REVIEW ARTICLE
December 2021. Christian Journal for Global Health 8(2)
Effects of local faith-actor engagement in the uptake and
coverage of immunization in low- and middle-income
countries: A literature review
Sara Melillo a, Rebecca Strachan b, Carolyn J O'Brienc, Chizoba Wonodid, Mona
Bormete, Doug Fountain f
a MPH, USAID’s MOMENTUM Country and Global Leadership
b MSc, USAID’s MOMENTUM Country and Global Leadership
c MSPH, USAID’s MOMENTUM Country and Global Leadership, Christian Connections for International Health
d MD, MPH, DrPH, USAID’s MOMENTUM Country and Global Leadership, Johns Hopkins Bloomberg School of
Public Health, International Vaccine Access Center
e MPH, CHES, USAID’s MOMENTUM Country and Global Leadership, Christian Connections for International Health
f MPA, USAID’s MOMENTUM Country and Global Leadership, Christian Connections for International Health
Abstract
Introduction: Religious leaders are universally recognized as having an influence on
immunization uptake and coverage in low- and middle-income countries (LMICs).
Despite this, there is limited understanding of three questions: 1) how do religious
leaders impact the uptake and coverage of immunization in LMICs? 2) what successful
strategies exist for working with local faith actors to improve immunization
acceptance? and 3) what evidence gaps exist in relation to faith engagement and
immunization?
Methods: In January 2021, we searched PubMed and Google Scholar databases
covering the period from January 1, 2011 to January 15, 2021 with key search terms
related to faith engagement and immunization in peer-reviewed literature and
conducted a gray literature review to answer these three questions. We excluded
articles covering faith engagement and immunization in high-income countries, news
articles, online blogs, social media postings, and articles in languages outside of
English. Data were coded to guide thematic analysis.
Results: We found extensive evidence supporting the value of religious engagement
for immunization promotion and acceptance in LMICs across faiths. However, there
was limited rigorous evidence and examples of specific approaches for engaging local
faith actors to strengthen immunization uptake in LMICs. As a result, there is a lack of
widely shared knowledge of what works (or doesn’t) and successful models for
engaging local faith actors. Additional current evidence gaps include: few rigorous
study designs; a lack of vaccine hesitancy studies outside of Nigeria and Pakistan; and
limited exploration of faith engagement and immunization in religions other than Islam
and Christianity.
Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain 3
May 2022. Christian Journal for Global Health 9(1)
Conclusions: Our review findings reinforce the powerful role local faith actors play in
diverse communities within LMICs in both promoting and inhibiting immunization
uptake. The literature review comes at a critical time, given the urgent need to expand
access to COVID-19 vaccination in LMICs. Findings from this review will advance
understanding on how to more effectively engage local faith actors in promoting
immunization campaigns and addressing vaccine hesitancy, which is more complex
than expected. Further study is needed to understand how to most effectively counter
vaccine hesitancy in different geographic, linguistic, and socio-cultural context.
Key Words: vaccine hesitancy, systematic review, immunization, low- and middle-
income countries, faith-based organizations, religious leaders, local faith actors
Introduction
Religious leaders and local faith actors are
universally recognized as having an influence on
immunization uptake and coverage in low- and
middle-income countries (LMICs).1,2 This
association between religion and vaccination dates
back to as early as 1,000 AD, when a Buddhist nun
was described as grinding scabs from a smallpox-
infected person into a powder, blowing it into a non-
immune person’s nostrils to induce immunity.3-5
Today, many major religions commonly
believe that vaccination—the act of administering a
substance that stimulates the body’s immune
response against diseases—supports their shared
objectives of preserving and protecting life, health,
well-being, equity, and prevention of suffering,
especially among children and other innocents.5
Some religions even call for vaccination as a moral
imperative to preserve the lives of children or within
a community.3,6
Yet, despite the powerful positive potential to
reduce and eliminate diseases such as smallpox and
polio, religious factors remain the third most
frequently cited reason for vaccine hesitancy in
global surveys.7-13 Vaccine hesitancy in this case is
defined as delay in acceptance or refusal of vaccines
despite the availability of vaccination services.
Religiously-linked, vaccine hesitancy concerns are
especially pronounced and rising in LMICs, though
often these concerns are inter-mixed with others
related to political, economic, or social issues.13-15
Prominent media coverage and academic study of
widespread polio vaccine hesitancy among Muslim
communities in Northern Nigeria and Pakistan in the
2000s and 2010s has further heightened awareness
and interest in vaccine hesitancy and faith
communities.
Specific aims of the literature review
There is still limited information on and
understanding of how faith actors impact the uptake
and coverage of immunizations in LMICs, as well as
what interventions work to counter vaccine
hesitancy among local faith actors. To date, the bulk
of research on vaccine hesitancy and faith
communities has been conducted in high-income
countries. We are unaware of efforts to validate
vaccine hesitancy measurement tools in sub-Saharan
Africa.16
This is a critical evidence gap, as vaccine
hesitancy among faith communities has been
demonstrated to negatively impact immunization
coverage in certain LMICs.17 The rollout of COVID-
19 vaccinations in LMICs also represents an acute
challenge and opportunity to engage faith leaders in
what will be the largest public health vaccination
campaign in the past 100 years.
The Faith Engagement Team of the US
Agency for International Development’s (USAID’s)
MOMENTUM Country and Global Leadership
program undertook a study of the role of faith
communities in vaccine hesitancy. In January 2021,
4 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
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we conducted a literature review to answer three key
questions: 1) How do religious leaders and faith-
based organizations impact the uptake and coverage
of immunization in LMICs? 2) What successful
strategies exist for working with local faith actors
and communities to improve immunization
acceptance and reduce vaccine hesitancy? and 3)
What evidence gaps exist in relation to faith
engagement and immunization? Findings will
advance understanding on how to more effectively
engage local faith actors in promoting routine and
supplementary immunization campaigns and
reducing vaccine hesitancy.
Methods
Search strategy
The research team searched PubMed and
Google Scholar databases for peer-reviewed
literature for the period from January 1, 2011 to
January 15, 2021 with key search terms related to
faith engagement and immunization (Figure 1).
Figure 1. Literature review search terms
We combined the following terms: vaccin*, immuniz*,
immunis*, vaccine hesitancy AND faith, faith-based, faith
actors, relig*, church, mosque, temple, Christian, Muslim,
Islam, Hindu, Buddhis* AND Low- and Middle-Income
Countries, LMICs, Africa, Asia, Latin America.
Note. The asterisk* indicates a wildcard symbol enabling a
broader search by finding words that start with the same
letters/word stems.
