Title : Barriers, facilitators and public health strategies for COVID-19 vaccine uptake in low- and middle-income countries: A scoping review

Background: COVID-19 vaccination was a major public health intervention during the pandemic, but uptake varied widely across low- and middle-income countries. Acceptance was shaped by safety concerns, misinformation, trust, access barriers, cultural beliefs and the strength of public health response systems. This scoping review mapped evidence on barriers, facilitators and public health response strategies influencing COVID-19 vaccine uptake in low- and middle-income countries.

Methodology: This scoping review was guided by the Joanna Briggs Institute approach and the PRISMA extension for scoping reviews. The Population, Concept and Context framework was used to define eligibility criteria. Searches were conducted in PubMed, MEDLINE, Scopus, Google Scholar and ScienceDirect, with additional searches of grey literature and public health organisation sources. Studies published in English from 2021 onwards were considered. Data were extracted into a structured charting matrix and synthesised narratively according to the review objectives.

Results: A total of 238 studies were included. The evidence covered low- and middle-income country settings across sub-Saharan Africa, South Asia, Southeast Asia, Latin America and the Caribbean, including single-country studies and multi-country datasets. Cross-sectional and survey-based studies were dominant, accounting for 176 included studies, with fewer qualitative, mixed-methods and intervention studies. The main barriers to COVID-19 vaccine uptake were safety and side-effect concerns, misinformation, conspiracy beliefs, low institutional trust, limited vaccine access, logistical difficulties, religious beliefs and cultural concerns. Key facilitators included trust in healthcare workers, perceived vaccine benefits, accurate vaccine knowledge, community engagement, improved access and locally adapted public health communication. Public health response strategies included risk communication, health education, trusted messenger approaches, social media campaigns, community mobilisation and equity-focused service delivery.

Conclusion: COVID-19 vaccine uptake in low- and middle-income countries was shaped by both individual beliefs and wider structural conditions. Improving vaccine acceptance requires more than vaccine availability; it requires transparent communication, trusted community engagement, equitable access and strong health system delivery. Future vaccination programmes should prioritise context-specific strategies that address misinformation, build trust and reduce practical barriers to uptake.

Keywords: COVID-19; vaccine uptake; vaccine hesitancy; vaccine acceptance; low- and middle-income countries; public health response; misinformation; scoping review.

Evans Akwaboah is a Graduate Research Assistant at the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana. He holds a First Class BSc in Biological Sciences from Kwame Nkrumah University of Science and Technology. His research interests span infectious disease epidemiology, public health, evidence synthesis and scientific communication, with particular interest in translating research evidence into practical strategies that strengthen prevention, trust and equitable health service delivery.