Title Goes Here Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 1 | 11 REVIEW ARTICLE The willingness of COVID-19 vaccination and associated factors: A systematic review Tiara Fani1, Kriswiharsi Kun Saptorini1, Aprilia Diah Anggreani1 1 Associate Degree of Medical Record and Health Information Program, Faculty of Health Science, Dian Nuswatoro University, Semarang City. Indonesia. Corresponding author: Tiara Fani; Address: Faculty of Health Science, Dian Nuswatoro University, Semarang City, Indonesia; E-mail: tiara.fani@dsn.dinus.ac.id Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 2 | 11 Abstract Aim: Vaccination is an effective approach to avoid infection and reduce morbidity and mortality of infectious diseases. However, in previous infectious disease vaccination programs, some people were hesitant to get vaccinated. To develop an effective vaccination program or policy, the government or public health officials need to understand the factors that influence the willingness of COVID-19 vaccination from the various studies. Methods: Between 1-18 December 2020, articles were searched from PubMed and ScienceDirect with the following key terms: Willingness, Acceptance, Acceptability, COVID- 19 vaccine, and COVID-19 vaccination. Eligibility for article inclusion criteria was determined by PRISMA. Results: 20 studies were included in this review. All studies were conducted in the early days of the COVID-19 pandemic. The willingness of COVID-19 vaccination ranged from 60-97% among the general population, 28-63% among healthcare workers, 56-65% among parents or caregivers, and 73% among factory workers. The common factors that affected the willingness of COVID-19 vaccination: gender, age, education, individual perception about diseases and the vaccine, trust in the government, statements of public health officials and health providers. Conclusion: Concerns about disease risk, effectiveness, and side effects are important factors associated with vaccination willingness. To avoid vaccination hesitancy in the community, public health officials need to disseminate detailed information about the vaccines like efficacy level and side effects, and continue to provide information about the risks of COVID- 19 for personal health and others through various online media to avoid vaccination hesitancy. Keywords: COVID-19, determinants, vaccination willingness. Conflicts of interest: None declared. Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 3 | 11 Introduction Until the end of 2020, there was no cure or herd immunity for the COVID-19 outbreak. The pandemic is a serious threat to public health and welfare (1). Vaccination is an effective approach to stop and prohibit infection and reduce morbidity and mortality of infectious diseases (2). In 2020, several countries had developed and distributed COVID-19 vaccines to reduce and eradicate the COVID-19 outbreak (3). During a disease pandemic such as the COVID-19 pandemic, vaccines must be developed and distributed effectively and efficiently. Some people were still hesitant to get vaccinated in previous infectious disease vaccination programs (2). Therefore, it is necessary to formulate a vaccination program or policy that can encourage people to get vaccinated. To develop an effective vaccination program or policy, the government or public health officials need to understand the factors that influence people's decisions to accept or reject vaccines. In 2020, several surveys have examined the acceptance or willingness of the COVID-19 vaccine and the determinant factors. Therefore, this systematic review of published articles combined data from related surveys and identified factors that influence COVID-19 vaccination willingness in the general and specific populations. Methods Search Strategy We searched for articles indexed in the electronic databases of PubMed and Sciencedirect with the following key terms: Willingness, Acceptance, Acceptability, COVID-19 vaccine, and COVID-19 vaccination. Articles were searched 1-18 December, 2020. The search terms were combined with the Boolean operator as follows: “(willingness OR acceptance OR acceptability) AND (covid-19 vaccine OR covid-19 vaccination)”. Furthermore, relevant articles had extracted from the references section of the manuscripts found in the initial search. Selection criteria We searched articles that examine the willingness or acceptance of COVID-19 vaccination. We included observational research articles; research on the prevalence of willingness to take the COVID-19 vaccine, and