We supplemented the peer-reviewed database
searches with a gray literature search, recognizing
that many interventions related to religious leaders
are not published in peer-reviewed journals. The
review included a keyword search across several
online databases and organizational websites for the
same period: Google, the Vaccine Confidence
Project Literature Archive, and USAID’s Maternal
and Child Survival Program website. References in
papers meeting inclusion criteria were searched for
further relevant studies for potential review. The
authors also solicited submissions from a cohort of
key informants who included experts from the
USAID MOMENTUM Country and Global
Leadership program and from a cohort of 18 global
faith engagement and immunization experts drawn
from Christian Connections for International
Health’s (CCIH) networks.
Inclusion/exclusion criteria
We included peer-reviewed studies and gray
resources meeting the following criteria: 1) the study
context was an LMIC; 2) it included any of the
search keywords in the title or abstract; 3) the main
focus of the study or resource was related to faith-
actor engagement and immunization and/or vaccine
hesitancy; 4) it was published between January 1,
2011 and January 15, 2021; and 5) it was published
in English. Resources were excluded if they were
about faith engagement and immunization in high-
income countries, news articles, online blogs, or
references to social media postings.
As depicted in Figure 2, the literature review
found an initial 434 articles through initial search
terms and an assessment of relevance using the pre-
identified inclusion criteria. All articles that met the
inclusion criteria (137) were included for quality
assessment and data extraction. Of these, 27
duplicate references were manually removed,
leaving 110 resources. These are presented in
Appendix 1.
Figure 2. Literature Review Search Strategy
Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain 5
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Note. *Using literature review search terms in Figure 1
Data extraction and analysis
We reviewed the 110 relevant papers and
entered qualitative and quantitative descriptive
information into an Excel data extraction matrix
template that included the following categories:
author, year, publication; country(ies), and/or region
covered; type of study/article/resource; focal
religion(s); and topical area of focus (including
vaccine hesitancy, specific types of vaccine). The
matrix also captured key observations and findings,
vaccine hesitancy findings, evidence-based
interventions related to engaging local faith actors
and immunization, promising practices for faith
engagement and immunization, and reported
evidence gaps. Data were coded using a predefined
set of themes and sub-themes from the matrix
categories to answer the three literature review
questions.
Results
Description of the resources reviewed
Despite results, there is still scant published
evidence of the role of religion and local faith actors
on immunization.1 Most studies treat religion as a
confounding variable without a detailed
examination of the nuanced impact or inter-related
factors (social/political/economic) that impact
immunization uptake.1,2 The review did find a
number of key thematic foci, as depicted in Table 1.
Table 1. Key Themes Found in Literature Review (see Appendix 1 for full listing of resources)
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Theme Relevant Materials
Main Topical Focus of Article
Religion/local faith
actors and
immunization
Akseer, N (2018); Alemu M (2016); Ames H (2017); Asress A and Bezabih L (2018); Bangura JB (2020);
Berkley Center (2020); Berkley Center (2012); Boulton ML and Wagner AL (2021); Catholic Relief Services
(2019); Christian Connections for International Health (2017); Costa JC (2020); Gavi (2015); Glatman-
Freedman A and Nichols K (2012); Grabenstein JD (2013); International Interfaith Peace Corps (2016);
Jalloh MF (2020); Makoka M (2020); Malande OO (2019); Marshall K (2013); Morry C (2019); Mukungwa
T (2015); Mupere E (2020); Nnadi C (2017); Olivier, J (2016); Oyo-Ita A (2020); Soura A (2013); UNICEF
(2012); UNICEF (2015); Vatican Commission for COVID-19 (2021); Vermandere H (2016); Wesevich A
(2016); Wilkinson O and Marshall K (2021); Wonodi CB (2012); Woo, YL (2012); World Council of
Churches and World Jewish Congress (2020); World Faiths Development Dialogue (2012); World Health
Organization (WHO) (2017); (WHO) (2018); WHO/Sage Working Group on Vaccine Hesitancy, systematic
review (2014); World Vision, barrier analysis (2021)
Religion/local faith
actors and vaccine
hesitancy
Abakar MF (2018); Abubakar A (2019); Agrawal A (2020); Ahmed A (2018); Ahmed S (2014); Ansari, MT
(2020); Anyene, B (2014); Balbir Singh HK (2019); Barmania S and Reiss MJ (2020); Berkley Center (2021);
Cobos Muñoz D (2015); Cooper S (2018); de Figueiredo A (2020); Dubé E (2014); Ebrahim, AF (2013);
Evans D (2019); Falade BA (2014); Gallup and Wellcome Global Monitor (2018); Gerede R (2017); Ghinai I
(2013); Grandahl M (2018); Greenberger C (2017); Guzman-Holst A (2020); Ha W (2014); Habib MA,
community engagement (2017); Habib MA, knowledge and perceptions (2017); Hamdi S. (2018);
Harapan H (2021); Hussain SF (2016); International Vaccine Access Center (2020); Jalloh MF (2019);
Jamal D (2020); Jarrett C (2015); Kalok A (2020); Khan MU, Muslim scholars’ knowledge (2017); Khan
MU, knowledge, attitudes (2017); Khowaja AR (2012); Kriss JL (2016); Kucheba F (2021); Lane S (2018);
Larson, HJ (2016); Machekanyanga Z (2017); Marti M (2017); McArthur-Lloyd A (2016); Muslim religious
scholars (2014)l Nasir JA (2017); Nasir SG (2014); Ndiaye K (2013); Njeru I (2016); Olivier J. (2014);
Olorunsaiye CZ (2017); Olufowote JO (2016); Owoaje E (2020); Padela AI (2014); Padmawati RS (2019);
Peckham R (2018); Pelčić G (2016); Pugliese-Garcia M (2018); Remes P (2012); Renne E (2010);
Sabahelzain MM (2019); Syiroj ATR (2019); Taylor S (2017); Tefera YA (2018); Turiho AK (2017); Wagner
AL (2019); Wong LP and Wong PF (2020); Wong LP (2020); WHO/Sage Working Group on Vaccine
Hesitancy, systematic review (2014); WHO/Sage Working Group on Vaccine Hesitancy, report (2014)
New vaccine
acceptance
Padmawati RS (2019); Wonodi CB (2012)
Faith-Based Concerns or Interest with Specific Vaccines
Polio Agrawal A (2020); Ahmed S (2014); Falade BA (2014); Ghinai I (2013); Habib MA, community
engagement (2017); Habib MA, knowledge and perceptions (2017); Hussain SF (2016); Khan MU, Muslim
