What can we learn to increase vaccination in Latin America: Factors associated with COVID-19 vaccination

Susana Torres; Juan Pablo Román-Calderón; Mariantonia Lemos

doi:10.22235/cp.v19i2.4460

Authors

Susana Torres Universidad EAFIT https://orcid.org/0000-0001-5393-1296
Juan Pablo Román-Calderón Universidad EAFIT https://orcid.org/0000-0002-4352-8513
Mariantonia Lemos Universidad EAFIT https://orcid.org/0000-0002-9131-4704

DOI:

https://doi.org/10.22235/cp.v19i2.4460

Keywords:

COVID 19, Latin America, Vaccination, COM-B model

Abstract

Background: Even though vaccination may serve to effectively overcome the COVID-19 pandemic, vaccine hesitancy is still prevalent and affected by different variables. This research is intended to understand which variables influence the likelihood of an individual getting a COVID-19 vaccine in a sample from Latin America, applying the COM-B model. Method: 368 individuals from Latin America answered a self-administered, cross-sectional survey from the iCARE study. Survey data began in March 2020 using convenience snowball sampling (globally) and parallel representative sampling in targeted countries. Results: A structural equation model showed that knowing that getting vaccinated will help protect others, wanting to contribute to high vaccination rates among the population to achieve herd immunity, and believing that getting vaccinated would reduce personal worries and anxiety predict the likelihood of an individual getting vaccinated. This shows that in this sample, motivators are more salient than capabilities and opportunities regarding vaccination uptake. Conclusions: Campaigns to reduce vaccine hesitancy need to highlight the prosocial factors of getting vaccinated and increase vulnerability and risk perceptions regarding the disease.

Downloads

Download data is not yet available.

References

Argote, P., Barham, E., Daly, S. Z., Gerez, J. E., Marshall, J., & Pocasangre, O. (2021). The shot, the message, and the messenger: COVID-19 vaccine acceptance in Latin America. Npj Vaccines, 6(1). https://doi.org/10.1038/s41541-021-00380-x

Askarian, M., Semenov, A., Llopis, F., Rubulotta, F., Dragovac, G., Pshenichnaya, N., Assadian, O., & Ruch, Y. (2022). The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 countries: A multicenrer cross-sectional study. EXCLI Journal, 21, 93-103. https://doi.org/10.17179/excli2021-4439

Bacon, S. L., Lavoie, K. L., Boyle, J., Stojanovic, J., & Joyal-Desmarais, K. (2021). International assessment of the link between COVID-19 related attitudes, concerns and behaviours in relation to public health policies: Optimising policy strategies to improve health, economic and quality of life outcomes (the iCARE Study). BMJ Open, 11(3). https://doi.org/10.1136/bmjopen-2020-046127

Bates, B. R., Villegas-Botero, A., Costales, J. A., Moncayo, A. L., Tami, A., Carvajal, A., & Grijalva, M. J. (2022). COVID-19 Vaccine Hesitancy in Three Latin American Countries: Reasons Given for Not Becoming Vaccinated in Colombia, Ecuador, and Venezuela. Health Communication, 37(12), 1465-1475. https://doi.org/10.1080/10410236.2022.2035943

Betsch, C., Böhm, R., & Korn, L. (2013). Inviting free-riders or appealing to prosocial behavior? Game-theoretical reflections on communicating herd immunity in vaccine advocacy. Health Psychology, 32(9), 978-985. https://doi.org/10.1037/a0031590

Bhopal, S., & Nielsen, M. (2021). Vaccine hesitancy in low- And middle-income countries: Potential implications for the COVID-19 response. Archives of Disease in Childhood, 106(2), 113–114. https://doi.org/10.1136/archdischild-2020-318988

Blank, P. R., Bonnelye, G., Ducastel, A., & Szucs, T. D. (2012). Attitudes of the General Public and General Practitioners in Five Countries towards Pandemic and Seasonal Influenza Vaccines during Season 2009/2010. PLoS ONE, 7(10), 1-8. https://doi.org/10.1371/journal.pone.0045450

Böhm, R., & Betsch, C. (2022). Prosocial vaccination. Current Opinion in Psychology, 43, 307-311. https://doi.org/10.1016/j.copsyc.2021.08.010

Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychology, 26(2), 136-145. https://doi.org/10.1037/0278-6133.26.2.136