COVID-19 vaccination willingness/acceptance factors. We excluded articles: systematic reviews, narrative reviews, data articles, letters to editors, and published on pre-print or pre-proof servers; articles published in languages other than English; information about COVID-19 vaccination acceptance or hesitancy was unclear. Eligibility for article inclusion and exclusion criteria determined by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) according to the diagram in Figure 1. Results Study Selection 822 articles were found in the electronic database PubMed and Sciencedirect. From the search results, 20 articles met the selection criteria for further analysis (Figure 1). Study Characteristics The studies included in the analysis observed general populations (70%) (4-17) healthcare workers (15%) (18-20) parents and caregivers (10%) (11,21) and factory workers (5%) (22). All surveys in reviewed articles were self-administered (based on online surveys), and the sample size ranged from 613 to 13,426 respondents. The studies mostly surveyed in China, US and European Countries and were mostly conducted in the early days of the pandemic before the COVID-19 vaccine availability in the respective countries. 40% articles were published in journals on vaccines (Table 1). Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 4 | 11 Vaccination Willingne The reported willingness to participate in the COVID-19 vaccination ranged from 60.0% to 97.0% among general population respondents (4-7,9,10,12-17,23), 27.7% to 63.0% among healthcare workers (18-20), 55.8%-65.0% among parents or caregivers (11,21), and 72.6% among factory workers (22). Figure 1. PRISMA diagram of studies selected Records identified through database searching Sciencedirect and Pubmed (n = 822) Articles Excluded Duplicates (n = 8) Articles Screened by the abstract (n = 814) Full-text articles assessed for eligibility (n=32) Studies Included (n = 20) Articles Excluded • Irrelevant (n = 705) • Full-text not available (n=55) • Articles not in English (n=3) • Preprints, preproof, review articles (n= 19) Articles Excluded • Did not report percentages of COVID-19 Vaccination acceptance (n=10) • Did not report study population (n=1) • Data Article (n=1) Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 5 | 11 Table 1. Study characteristics Study Journal Year Country n Time of Study Data Collection Method Characteristic of Participants COVID-19 Vaccination Willingness Kwok, Kin On et al (18) International Journal of Nursing Studies 2020 China 1205 mid-March and late April 2020 Online survey Nurses with mean age = 40.79, mostly female nurses (90%). 63% Bell, Sadie et al (21) Vaccine 2020 England 1252 April 19 and May 11, 2020 Online survey and structure interview parent or guardian of a child aged ≤18 months, England residents, and aged above 16 years. Definitely Accept: 55.8%; Unsure but leaning towards yes: 34.3% Guidry et al (4) American Journal of Infection Control 2020 US 788 Jul-20 Online survey General Populations above 18 years 60% definitely or probably willing to take COVID-19 vaccine. Karlsson et al (5) Personality and Individual Differences 2020 Finland 1325 3rd and 17th of April 2020 Online survey General Populations whose Facebook users ¾ of respondents (21.83% likely, 51.1% very likely) Malik et al (10) EClinical Medicine 2020 US 672 May-20 Online survey General Populations above 18 years 67% Goldman et al (11) Vaccine 2020 Canada, USA, Japan, Spain, Switzerland, Israel. 1541 March 26- May 31, 2020 Online survey Caregivers and their children arrive to 16 pediatric Emergency Departments (ED) 65% Sarasty et al (12) Vaccine 2020 Ecuador 1,050 April 2 to 7, 2020 Online survey General Populations 97% Detoc et al (23) Vaccine 2020 France 3259 March 26 to April 20,2020 Online survey General Populations above 18 years and adult patients in France. 77.6% (general populations) 81.5%, (healthcare workers) 73.7% (non-healthcare workers) Leng et al (13) Vaccine 2020 China 1883 Not reported Online survey General Population in some Chinese provinces. 