scholars’ knowledge (2017); Khan MU, knowledge, attitudes (2017); Khowaja AR (2012); McArthur-Lloyd
A (2016); Nasir JA (2017); Nasir SG (2014); Ndiaye K (2013); Njeru I (2016); Olufowote JO (2016); Owoaje
E (2020); Peckham R (2018); Renne E (2010); Taylor S (2017)
COVID-19 Barmania S and Reiss MJ (2020); Berkley Center (2021); Berkley Center (2020); Vatican Commission
(2021); Wilkinson O and Marshall K (2021); World Council of Churches and World Jewish Congress
(2020); World Vision, PowerPoint (2021); World Vision, website (2021)
Rotavirus Padmawati RS (2019); Wesevich A (2016)
Table 1. Key Themes Found in Literature Review [continued]
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Religion of Focus in Relation to Immunization Exploration
Multiple religions
or no specific
religion
Akseer, N (2018); Bangura JB (2020); Barmania S and Reiss MJ (2020); Berkley Center (2021); Berkley
Center (2020); Berkley Center (2012); Boulton ML and Wagner AL (2021); Catholic Relief Services (2019);
Christian Connections for International Health (2017); Cobos Muñoz D (2015); Cooper S (2018); Costa JC
(2020); Dubé E (2014); Gavi (2015); Glatman-Freedman A and Nichols K (2012); Grabenstein JD (2013);
Guzman-Holst A (2020); International Interfaith Peace Corps (2016); Jalloh MF (2020); Jarrett C (2015);
Lane S (2018); Larson, HJ (2016); Marshall K (2013); Marti M (2017); Morry C (2019); Mupere E (2020);
Nnadi C (2017); Olivier J (2014); Olivier J (2016); Olorunsaiye CZ (2017); Remes P (2012); Soura A (2013);
Tefera YA (2018); Turiho AK (2017); UNICEF (2012); UNICEF (2015); Wagner AL (2019); Wilkinson O and
Marshall K (2021); Wonodi CB (2012); Wong LP (2020); World Council of Churches and World Jewish
Congress (2020); World Faiths Development Dialogue (2012); WHO (2018); WHO (2017); WHO/Sage
Working Group on Vaccine Hesitancy, systematic review (2014); World Vision, barrier analysis (2021)
Muslim Abakar MF (2018); Abubakar A (2019); Agrawal A (2020); Ahmed A (2018); Ahmed S (2014); Ansari, MT
(2020); Anyene, B (2014); Balbir Singh HK (2019); de Figueiredo A (2020); Ebrahim AF (2013); Falade BA
(2014); Ghinai I (2013); Habib MA, community engagement (2017); Habib MA, knowledge and
perceptions (2017); Hamdi S (2018); Harapan H (2021); Hussain SF (2016); Jalloh MF (2019); Jamal D
(2020); Kalok A (2020); Khan MU, Muslim scholars’ knowledge (2017); Khan MU, knowledge, attitudes
(2017); Khowaja AR (2012); McArthur-Lloyd A (2016); Muslim religious scholars (2014); Nasir JA (2017);
Nasir SG (2014); Ndiaye K (2013); Olufowote JO (2016); Owoaje E (2020); Oyo-Ita A (2020); Padela AI
(2014); Padmawati RS (2019); Peckham R (2018); Remes P (2012); Renne E (2010); Sabahelzain MM
(2019); Syiroj ATR (2019); Taylor S (2017); Vermandere H (2016); Wong LP and Wong PF (2020); Woo, YL
(2012)
Christian Alemu M (2016); Ames H (2017); Asress A and Bezabih L (2018); Evans D (2019); Gerede R (2017); Ha, W
(2014); Kriss JL (2016); Kucheba F (2021); Machekanyanga Z (2017); Makoka, M (2020); Malande OO
(2019); Mukungwa T (2015); Njeru I (2016); Pugliese-Garcia M (2018); Remes P (2012); Vatican
Commission for COVID-19 (2021); Wesevich A (2016)
Non-Muslim or
Non-Christian
Grandahl M (2018); Greenberger C (2017); Malande OO (2019)
Study/resource type and quality
The review found a total of 110 relevant
articles, 69% of which were peer reviewed, and the
other 31% were from gray literature. While the
literature review did not explicitly assess and score
study quality, the quality of literature reviewed
appears mixed based upon the study designs found.
Most peer-reviewed literature cited was
observational in nature; gray literature or discussion
papers represented 44.5% of resources reviewed.
The review found only three intervention studies
(2.7%) examining approaches for engaging faith
leaders. As the dominant resource type, the
descriptive literature consisted of cross-sectional
studies, qualitative studies, mixed methods, and data
analysis. Additionally, there were several comment-
aries and discussion papers along with both literature
and systematic reviews. The gray literature consisted
of tools, guidelines, various resources, and reports.
There were a variety of additional gray resources
found including books, evaluations, poster/oral
presentations, and unpublished theses.
Topical focus
The relevant literature was predominantly
focused on vaccine hesitancy (60%) among different
faith groups, versus a general exploration of
religious engagement and vaccines (36%). The
remaining 4% of resources focused on new vaccine
acceptance among local faith actors and vaccines
delivered by local faith actors in humanitarian
environments. Of the articles that examined a
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specific vaccine type, there was a focus on
campaign-based vaccinations and so-called
“controversial” vaccines (those causing hesitancy),
rather than routine immunizations. The resource
breakdown included:
• Polio (20)
• Human papillomavirus (HPV) (9)
• COVID-19 vaccination (8)
• Childhood immunization generally (5)
• Rotavirus (2)
Time period
At least five articles have been published every
year since 2012 on the topic of local faith actors and
immunization in LMICs. Interest in the topic appear
to be rising as 70% of the resources identified were
published within the last five years of the review
(2016–2020). Last year (2020) was the peak, with
20 articles published.
Religions of focus
Just under half the resources found (42%)
focused on multiple religions or general local faith-
actor engagement and immunization rather than
specific religions. The majority of studies with an
explicit religious focus examined large-scale
organized, monotheistic faiths (Islam, Christianity),
and mainline religions—those linked to established
denominations in the global North. Only eight
studies explored immunization and faith engagement
in traditional, folk, or growing non-networked
religions such as Pentecostal or Charismatic
denominations (12.5%), a growing proportion of
religions in LMICs. We found few studies exploring
immunization in the context of Buddhist or Hindu
faiths in Asia.
The literature also reflects a heavy focus on
polio vaccine hesitancy among Muslim populations,
with 19% of all resources focused on that topic. The
hesitancy literature in general focuses primarily on
countries with large or predominantly Muslim
populations, with the exception of Apostolic
Christian denominations within Zimbabwe.