Burki, T. (2020). COVID-19 in Latin America. The Lancet. Infectious Diseases, 20(5), 547-548. https://doi.org/10.1016/S1473-3099(20)30303-0

Cankat, S., Demael, M. U., & Swadling, L. (2023). In search of a pan-coronavirus vaccine: next-generation vaccine design and immune mechanisms. Cellular and Molecular Immunology, 21(2), 103–118. https://doi.org/10.1038/s41423-023-01116-8

Castilla, J., Guevara, M., Miqueleiz, A., Baigorria, F., Ibero-Esparza, C., Navascués, A., Trobajo-Sanmartín, C., Martínez-Baz, I., Casado, I., Burgui, C., & Ezpeleta, C. (2021). Risk factors of infection, hospitalization and death from SARS-CoV-2: A population-based cohort study. Journal of Clinical Medicine, 10(12), 1-13. https://doi.org/10.3390/jcm10122608

Caycho-Rodríguez, T., Valencia, P. D., Vilca, L. W., Carbajal-León, C., Vivanco-Vidal, A., Saroli-Araníbar, D., Reyes-Bossio, M., White, M., Rojas-Jara, C., Polanco-Carrasco, R., Gallegos, M., Cervigni, M., Martino, P., Palacios, D. A., Moreta-Herrera, R., Samaniego-Pinho, A., Rivera, M. E. L., Ferrari, I. F., Flores-Mendoza, C., … Intimayta-Escalante, C. (2022). Prevalence and Predictors of Intention to be Vaccinated Against COVID-19 in Thirteen Latin American and Caribbean Countries. Trends in Psychology, 31, 865-889. https://doi.org/10.1007/s43076-022-00170-x

Chan, I. L., Mowson, R., Pedro, J., Roberti, J., Contreras, M., & Velandia-gonzález, M. (2022). Promoting immunization equity in Latin America and the Caribbean: Case studies, lessons learned, and their implication for COVID-19 vaccine equity. Vaccine, 40(13), 1977-1986. https://doi.org/10.1016/j.vaccine.2022.02.051

Contreras-Arrieta, S., Murrain, H., Vallejo, B. H., López, L. A. C., Hernández, F., Velasco, N., Garzón, J. S., Restrepo, S., & Varela, A. R. (2023). Vaccination against COVID-19 in Bogotá - Colombia: lessons and strategies in health pedagogy, risk communication and community participation, using behavioral sciences. Infectio, 27(3), 173-182. https://doi.org/10.22354/24223794.1142

d’Alessandro, E., Hubert, D., Launay, O., Bassinet, L., Lortholary, O., Jaffre, Y., & Sermet-Gaudelus, I. (2012). Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: A qualitative approach. PLoS ONE, 7(4). https://doi.org/10.1371/journal.pone.0034054

Debbag, R., Gallo, J., Ávila-Agüero, M. L., Beltran, C., Brea-Del Castillo, J., Puentes, A., & Enrique, S. (2025). Rebuilding vaccine confidence in Latin America and the Caribbean: strategies for the post-pandemic era. Expert Review of Vaccines, 24(1), 615–623. https://doi.org/10.1080/14760584.2025.2527327

Díaz, L., Villarreal, D. M., Márquez, K., & Scartascini, C. (2025). Combating Vaccine Hesitancy: The Case of HPV Vaccination. https://doi.org/10.18235/0013410

Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., Srouji, S., & Sela, E. (2020). Vaccine hesitancy: the next challenge in the fight against COVID-19. European Journal of Epidemiology, 35(8), 775-779. https://doi.org/10.1007/s10654-020-00671-y

Eureka-Putri-Taju, A., & Saadah, K. (2023). Corruption in Mexico and Vaccine Refusal. KnE Social Sciences, 8(3), 11-21. https://doi.org/10.18502/kss.v8i3.12812

Giese, H., Neth, H., Wegwarth, O., Gaissmaier, W., & Stok, F. M. (2023). How to convince the vaccine-hesitant? An ease-of-access nudge, but not risk-related information increased Covid vaccination-related behaviors in the unvaccinated. Applied Psychology: Health and Well-Being, 16(1), 198-215. https://doi.org/10.1111/aphw.12479

Guzman-Holst, A., DeAntonio, R., Prado-Cohrs, D., & Juliao, P. (2020). Barriers to vaccination in Latin America: A systematic literature review. Vaccine, 38(3), 470–481. https://doi.org/10.1016/j.vaccine.2019.10.088

