamri, Praveen Malik, Teena Vishwakarma, Suhaib Iqbal, Ashish Singh Chauhan, M Ravi Kumar, Mahendra Pratap Singh, Muhammed Shabil, Renuka Jyothi S, Ganesh Bushi, Irwanjot Kaur, Ali A Rabaan, Quazi Syed Zahiruddin, Mahalaqua Nazli Khatib, Amal A Sabour, Sanjit Sah, Nawal A Al Kaabi, Ali Al Bshabshe, Maha F Al-Subaie, Hayam A Alrasheed, Mubarak Alfaresi, Hawra Albayat, Rachana Mehta, Tarek Sulaiman

Journal: Immunity, inflammation and disease 2025;13(5):e70205

PMID: 40365988

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Abstract

BACKGROUND

Malaria is a life-threatening disease caused by Plasmodium parasites, transmitted through the bites of infected female Anopheles mosquitoes. It remains a major global health issue, with 263 million cases and 597,000 deaths in 2023, primarily affecting young children and pregnant women. This review evaluates awareness, acceptance, hesitancy, and willingness to pay (WTP) for the RTS,S/AS01 malaria vaccine, along with the key factors influencing these outcomes.

METHODS

A comprehensive literature search was conducted in Web of Science, PubMed, and Embase, covering publications up to 18 June 2024. Observational studies assessing awareness, acceptance, hesitancy, and WTP for the malaria vaccine in endemic regions were included. Two independent reviewers screened the studies. Data extraction was performed using Nested Knowledge software and analyzed with R v.4.4. Pooled prevalences were estimated using random-effects models, and heterogeneity was assessed with the I² statistic.

RESULTS

Eighteen studies with 21,975 participants provided insights into malaria vaccine dynamics: 32% awareness (95% CI, 18%-50%), 83% acceptance (95% CI, 75%-89%), 14% hesitancy (95% CI, 7%-26%), and 58% WTP (95% CI, 34%-79%). Key determinants of acceptance included age, where younger adults (18-24 years) showed lower acceptance (OR = 0.64, 95% CI, 0.35-0.93). Employment, particularly farmers, had higher acceptance rates (OR = 3.20, 95% CI, 1.00-7.40). Lower socioeconomic status and larger family sizes were associated with decreased acceptance (OR = 0.18, 95% CI, 0.02-0.38).

CONCLUSION

This review revealed an 83% acceptance rate for the malaria vaccine, with variability in awareness (32%), hesitancy (14%), and willingness to pay (58%). Age, employment, and socioeconomic status were significant determinants of acceptance. However, due to potential publication bias and high heterogeneity, these findings should be cautiously interpreted. The results highlight the necessity for targeted interventions to enhance vaccine acceptance. Further research is required to elucidate factors that influence vaccine acceptance.

Address: School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India.; Division of Evidence Synthessis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, Maharashtra, India.; Department of Biotechnology and Genetics, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India.; Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, India.; Department of Medicine, NIMS University, Jaipur, Rajasthan, India.; Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, Punjab, India.; Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, India.; Division of Research and Innovation, Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, Uttarakhand, India.; IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, India.; New Delhi Institute of Management, Delhi, India.; South Asia Infant Feeding Research Network, Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, Maharashtra, India.; Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India.; University Center for Research and Development, Chandigarh University, Mohali, Punjab, India.; Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq.; Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India.; Dr Lal PathLabs - Nepal, Maharajgunj, Kathmandu, Nepal.; Department of Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune, India.; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune, Maharashtra, India.; SR Sanjeevani Hospital, Kalyanpur, Siraha, Nepal.; Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia.; Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.; Adult critical care Department of medicine, Division of adult critical care, College of medicine, King Khalid University, Abha, Saudi Arabia.; College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates.; Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates.; Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.; Department of Microbiology, National Reference Laboratory, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.; Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia.; Food Science and Nutrition, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia.; Research Center, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia.; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.; Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.; Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan.

DOI: 10.1002/iid3.70205

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MeSH Terms: Female, Humans, Health Knowledge, Attitudes, Practice, Malaria, Malaria Vaccines, Patient Acceptance of Health Care, Vaccination Hesitancy