Geographic focus
Nearly half of the studies that met the inclusion
criteria (44%) offered a global or multi-country
focus in LMICs, rather than zeroing in on a specific
geographic area. The other resources were localized
to specific regions, predominantly sub-Saharan
Africa (34%), followed by Southeast and South Asia
(19%). Within sub-Saharan Africa, the majority of
resources focused on Nigeria (16 articles), with
fewer resources from Ethiopia, Kenya, Uganda,
Tanzania, Zambia, and Zimbabwe (Figure 3).
Figure 3. Literature review findings: Top focal countries (as of January 15, 2021)
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Within the Southeast and South Asian region,
the majority of resources were specific to Pakistan
(12 articles), while Afghanistan, Bangladesh, India,
Indonesia, and Malaysia had fewer published
research resources. The literature review uncovered
major research gaps for the Latin American and
Caribbean region, and only three resources were
found for the Middle East and North Africa. There
were no articles published for Eastern Europe nor the
Asia Pacific region.
Discussion
Question 1: How do religious leaders and
faith-based organizations impact the uptake
and coverage of immunization in LMICs?
Measuring the precise impact and causality of
local faith actors on immunization rates is
challenging. Most studies generally treat religion as
a confounding variable without a detailed
examination of the nuanced impact or inter-related
factors (social/political/economic) that effect
immunization uptake.1,2 This remains an important
area for future research and exploration.
The reviewed literature did demonstrate four
main mechanisms through which religious leaders
and faith actors impact immunization uptake in
LMICs: 1) influencing caretaker beliefs and
values,1,2,17,18 2) impacting access to resources that
facilitate immunization uptake,1 3) communicating
immunization messages and conducting
mobilization,2 and 4) providing routine
immunizations in hard-to-reach areas or
humanitarian settings. These findings suggest that
continued investment in and engagement with faith
leaders can be a valuable strategy for immunization
programming.2,19 At the same time, the review did
not find detailed explorations and analysis of the
dynamics and mechanisms of how faith actors
specifically influenced immunization uptake and
coverage within local communities. This may
warrant additional research in this area to unpack the
influence and interplay of local faith actors within
communities to better understand these mechanisms
and design evidence-based interventions.
Religiously-linked vaccine hesitancy
Vaccine hesitancy is a complex phenomenon.
Few religious groups or their sacred texts explicitly
reject immunization (Figure 4).3,5,11,12,20,21
Figure 4. What major religions say about vaccines
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Multiple resources reviewed suggested that
vaccination hesitancy is often cloaked under the
guise of “religion,” without a theologically-
grounded objection.3,12 Instead, religious objections
to vaccination serve as a cover or proxy for concerns
about safety, social norms, socio-cultural issues,
political, and economic factors.2,3,5,26,27
Common faith-linked vaccine hesitancy views
across religions included the belief(s) that:
• Humans should not attempt to override God’s
will with man-made solutions.3,4,28
• God created a perfect world, including a
perfect immune system: humanity should not
attempt to improve on it.4
• The human body is a temple of God—
immunizations introduce potentially harmful
viruses, bacteria, and/or derivatives of
forbidden substances.4
• Violations against taking life, including the use
of fetal tissue from abortions, which are used
in the development of cell lines used to make
certain vaccines.4,21
• Violation of dietary laws (such as using
vaccine development materials with porcine or
bovine origins).3
The review found additional vaccine hesitancy
themes, including: promotion of faith healers and/or
the power of prayer over the use of vaccines or
medicine,11,29,30 distrust of Western medicine/fear
that vaccines are being tested on their
community,29,30 worry that vaccines will sterilize
recipients/impact fertility, and the promotion of
traditional remedies rather than biomedical
solutions.8,30,31
While these vaccine hesitancy themes were
explored in numerous resources in the review, we did
not find systematic analysis or study of the specific
actions that local faith actors took to translate these
beliefs into action and influence social norms,
outside of specific references to case studies of
vaccine hesitancy in certain countries among local
faith actors. In these specific country examples,
actions taken by local faith actors included sharing
anti-vaccine messaging within houses of worship;
disseminating anti-vaccination messaging
informally within the community outside religious
structures; broadcasting anti-vaccine messaging on
mass media channels; and establishing formal or
informal boycotts and encouraging adherents to
avoid immunizing their children.
Heavy emphasis on Islam and vaccine
hesitancy
The literature review found extensive
documentation and exploration of Islam and vaccine
hesitancy in LMICs, amounting to 69% of all studies
with a specific single religion focus. This is likely
due, in part, to very visible cases of vaccine
hesitancy and boycotts in the early 2000s in northern
Nigeria, Pakistan, and Afghanistan as well as the
finding that Muslim religious leaders are especially
influential in impacting vaccine uptake and
hesitancy.32,33
Several references underscore the principle
that Islamic theology generally supports
immunization,14,22,23 and there are predominantly
Muslim countries with low rates of reported vaccine
hesitancy, including Bangladesh, Malaysia, Niger,
and Saudi Arabia. The review did find multiple
studies that suggested lower coverage of
immunizations among Muslim populations in
LMICs (across countries and within countries of
heterogenous religions).1,14-16,34 Major drivers of
vaccine hesitancy among Muslim faith communities
identified in the studies included concerns that
vaccines may contain haram materials (those
prohibited under Islamic law) ,14,33,35 fears that
immunization would impact the fertility of
recipients,32,36 and beliefs that vaccinations were part
of a Western conspiracy to harm their population.29,30
Other religions of interest
Christian denominations accounted for 23% of
all resources with a single religious focus in the
literature review, with a strong focus on Apostolic
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May 2022. Christian Journal for Global Health 9(1)
denominations in Zimbabwe and Southern Africa.
Originating from the Protestant Pentecostal church,
Apostolic churches reflect a desire to emulate first-
century Christianity in its faith, practices, and
government and have historically objected to most
medical interventions in lieu of prayer for healing.9,11
Multiple studies showed lower basic immunization
uptake and completion in Zimbabwe among
Apostolic communities, with varying attitudes and
degrees of refusal toward immunization among sub-
sects, indicating a need for further study and
interventions to address this growing population in
Southern Africa. 8,9,11,20,37
Despite much coverage in news media and
popular culture focused on the use of cells from
aborted fetuses to develop vaccines, the review only
found two resources meeting inclusion criteria
focused on vaccine hesitancy among Catholic
populations where Catholic bishops in Kenya led a
call for the boycott of the maternal tetanus toxoid
(fertility concerns) and childhood polio vaccines
(safety concerns).29,38
Vaccines of concern to faith actors
Religiously-linked polio vaccine hesitancy
featured most prominently within the literature
(representing 20 articles/41.7% of all articles with a
specific vaccine focus), with examples from
Pakistan,32,35,39,40 Nigeria,41–43 and Kenya.38 This
hesitancy contributed to increased reported caretaker
vaccine refusal in Kenya due to safety concerns.38
Polio vaccine rejection by religious and community
leaders was linked with overall reduced polio
vaccine coverage in Nigeria.41,43 In Pakistan,
multiple barriers were found, including concerns that
vaccines include non-halal ingredients35 and fears of
a Western plot to sterilize Muslims or reduce the
Muslim population.32,39
HPV immunization was found to be the second
most frequently cited vaccine with religious
objections. The HPV vaccine creates faith-linked
challenges in both higher- and lower-income
countries due to its perceived links to sexual activity.