Habersaat, K. B., & Jackson, C. (2020). Understanding vaccine acceptance and demand—and ways to increase them. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 63(1), 32-39. https://doi.org/10.1007/s00103-019-03063-0

Herry, A. M., Greaves, D., Smith, P., Toledo, N. A., Wildman, A., Wildman, T., Browne, R., Chen, M., Jones, M., & Aymat, S. (2023). Facilitators of and barriers to COVID-19 vaccination in Grenada: a qualitative study. Revista Panamericana de Salud Pública, 47, 1. https://doi.org/10.26633/rpsp.2023.44

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1-55. https://doi.org/10.1080/10705519909540118

Kaur, S. P., & Gupta, V. (2020). COVID-19 Vaccine: A comprehensive status report. Virus Research, 288. https://doi.org/10.1016/j.virusres.2020.198114

La Rotta, J., Escobar, O., Ávila-Aguero, M. L., Torres, J. P., Sini de Almeida, R., Morales, G. del C., & Srivastava, A. (2023). COVID-19 in Latin America: A Snapshot in Time and the Road Ahead. Infectious Diseases and Therapy, 12(2), 389-410. https://doi.org/10.1007/s40121-022-00748-z

Lapo-Talledo, G. J., Talledo-Delgado, J. A., Portalanza, D., Ballaz, S., & Siteneski, A. (2023). Analysis of Socio-demographic, Economic and Individual Reasons for COVID-19 Vaccination Hesitancy in Ecuador: A Nationwide Longitudinal Study. Journal of Community Health, 48(3), 467-479. https://doi.org/10.1007/s10900-023-01188-7

Lazarus, J. V., Ratzan, S. C., Palayew, A., Gostin, L. O., Larson, H. J., Rabin, K., Kimball, S., & El-Mohandes, A. (2021). A global survey of potential acceptance of a COVID-19 vaccine. Nature Medicine, 27(2), 225–228. https://doi.org/10.1038/s41591-020-1124-9

MacDonald, N. E., Eskola, J., Liang, X., Chaudhuri, M., Dube, E., Gellin, B., Goldstein, S., Larson, H., Manzo, M. L., Reingold, A., Tshering, K., Zhou, Y., Duclos, P., Guirguis, S., Hickler, B., & Schuster, M. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036

Matos, C. C. de S. A., Gonçalves, B. A., & Couto, M. T. (2022). Vaccine hesitancy in the global south: Towards a critical perspective on global health. Global Public Health, 17(6), 1087–1098. https://doi.org/10.1080/17441692.2021.1912138

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1). https://doi.org/10.1186/1748-5908-6-42

Moore, S., Hill, E. M., Dyson, L., Tildesley, M. J., & Keeling, M. J. (2023). Retrospectively modeling the effects of increased global vaccine sharing on the COVID-19 pandemic. Nature Medicine, 28(11), 2416-2423. https://doi.org/10.1038/s41591-022-02064-y

Murphy, J., Vallières, F., Bentall, R. P., Shevlin, M., Mcbride, O., Hartman, T. K., Mckay, R., Bennett, K., Mason, L., Gibson-miller, J., Levita, L., Martinez, A. P., Stocks, T. V. A., Karatzias, T., & Hyland, P. (2021). Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nature Communications, 12(29). https://doi.org/10.1038/s41467-020-20226-9

Muthén, L. K., & Muthén, B. O. (2017). Mplus User’s Guide (8th ed.) [Software].

Nunnally, J. C. (1978). Psychometric theory. McGrawHill.

Orensteina, W. A., & Ahmedb, R. (2017). Simply put: Vaccination saves lives. Proceedings of the National Academy of Sciences of the United States of America, 114(16), 4031–4033. https://doi.org/10.1073/pnas.1704507114

Pablos-Méndez, A., Vega, J., Aranguren, F. P., Tabish, H., & Raviglione, M. C. (2020). Covid-19 in Latin America. The BMJ, 370, 369-370. https://doi.org/10.1136/bmj.m2939

Pandher, R., & Bilszta, J. L. C. (2023). Novel COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students: a scoping review. Medical Education Online, 28(1). https://doi.org/10.1080/10872981.2023.2175620