84.77% Reiter et al (14) Vaccine 2020 United States 2,006 May-20 Online survey US General Populations aged ≥18 years 69% Wang K. et al (19) Vaccine 2020 China 806 26 February and 31 March 2020 Online survey Nurses 40.0% Wang J. et al (15) Vaccine 2020 China 2058 Mar-20 Online survey General Populations above 18 years in China 91.3% Harapan et al (16) Frontiers in Public Health 2020 Indonesia 1,359 March 25 and April 6, 2020 Online survey General population in Indonesia 93.3% (95% effective vaccine), 67.0% (50% effectiveness) Lazarus et al (17) Nature Medicine 2020 19 countries 13,426 Jun-20 Online survey General populations in 19 countries 46.8% and 24.7% Completely and somewhat agree. Palamenghi et al (6) European Journal of Epidemiology 2020 Italy 968 Not reported Online survey General Populations 59% Al-Mohaithef et al (7) Journal of Multidisciplinar y Healthcare 2020 Saudi Arabia 992 Not reported Online survey General population in 4 major cities (Dammam, Jeddah, Riyadh, and Abha) in Saudi Arabia 642 have an interest to accept the COVID-19 vaccine Salali et al (8) Cambridge University Press 2020 UK and Turkey UK: 1088 Turkey: 3936 May-20 Online survey General Populations above 18 years Not reported Nzaji et al (20) Pragmatic and Observational Research 2020 Congo 613 March to April 30,2020 Online survey HCWs in some referral Hospital and University Hospital in Lubumbashi, Mbuji-Mayi, and Kamina towns 27.7% Zhang et al (22) JMIR Pediatrics And Parenting 2020 China 1052 September 1 to 7, 2020 Online survey Factory workers in Shenzhen who had at least 1 child under 18 years 72.6% Neumann- Böhme, Sebastian et al (9) The European Journal of Health Economics 2020 Germany, Italy, Denmark, France, Portugal, the Netherlands, UK 7664 2 and 15 April, 2020 Online survey General populations 73.9% Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 6 | 11 Socio-Demographic Factors Several studies have reported that socio- demographic factors influence a person's decision to take the COVID-19 vaccine. Most studies show that men were more interested to participate in the COVID-19 vaccination than women, both in the general populations and among healthcare workers (4,8-11,14,15,17,19,20,23). Several studies have shown that age is related to the decision to take the COVID-19 vaccine. People in the older age groups (=>40years) were more willing to take the COVID-19 vaccine (5-7,9-11,13,17,20,23), but one study showed the opposite (18). Meanwhile, in the young and middle age groups, there was no consistency, several studies reported that the younger (<24 years) (6,18) or middle age groups (24-<40 years) (17) were more willing to take the vaccine, other studies reported opposite results (6,17). Four articles reported that the education level is associated with the willingness to participate in COVID-19 vaccination, but there was inconsistency in the results. Three articles reported that people showed more willingness with higher education (4,10,17) to get COVID-19 vaccine, while one article reported this for people with lower education (13). Other demographic variables related to willingness to participate in vaccination against COVID-19 are being married, marital status (7,15), working as a healthcare workers (20,23), working in private services (19), and household income (13,14,17,21). Determinant of willingness The factors or reasons that influence the general population's willingness to participate in Covid-19 Vaccination vary considerably. Common factors or reasons to accept COVID-19 vaccination are perceptions to contract more likely COVID- 19 (5,7,8,13-15) and COVID-19 as a severe/dangerous disease (5,14,23), those who had a higher perceived-risk level of COVID-19 infection (10,14,16,23), those who had been vaccinated against influenza (11,15,19), those who had higher trust that the vaccine is safe (5,6,13,20), living in a country or place with a higher number of COVID-19 cases (14,15,17) or if vaccine was free, cheap, or convenient (13,15,16), other factors are less frequently named in the selected literature. Among parents or caregivers, the factors that influence the willingness to get COVID-19 vaccination for their children were: age of the child (11,22), family support, perceived behavioral control about COVID-19 vaccination in children, had a higher exposure to positive information about COVID-19 vaccination, avoiding social gatherings with other people or crowded places (22), having children that were up-to- date on their vaccines and had no chronic illness; caregiver/parents that have concerns about their child and others (11), and having 2-3 children (21). Several factors that make people refuse to be vaccinated are: those who are concerned about the vaccine safety and side effects (9,11,13-15,17,19), concerns related to vaccines that are new or developed rapidly (11,19), concerns about the effectiveness of vaccines to prevent transmission of COVID-19 (16,19), if vaccines have a short protection duration (≤2 years), and required higher doses (13). Discussion Before the