The review found broader religious objections to
HPV vaccination among Catholic7 and Muslim44
communities globally and specific concerns in
Brazil,8,45 Indonesia,8,45 Kenya,46 Malaysia,47
Tanzania,8,45 and Zambia.28 The literature review
also found instances of religiously-linked vaccine
hesitancy among the following specific
immunizations (as opposed to general immunization
hesitancy): measles, mumps, and rubella
(Indonesia18,34, Sudan 48); rotavirus (Indonesia33,
Zambia49); cholera (Zambia30); and pertussis
(Nigeria14,36).
Question 2. What successful strategies exist
for working with local faith actors and
communities to improve immunization
acceptance and reduce vaccine hesitancy?
The literature review found limited high-
quality evidence and examples of specific
approaches for engaging local faith actors to
strengthen routine immunization and campaign-
based immunization uptake. Most interventions
involved engaging religious leaders and the local
community in dialogue-based interventions50 and
engaging religious leaders and church structures in
social mobilization and advocacy.1,2,44,49,51–53
Improving immunization uptake and coverage
One study found that working with religious
leaders on a multi-pronged immunization promotion
and delivery strategy, including targeting priority
populations and increasing service delivery
availability, was more effective for increasing
vaccine uptake than messaging with religious leaders
alone.50 Using church infrastructure, faith-based
health facilities, and religious rituals as vaccination
messaging or delivery points, including in
humanitarian settings, was also found to be effective
for increasing vaccine coverage.19,28,54
Reducing religiously-linked vaccine hesitancy
The review found limited examples of
evidence-based approaches for tackling faith-linked
12 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
May 2022. Christian Journal for Global Health 9(1)
vaccine hesitancy. Engaging faith-based organiza-
tions and faith leaders in the rollout of new vaccines
was found in multiple studies to be important for
increasing community acceptability and uptake and
preventing potential vaccine hesitancy.55–57 Several
studies found that religious concerns focused on the
bioethics of vaccine production may be effectively
addressed through theological analyses of sacred text
and dialogue with faith leaders, including
understanding the alternatives among available
vaccines.25,55,58 In Muslim countries, where there is
concern that vaccines were manufactured with
haram (forbidden) materials, acknowledging these
concerns and communicating effectively about them
with Muslim faith leaders and structures is
critical.14,59
Question 3. What evidence gaps exist in
relation to faith engagement and
immunization?
The literature review found promising
evidence of the value of religious engagement for
immunization promotion and acceptance in LMICs
across faiths. In particular, we found multiple
articles demonstrating the value of religious
engagement for immunization promotion and
acceptance,2,16, 60 studies of vaccine hesitancy among
Muslim leaders,32,33,35,36,40,41 comparisons of
immunization among different faiths within the same
countries,14,15,34 and reviews and discussion papers
on the correlation between faith engagement and
vaccine acceptance.1,2,17,18
Despite these findings, this literature review
found significant evidence gaps—described
below—that limit the generalizability of some
findings, such as:
• A dearth of peer-reviewed research and gray
literature on the influence of local faith actors
on vaccine hesitancy in LMICs as compared to
high-income countries.16
• Low-quality evidence of impact of religious
leaders’ engagement on uptake of vaccines and
the relative contribution of faith actors in
vaccine uptake.2,16, 60 The review found few
rigorous study designs. Most literature found
was observational in nature and gray literature
or discussion papers represented 44.5% of
resources reviewed; the review found only
three intervention studies (2.7%) examining
approaches for engaging faith leaders.
• Nearly 25% of all 110 reviewed resources
focused on Nigeria (16 total resources) and
Pakistan (12 total resources%), raising
questions if such findings are applicable to
other countries or regions.
• Similarly, the majority of studies with an
explicit religious focus examined large-scale
organized, monotheistic faiths (Islam,
Christianity), limiting their potential
applicability to differently organized religions.
• Few studies or resources examined or
evaluated the effectiveness of specific
interventions with local faith actors and
immunization and/or vaccine hesitancy. As a
result, there is a lack of widely shared
knowledge of what works (or doesn’t) and
successful models for engaging local faith
actors. We found few published articles or
gray literature that included the voices of local
faith actors as primary authors or significant
contributors discussing their role within
immunization programs, indicating a need for
further dialogue and research in this area.
Limitations
It is well-known that many local faith-based
organizations and actors maintain practice-based
knowledge and are less likely to publish their
findings in journals. This literature review and its
conclusions may therefore be subject to publication
bias, in that unsuccessful interventions may be less
likely to be documented in either the peer-reviewed
or gray literature. In addition, the review excluded
non-English language resources, potentially missing
observations and promising practices.
Several other factors also warrant caution on
extrapolating findings more broadly. While the
literature did not explicitly assess and score study
Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain 13
May 2022. Christian Journal for Global Health 9(1)
quality, the quality of literature remains mixed,
based upon review of study/resource type, limiting
generalizability and rigor of conclusions. As noted
above, the review found evidence gaps among
certain geographies, religion types, and different
vaccines.
Finally, this literature was conducted amid the
early launch and rollout of COVID-19 vaccination
(January 2021). As such, the review found very
limited and explicit gray or peer-reviewed literature
on the topic of faith engagement and COVID-19
immunization. While many of the findings and
interventions may be applicable and effective if
applied to COVID-19 immunizations, further study
and investigation is warranted for this urgent public
health crisis.
Conclusions
Our literature review findings suggest that
continued investment in and engagement with local
faith actors can be a valuable strategy for
immunization programming in LMICs. The review
found that engaged religious leaders have long
contributed to achieving full immunization coverage
within their communities and today offer the
potential to help counter growing vaccine hesitancy
in some LMICs. At the same time, the review found
numerous troubling examples of religiously-linked
vaccine hesitancy, some well-known, such as
Indonesia, Nigeria, and Pakistan, and some lesser-
known examples in Burkina Faso, Chad, and Sudan.
More investigations and evidence are needed
regarding what interventions that involve local faith
actors are most effective, and in which contexts, in
promoting vaccine uptake. Vaccine hesitancy is a
highly complex phenomenon. The current peer-
reviewed and gray literature does not provide an
adaptable, concise roadmap for tackling these issues
in different geographic, cultural, linguistic, and other
contexts. In particular, further study is needed on the
role of faith leaders in the promotion of routine
immunization (rather than campaign-based
immunization), the impact of local faith actors on
vaccine uptake among growing Pentecostal,
Charismatic, and so-called “un-networked” faiths,
and vaccine hesitancy among Buddhist and Hindu
faiths in Asia.
Multiple studies and resources within the
review did identify the importance of listening,
understanding, and diagnosing some of the complex
and inter-related socio-cultural factors that
contribute to religiously-linked vaccine hesitancy.
These review findings should reinforce an important
caution for public health planners, policymakers, and
implementers to avoid the temptation to
oversimplify or blame faith actors for vaccine
hesitancy. Evidence repeatedly demonstrates that
apparent faith-based objections are sometimes a
convenient proxy for more complex, inter-related
socio-cultural, and political issues related to
immunization. In cases where vaccine hesitancy is
identified among local faith actors, the review
suggests that listening and dialoguing with faith
leaders is critical to finding theologically-acceptable
solutions to vaccine hesitancy.
In addition, this review suggests that more
work is needed to foster global and national-level
discussions to engage faith leaders in vaccine
hesitancy reduction efforts. Country-level strategies
to stimulate research and dialogue with religious
structures, interfaith networks, and theological
institutions may help identify some of these
underlying socio-cultural and political issues. To
increase understanding and scale-up of successful
strategies, we also encourage local faith actors and
implementers to more widely share their experiences
engaging religious leaders in immunization
programs, which are largely absent from peer-
reviewed and gray literature.
This review comes at a critical time, given the
rollout of COVID-19 vaccination in LMICs. At the
time of the literature review, most COVID-19
vaccine hesitancy research in LMICs was just getting
underway. However, emerging research in six
countries shows that endorsement of the COVID-19
vaccine by faith leaders will be critical to vaccine
acceptance.61,62 On a positive note, many religious
14 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
May 2022. Christian Journal for Global Health 9(1)
leaders and groups have taken a lead role on calls for
vaccine equity in LMICs and are leading the charge
to promote COVID-19 immunization in their
countries. It will be critical to adapt and scale
successful strategies from previous immunization
efforts with faith leaders to successfully respond to
this urgent public health crisis.
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http://etheses.lse.ac.uk/911/1/Falade_Vaccination-resistance-religion-and-attitudes-to-science-in-Nigeria.pdf
http://etheses.lse.ac.uk/911/1/Falade_Vaccination-resistance-religion-and-attitudes-to-science-in-Nigeria.pdf
https://doi.org/10.1080/17441692.2013.859720
https://doi.org/10.1080/17441692.2013.859720
https://doi.org/10.1186/s12889-020-09235-x
https://doi.org/10.1186/s12889-020-09235-x
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https://doi.org/10.1186/s12992-016-0211-7
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https://doi.org/10.7314/apjcp.2012.13.9.4651
https://doi.org/10.1371/journal.pone.0213882
https://doi.org/10.1371/journal.pone.0213882
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Peer Reviewed: Submitted 5 Oct 2021, accepted 1 Feb 2022, published __ June 2022
Competing Interests: None declared.
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https://doi.org/10.1177/2150131915622379
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https://jliflc.com/wp-content/uploads/2015/06/Gavi_Faith-Based-Engagement-28-01-15-short.docx
https://berkleycenter.georgetown.edu/publications/faith-immunization-past-present-and-potential-roles-of-faith-inspired-organizations
https://berkleycenter.georgetown.edu/publications/faith-immunization-past-present-and-potential-roles-of-faith-inspired-organizations
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https://doi.org/10.1186/s12889-015-2471-1
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https://www.who.int/immunization/sage/meetings/2014/october/3_SAGE_WG_Strategies_addressing_vaccine_hesitancy_2014.pdf
https://www.who.int/immunization/sage/meetings/2014/october/3_SAGE_WG_Strategies_addressing_vaccine_hesitancy_2014.pdf
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https://www.worldvision.org/about-us/media-center/faith-leaders-must-play-key-role-in-covid-19-vaccine-roll-out
https://www.worldvision.org/about-us/media-center/faith-leaders-must-play-key-role-in-covid-19-vaccine-roll-out
18 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
May 2022. Christian Journal for Global Health 9(1)
Funding: Christian Connections for International Health (CCIH) received primary research funding
from the United States Agency for International Development (USAID) MOMENTUM Country
Global Leadership Project (Grant/Award Number: Cooperative Agreement #7200AA20CA00002),
led by Jhpiego and partners
Correspondence: Carolyn J. O’Brien, CCIH, Virginia, USA. carolyn.obrien@ccih.org
Cite this article as: Melillo S, Strachan R, O’Brien CJ, Wonodi C, Bormet M & Fountain D. Effects of
local faith-actor engagement in the uptake and coverage of immunization in low- and middle-
income countries: A literature review. Christ J Global Health. May 2022;9(1):2-32.
https://doi.org/10.15566/cjgh.v9i1.587
© Authors. This is an open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are properly cited. To view a copy of the license, visit
http://creativecommons.org/licenses/by/4.0/
mailto:carolyn.obrien@ccih.org
https://doi.org/10.15566/cjgh.v9i1.587
http://creativecommons.org/licenses/by/4.0/
Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain 19
May 2022. Christian Journal for Global Health 9(1)
Appendix 1. Articles Reviewed
Reference and year Country(s)
and/ or
Region
Religions Resource Type/ Study Type Areas of Focus/ Key
Themes
Link to reference
2010
Renne, E. Islam and immunization in Northern Nigeria. Nigeria Islam Draft book chapter
Vaccine Hesitancy; Polio https://www.ascleiden.nl/Pdf/paperrenn
e.pdf
2012
Berkeley Center for Religion, Peace & World Affairs/World
Faiths Development Dialogue. Faith and immunizations
meeting report.
Global Multiple Meeting report Religion & immunization https://berkleycenter.georgetown.edu/n
ews/new-meeting-report-faith-and-
immunizations.
Glatman-Freedman A, Nichols K. The effect of social
determinants on immunization programs.