COVID-19 vaccine was available, all affected countries found it difficult to control the spread of COVID-19 by enforcing quarantine, lockdowns, social distancing, and mandatory use of face masks while in public places, and travel restrictions. The current pandemic has caused tremendous physical and psychosocial health impairments for society and has driven massive problems in the global economy. Therefore, various Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 7 | 11 countries have started to develop vaccines. Vaccines are an effective way to control the transmission of communicable disease outbreaks (24). There has been a lot of research to determine the vaccine acceptance/willingness and its associated factors. Based on this review, the willingness to get the COVID-19 vaccine varies considerably among general populations and healthcare workers. Most studies report a willingness to be vaccinated in the range of 50-70%. These results need essential consideration to support vaccination programs in the general populations and particular groups. Socio-demographic factors that most frequently affected the decision-making regarding COVID-19 vaccination were gender, age, and education in the general population and certain sub-groups. Men were more likely willing to get the COVID- 19 vaccine than women. Several systematic reviews reported that during the 2009 pH1N1 pandemic, pertussis, hepatitis B, and influenza vaccination met a consistently higher acceptance in males than females worldwide (2,25,26). Women were more concerned about vaccine side effects and getting infected by the novel disease. Therefore, women were more willing to use protective measures during epidemics or pandemics (27,28). Older age and higher educated people were more likely to have vaccine intentions. Older age groups had more willingness because they had higher incidence and mortality than a younger age. In addition, comorbidity as a higher COVID 19 risk factor is common among older people (29). Even though age, education, occupation, and household income were associated with covid 19 vaccine uptake intentions, the results were still inconsistent between the selected studies. Other factors and category differences in the selected studies may affect these inconsistent results. Personal perception regarding the risk of disease and the COVID-19 vaccine is an essential factor in vaccine acceptance. In previous vaccination programs, vaccine side effects and efficacy were the main considerations for vaccine acceptance (2,27,30). Vaccination acceptance was relatively high when people perceived that the vaccine has very high effectiveness, safety, and no adverse side effects. This review also found that vaccine acceptance was affected by personal perceptions of the severity, adverse effects (5,14,23), and disease transmission risks of COVID-19 (5,8,14-16,23,31,32). Concerns related to vaccine side effects and safety (6,9,11,13– 15,17,19,20), the effectiveness of the COVID-19 vaccine (14-16,19), vaccines that were new or developed rapidly (11,19) affected COVID-19 vaccine uptake. Some studies reported the duration of vaccine protection and vaccine doses also affected the willingness of COVID-19 vaccination (13). Several countries have distributed vaccines to the community. Several types of vaccines have an efficacy >90%, like Pfizer- BioNTech (95%), Moderna (94.5%), Russia's Sputnik V Vaccine (92%). Several vaccines with an efficacy rate <90% also were distributed in countries. For example, AstraZeneca with 70% average from a combination of two analyses. Sinovac Biotech (based on late-stage clinical trials in Brazil) a vaccine efficacy rate of 50.4%. However, recently other tests conducted by Butantan Institute, Brazil showed a 78% efficacy rate of Sinovac Biotech in mild cases and 100% in moderate and severe cases (33). After distribution, there were reports of vaccine side effects in patients after vaccine injection. Apart from the typical side effects of vaccines (muscle pain, headache, and fatigue), some cases reported severe/rare effects after vaccination. Uncommon reported side effects include Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 8 | 11 anaphylactic shock, facial paralysis, and even death after a few days of being injected with certain types of vaccines. Even so, it still needs further exploration (34). People were more likely to uptake the COVID-19 vaccine if the vaccines were free, cheap, or convenient (3,15,16). In this review, several studies reported healthcare provider recommendations on vaccination (14,15), people who trusted their government (8,17), and the health system in their respective country (7,35) affected vaccination acceptance. Nowadays, people access health information from various sources, including social media platforms that gain popularity globally. Social media popularity grows public health concerns regarding the impacts of anti-vaccination or conspiracy theory contents (36). A study showed that about 50% of the population has little evidence of conspiracy thinking about coronavirus. The conspiracy beliefs lead to mistrust, less compliance with government guidelines, and unwillingness to participate in future tests or treatment. The holders of coronavirus conspiracy beliefs were more likely to share their opinions with others (37). Therefore, misinformation about COVID-19 and vaccines will spread in the community. Misinformation about the efficacy and side effects of the vaccine lead to vaccine hesitancy. Public health officials should disseminate complete information about the vaccines like efficacy level and side effects through various online media. Providing detailed information about vaccines to the public is essential to avoid vaccine hesitancy due to widespread misinformation. The government and health providers also need to follow up on the widespread of misinformation about the vaccine. Limitations Hardly any studies with specific populations (health workers, parents or child caregivers, and factory workers) were selected in this review. Several factors and reasons related to the willingness of COVID-19 vaccination were inconsistent because the questions regarding the determinants in the selected studies varied. In addition, the article selection process did not consider the reported study bias in the reviewed articles. Conclusion The factors that consistently affected the willingness of COVID-19 vaccination include gender, age, and educational level, individual perception about the disease and the vaccine, as well as trust in the government, public health officials, and health providers. Concerns about disease risk, effectiveness, and side effects are the most important factors. Therefore, to avoid vaccination hesitancy in the community public health officials need to disseminate detailed information about the vaccines like efficacy level and side effects and continue to provide information about the risks of COVID-19 for personal health and others through various online media. The government and health providers also need to follow up on the widespread misinformation about the vaccine. Further research needs to explore health promotion methods in the vaccination program and health literacy in general populations. References 1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 [Internet]. Available from: https://www.who.int/director- general/speeches/detail/who- director-general-s-opening-remarks- at-the-media-briefing-on-covid-19--- 12-october-2020 (accessed: 2020 December 29, 2020). 2. Nguyen T, Henningsen KH, Brehaut JC, Hoe E, Wilson K. Acceptance of Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 9 | 11 a pandemic influenza vaccine: A systematic review of surveys of the general public. Infect Drug Resist 2011;4:197-207. 3. Oxford Martin School. Statistics and Research: Coronavirus (COVID-19) Vaccinations [Internet]. Available from: https://ourworldindata.org/covid- vaccinations (accessed: December 29, 2020). 4. Guidry JPD, Laestadius LI, Vraga EK, Miller CA, Perrin PB, Burton CW, et al. Willingness to get the COVID-19 vaccine with and without emergency use authorization. Am J Infect Control 2021;49:137-42. 5. Karlsson LC, Soveri A, Lewandowsky S, Karlsson L, Karlsson H, Nolvi S, et al. Fearing the disease or the vaccine: The case of COVID-19. Pers Individ Dif 2021;172:110590. 6. Palamenghi L, Barello S, Boccia S, Graffigna G. Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy. Eur J Epidemiol 2020;35:785-8. 7. Al-Mohaithef M, Padhi BK. Determinants of COVID-19 Vaccine Acceptance in Saudi Arabia: A Web- Based National Survey. J Multidiciplinary Healthc 2020;13:1657-63. 8. Salali GD, Uysal MS. COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol Med 2020;(i):26-8. 9. Neumann-Böhme S, Varghese NE, Sabat I, Barros PP, Brouwer W, van Exel J, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Heal Econ 2020;21:977-82. 10. Malik AA, McFadden SAM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. E Clinical Medicine 2020;26:100495. 11. Goldman RD, Yan TD, Seiler M, Cotanda CP, Brown JC, Klein EJ, et al. Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey. Vaccine 2020;38:7668-73. 12. Sarasty O, Carpio CE, Hudson D, Guerrero-Ochoa PA, Borja I. The demand for a COVID-19 vaccine in Ecuador. Vaccine 2020;38:8090-8. 13. Leng A, Maitland E, Wang S, Nicholas S, Liu R, Wang J. Individual preferences for COVID- 19 vaccination in China. Vaccine 2021;39:247-54. 14. Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine 2020;38:6500- 7. 15. Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al. Acceptance of covid-19 vaccination during the covid-19 pandemic in China. Vaccines 2020;8:1-14. 16. Harapan H, Wagner AL, Yufika A, Winardi W, Anwar S, Gan AK, et al. Acceptance of a COVID-19 Vaccine in Southeast Asia: A Cross-Sectional Study in Indonesia. Front Public Health 2020;8:1-8. 17. Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 2020;27:225-8. 18. Kwok KO, Li KK, Wei WI, Tang A, Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 10 | 11 Wong SYS, Lee SS. Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey. Int J Nurs Stud 2021;114:103854. 19. Wang K, Wong ELY, Ho KF, Cheung AWL, Chan EYY, Yeoh EK, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: A cross- sectional survey. Vaccine 2020;38:7049-56. 20. Nzaji MK, Ngombe LK, Mwamba GN, Ndala DBB, Miema JM, Lungoyo CL, et al. Acceptability of Vaccination Against COVID-19 Among Healthcare Workers in the Democratic Republic of the Congo. Pragmatic Obs Res 2020;11:103-9. 21. Bell S, Clarke R, Mounier-Jack S, Walker JL, Paterson P. Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England. Vaccine 2020;38:7789-98. 22. Zhang KC, Fang Y, Cao H, Chen H, Hu T, Chen YQ, et al. Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey. JMIR Pediatr Parent 2020;3:e24827. 23. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux- Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine 2020;38:7002-6. 24. Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China. PLoS Negl Trop Dis 2020;14:e0008961. 25. Klein SL, Pekosz A. Sex-based Biology and the Rational Design of Influenza Vaccination Strategies. J Infect Dis 2014;209S114-9. 26. Pulcini C, Massin S, Launay O, Verger P. Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey. Vaccine 201320;31:3943-9. 27. Lin C, Tu P, Beitsch LM. Confidence and Receptivity for COVID-19 Vaccines: A Rapid Systematic Review. Vaccines 2020;9:16. 28. Moran KR, Del Valle SY. A Meta- Analysis of the Association between Gender and Protective Behaviors in Response to Respiratory Epidemics and Pandemics. PLoS One 2016;11:e0164541. 29. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146:110-8. 30. Newman PA, Logie C. HIV vaccine acceptability: a systematic review and meta-analysis. AIDS 2010;24:1749-56. 31. Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. E Clinical Medicine 2020;26:100495. 32. Al-Mohaithef M, Padhi BK. Determinants of COVID-19 Vaccine Acceptance in Saudi Arabia: A Web- Fani T, Saptorini KK, Anggreani AD. The Willingness of COVID-19 Vaccination and Associated Factors: A Systematic Review (Review article). SEEJPH 2022, posted: 09 May 2022. DOI: 10.11576/seejph-5454 P a g e 11 | 11 Based National Survey. J Multidiscip Healthc 2020;13:1657. 33. Terry M. UPDATED Comparing COVID-19 Vaccines: Timelines, Types and Prices. BioSpace [Internet]. Available from: https://www.biospace.com/article/co mparing-covid-19-vaccines-pfizer- biontech-moderna-astrazeneca- oxford-j-and-j-russia-s-sputnik-v/ (accessed: January 25, 2021). 34. Freund A. COVID-19: Risks and side effects of vaccination. DW; 2021 [Internet]. Available from: https://www.dw.com/en/covid-19- risks-and-side-effects-of- vaccination/a-56136620 (accessed: January 25, 2021). 35. Larson HJ, Clarke RM, Jarrett C, Eckersberger E, Levine Z, Schulz WS, et al. Measuring trust in vaccination: A systematic review. Hum Vaccines Immunother 2018;141599-609. 36. Puri N, Coomes EA, Haghbayan H, Gunaratne K. Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases. Hum Vaccin Immunother 2020;16:2586-93. 37. Freeman D, Waite F, Rosebrock L, Petit A, Causier C, East A, et al. Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychol Med 2020;1-13. _____________________________________________________________________________________________ © 2022 Fani et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conflicts of interest: None declared. We searched articles that examine the willingness or acceptance of COVID-19 vaccination. We included observational research articles; research on the prevalence of willingness to take the COVID-19 vaccine, and COVID-19 vaccination willingness/acceptan... Results