Global - Low
income
countries
Multiple Review Religion & immunization Hum Vaccin Immunother. 8;3:293-301.
https://doi.org/10.4161/hv.19003
Khowaja AR, Khan SA, Nizam N, Omer SB, Zaidi A. Parental
perceptions surrounding polio and self-reported non-
participation in polio supplementary immunization
activities in Karachi, Pakistan: a mixed methods study.
Pakistan Islam Mixed methods study Vaccine Hesitancy; Polio Bull World Health Organ. 90(11):822-30.
https://doi.org/10.2471/BLT.12.106260
Remes P, et al. A qualitative study of HPV vaccine
acceptability among health workers, teachers, parents,
female pupils, and religious leaders in northwest Tanzania.
Tanzania Christian;
Islam
Qualitative semi-structured
interviews
Vaccine Hesitancy; HPV Vaccine. 30(36):5363-7.
https://doi.org/10.1016/j.vaccine.2012.0
6.025
UNICEF. Partnering with religious communities for
children.
Global Multiple Report Religion & immunization https://sites.unicef.org/about/partnershi
ps/files/Partnering_with_Religious_Com
munities_for_Children_(UNICEF).pdf
Wonodi CB, et al. Using social network analysis to examine
the decision-making process on new vaccine introduction
in Nigeria.
Nigeria None Mixed methods study using
qualitative [key informant
interviews (KIIs)] and
quantitative (survey) data
collection methods
Religion & immunization Health Policy Plan. 27(suppl 2): ii27–ii38.
https://doi.org/10.1093/heapol/czs037
https://www.ascleiden.nl/Pdf/paperrenne.pdf
https://www.ascleiden.nl/Pdf/paperrenne.pdf
https://berkleycenter.georgetown.edu/news/new-meeting-report-faith-and-immunizations
https://berkleycenter.georgetown.edu/news/new-meeting-report-faith-and-immunizations
https://berkleycenter.georgetown.edu/news/new-meeting-report-faith-and-immunizations
https://doi.org/10.4161/hv.19003
https://doi.org/10.2471/BLT.12.106260
https://doi.org/10.1016/j.vaccine.2012.06.025
https://doi.org/10.1016/j.vaccine.2012.06.025
https://sites.unicef.org/about/partnerships/files/Partnering_with_Religious_Communities_for_Children_(UNICEF).pdf
https://sites.unicef.org/about/partnerships/files/Partnering_with_Religious_Communities_for_Children_(UNICEF).pdf
https://sites.unicef.org/about/partnerships/files/Partnering_with_Religious_Communities_for_Children_(UNICEF).pdf
https://doi.org/10.1093/heapol/czs037
20 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
May 2022. Christian Journal for Global Health 9(1)
Woo YL, Razali SM, Chong KR, Omar SZ. Does the success
of a school-based HPV vaccine programme depend on
teachers' knowledge and religion?–a survey in a
multicultural society.
Malaysia Islam;
multiple
faiths
Survey Multi-cultural society; HPV Asian Pac J Cancer Preve. 13(9): 4651-4.
https://doi.org/10.7314/apjcp.2012.13.9.
4651
World Faiths Development Dialogue. Faith &
immunization: past, present, and potential roles of faith-
inspired organizations.
Global Multiple
religions
White paper Religion & immunization;
New Immunizations
https://berkleycenter.georgetown.edu/p
ublications/faith-immunization-past-
present-and-potential-roles-of-faith-
inspired-organizations
2013
Ebrahim AF. Islam & vaccination.
Global Islam Book Vaccine hesitancy Islamic Medical Association of South
Africa.
Ghinai I, Willott C, Dadari I, Larson HJ. Listening to the
rumours: what the northern Nigeria polio vaccine boycott
can tell us ten years on.
Nigeria Islam Mixed methods data analysis
and qualitative analysis
Vaccine Hesitancy; Polio Glob Public Health. 8(10):1138-50.
https://doi.org/10.1080/17441692.2013.
859720
Grabenstein JD. What the world's religions teach, applied
to vaccines and immune globulins.
Global Hindu,
Buddhism,
Judaism,
Jainism,
Christian,
Islam
Review Immunization and faith Vaccine. 31(16):2011-23.
https://doi.org/10.1016/j.vaccine.2013.0
2.026
Ndiaye K. The Influence of religious and traditional rulers
in polio vaccination efforts in Northern Nigeria.
Nigeria Islam Discussion paper
[Unpublished research
paper]
Vaccine Hesitancy; Polio https://ssrn.com/abstract=2250207
Marshall K. Engaging faith communities on immunization:
what's next?
Global Multiple
faiths
Technical Brief Vaccine Hesitancy;
Religion & immunization
The Berkley Center for Religion, Peace &
World Affairs.
https://berkleycenter.georgetown.edu/p
ublications/engaging-faith-communities-
on-immunization-what-next
Soura A, Pison G, Senderowicz L, Rossier C. Religious
differences in child vaccination rates in urban Africa:
Burkina Faso Islam,
Catholic
Statistical analysis Religion & immunization;
Routine Immunization
Etude Popul Afr. 27(2):174-187.
https://aps.journals.ac.za/pub/article/vie
https://doi.org/10.7314/apjcp.2012.13.9.4651
https://doi.org/10.7314/apjcp.2012.13.9.4651
https://doi.org/10.1080/17441692.2013.859720
https://doi.org/10.1080/17441692.2013.859720
https://doi.org/10.1016/j.vaccine.2013.02.026
https://doi.org/10.1016/j.vaccine.2013.02.026
https://ssrn.com/abstract=2250207
https://berkleycenter.georgetown.edu/publications/engaging-faith-communities-on-immunization-what-next
https://berkleycenter.georgetown.edu/publications/engaging-faith-communities-on-immunization-what-next
https://berkleycenter.georgetown.edu/publications/engaging-faith-communities-on-immunization-what-next
https://aps.journals.ac.za/pub/article/view/439/393
Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain 21
May 2022. Christian Journal for Global Health 9(1)
Comparison of population surveillance data from
Ouagadougou, Burkina Faso
w/439/393
2014
Ahmed S, et al. Resistance to polio vaccination in some
Muslim communities and the actual Islamic perspectives—
a critical Review.
Pakistan;
Nigeria;
Afghanistan;
India
Islam Review article Vaccine Hesitancy; Polio J Pharm Technol. 7(4):494-5.
https://doi.org/10.52711/0974-
360X.2022.00001
Anyene B. Routine immunization in Nigeria: the role of
politics, religion and cultural practices
Nigeria Islam;
Christian
Discussion paper Vaccine Hesitancy Afr J Health Econ. 3.
https://www.ajhe.org.in/uploads/55/307
5_pdf.pdf
Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M.
Mapping vaccine hesitancy—country-specific
characteristics of a global phenomenon.
Global None Mixed methods study Vaccine Hesitancy Vaccine. 32(49):6649-54.
https://doi.org/10.1016/j.vaccine.2014.0
9.039
Falade BA. Vaccination resistance, religion, and attitudes
to science in Nigeria.
Nigeria Islam PhD thesis [Unpublished
doctoral dissertation thesis].
Vaccine Hesitancy;
Religion & immunization;
Polio
http://etheses.lse.ac.uk/911/1/Falade_Va
ccination-resistance-religion-and-
attitudes-to-science-in-Nigeria.pdf
Ha W, Salama P, Gwavuya S, Kanjala C. Is religion the
forgotten variable in maternal and child health? Evidence
from Zimbabwe.
Zimbabwe Apostolic Statistics review Vaccine Hesitancy; BCG
Vaccine
Soc Sci Med. 1982;118:80–8.
https://doi.org/10.1016/j.socscimed.2014
.07.066
Muslim religious scholars. Dakar declaration on
vaccination.
Africa Islam Declaration Vaccine Hesitancy International Conference on Vaccination
and Religion. Dakar, Senegal.
https://www.afro.who.int/sites/default/fi
les/2017-
09/Religious%20Leaders%20Declaration.
pdf
Nasir SG, et al. From intense rejection to advocacy: how
Muslim clerics were engaged in a polio eradication
initiative in Northern Nigeria.
Nigeria Islam Analysis Vaccine Hesitancy; Polio PLoS Med. 11(8):e1001687.
https://doi.org/10.1371/journal.pmed.10
01687
https://aps.journals.ac.za/pub/article/view/439/393
https://doi.org/10.52711/0974-360X.2022.00001
https://doi.org/10.52711/0974-360X.2022.00001
https://www.ajhe.org.in/uploads/55/3075_pdf.pdf
https://www.ajhe.org.in/uploads/55/3075_pdf.pdf
https://doi.org/10.1016/j.vaccine.2014.09.039
https://doi.org/10.1016/j.vaccine.2014.09.039
http://etheses.lse.ac.uk/911/1/Falade_Vaccination-resistance-religion-and-attitudes-to-science-in-Nigeria.pdf
http://etheses.lse.ac.uk/911/1/Falade_Vaccination-resistance-religion-and-attitudes-to-science-in-Nigeria.pdf
http://etheses.lse.ac.uk/911/1/Falade_Vaccination-resistance-religion-and-attitudes-to-science-in-Nigeria.pdf
https://doi.org/10.1016/j.socscimed.2014.07.066
https://doi.org/10.1016/j.socscimed.2014.07.066
https://www.afro.who.int/sites/default/files/2017-09/Religious%20Leaders%20Declaration.pdf
https://www.afro.who.int/sites/default/files/2017-09/Religious%20Leaders%20Declaration.pdf
https://www.afro.who.int/sites/default/files/2017-09/Religious%20Leaders%20Declaration.pdf
https://www.afro.who.int/sites/default/files/2017-09/Religious%20Leaders%20Declaration.pdf
https://doi.org/10.1371/journal.pmed.1001687
https://doi.org/10.1371/journal.pmed.1001687
22 Melillo, Strachan, O’Brien, Wonodi, Bormet & Fountain
May 2022. Christian Journal for Global Health 9(1)
Olivier J. Local faith communities and immunization for
community and health systems strengthening.
Global Multiple Literature review Vaccine Hesitancy;
Religion & immunization
Joint Learning Initiative on Faith and Local
Communities. https://jliflc.com/wp-
content/uploads/2014/09/LOCAL-FAITH-
COMMUNITIES-AND-IMMUNIZATION-
FOR-COMMUNITY-AND-HEALTH-
SYSTEMS.pdf
Padela AI, Furber SW, Kholwadia MA, & Moosa E. Dire
necessity and transformation: entry-points for modern
science in Islamic bioethical assessment of porcine
products in vaccines.
Global Islam Bioethical commentary Vaccine Hesitancy Bioethics. 28(2):59-66.
https://doi.org/10.1111/bioe.12016
World Health Organization/Sage Working Group on
Vaccine Hesitancy. Strategies for addressing vaccine
hesitancy— systematic review.
Global None Review article Vaccine Hesitancy;
Religion & immunization
https://www.who.int/immunization/sage
/meetings/2014/october/3_SAGE_WG_St
rategies_addressing_vaccine_hesitancy_2
014.pdf
World Health Organization/Sage Working Group on
Vaccine Hesitancy. Report of the Sage Working Group on
vaccine hesitancy
Global None Report Vaccine Hesitancy https://www.who.int/immunization/sage
/meetings/2014/october/SAGE_working_
group_revised_report_vaccine_hesitancy.
pdf?ua=1%20
2015
Cobos Muñoz D, Monzón Llamas L, Bosch-Capblanch X.
Exposing concerns about vaccination in low- and middle-
income countries: a systematic review.
Global -
LMICs
Review Vaccine Hesitancy Int J Public Health. 60:767–80.
https://doi.org/10.1007/s00038-015-
0715-6
Gavi. Approach to engagement with the faith-based
community.
Global Multiple
religions
White paper Religion & immunization
Jarrett C, Wilson R, O’Leary M, Eckersberge E, Larson H.
Strategies for addressing vaccine hesitancy—a systematic
review.
Global None Review Vaccine Hesitancy Vaccine. 33(34):4180-90.
https://doi.org/10.1016/j.vaccine.2015.0
4.040
Khan MU, et al. Knowledge, attitudes and perceptions
towards polio immunization among residents of two highly
affected regions of Pakistan.
Pakistan Islam Descriptive cross-sectional
study
Vaccine Hesitancy; Polio BMC Public Health. 15:1100.
https://doi.org/10.1186/s12889-015-
https://jliflc.com/wp-content/uploads/2014/09/LOCAL-FAITH-COMMUNITIES-AND-IMMUNIZATION-FOR-COMMUNITY-AND-HEALTH-SYSTEMS.pdf
https://jliflc.com/wp-content/uploads/2014/09/LOCAL-FAITH-COMMUNITIES-AND-IMMUNIZATION-FOR-COMMUNITY-AND-HEALTH-SYSTEMS.pdf
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Abstract
Introduction
Methods
Results
Description of the resources reviewed
Despite results, there is still scant published evidence of the role of religion and local faith actors on immunization.1 Most studies treat religion as a confounding variable without a detailed examination of the nuanced impact or inter-related fact...
Figure 3. Literature review findings: Top focal countries (as of January 15, 2021)
References
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