Paul, E., Steptoe, A., & Fancourt, D. (2021). Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications. The Lancet regional health. Europe, 1, 100012. https://doi.org/10.1016/j.lanepe.2020.100012

Pogue, K., Jensen, J. L., Stancil, C. K., Ferguson, D. G., Hughes, S. J., Mello, E. J., Burgess, R., Berges, B. K., Quaye, A., & Poole, B. D. (2020). Influences on attitudes regarding potential covid‐19 vaccination in the united states. Vaccines, 8(4), 1-14. https://doi.org/10.3390/vaccines8040582

Qin, C., Wang, R., Tao, L., Liu, M., & Liu, J. (2022). Acceptance of a Third Dose of COVID-19 Vaccine and Associated Factors in China Based on Health Belief Model: A National Cross-Sectional Study. Vaccines, 10(1), 1-13. https://doi.org/10.3390/vaccines10010089

Ramonfaur, D., Limaye, R. J., Hinojosa-González, D. E., Barrera, F. J., Rodríguez-Gómez, G. P., & Castillo-Salgado, C. (2024). COVID-19 vaccine hesitancy prevalence in Mexico: A systematic review and metanalysis. Vaccine, 18, 100488. https://doi.org/10.1016/j.jvacx.2024.100488

Rivera, T., Brustrom, J., Vera Antelo, M., Puertas, E. B., Rhoda, D. A., & Velandia-Gonzalez, M. (2023). Understanding COVID-19 Vaccine Acceptance among Latin American Health Workers: Implications for Designing Interventions. Vaccines, 11(9), 1-15. https://doi.org/10.3390/vaccines11091471

Roberti, J., Ini, N., Belizan, M., & Alonso, J. P. (2024). Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. Cadernos de Saude Publica, 40(6). https://doi.org/10.1590/0102-311XEN165023

Rodrigues, E. S., Mendes, E. D. T., & Nucci, L. B. (2023). Parental Justifications for Not Vaccinating Children or Adolescents against Human Papillomavirus (HPV). Vaccines, 11(3), 506. https://doi.org/10.3390/vaccines11030506

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175-183.

Rubinstein, H., Marcu, A., Yardley, L., & Michie, S. (2015). Public preferences for vaccination and antiviral medicines under different pandemic flu outbreak scenarios. BMC Public Health, 15(1), 1-13. https://doi.org/10.1186/s12889-015-1541-8

Ruiz, J. B., & Bell, R. A. (2021). Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey. Vaccine, 39(7), 1080-1086. https://doi.org/10.1016/j.vaccine.2021.01.010

Salazar-Fernández, C., Baeza-Rivera, M. J., Villanueva, M., Bautista, J. A. P., Navarro, R. M., & Pino, M. (2022). Predictors of COVID-19 Vaccine Intention: Evidence from Chile, Mexico, and Colombia. Vaccines, 10(7). https://doi.org/10.3390/vaccines10071129

Sallam, M. (2021). Covid-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9(2), 1-15. https://doi.org/10.3390/vaccines9020160

Searles, M., Jose Ronquillo Mora, Y., Carlo, L., Heydari, N., Takyiwaa, Y., Borbor-Cordova, M. J., & Campagna, C. D. (2023). Zika virus knowledge and vaccine acceptance among undergraduate students in Guayaquil, Ecuador. Vaccine: X, 13, 100258. https://doi.org/10.1016/j.jvacx.2022.100258

Shafie, A. A., Moreira, E. D., Di Pasquale, A., Demuth, D., & Yin, J. Y. S. (2023). Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP). Vaccines, 11(3), 575. https://doi.org/10.3390/vaccines11030575

Siewchaisakul, P., Sarakarn, P., Nanthanangkul, S., Longkul, J., Boonchieng, W., & Wungrath, J. (2022). Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand. PLoS ONE, 17(6), e0270023. https://doi.org/10.1371/journal.pone.0270023

Stojanovic, J., Boucher, V. G., Gagne, M., Gupta, S., Joyal-Desmarais, K., Paduano, S., Aburub, A. S., Sheinfeld Gorin, S. N., Kassianos, A. P., Ribeiro, P. A. B., Bacon, S. L., & Lavoie, K. L. (2021). Global trends and correlates of covid-19 vaccination hesitancy: Findings from the icare study. Vaccines, 9(6), 1-13. https://doi.org/10.3390/vaccines9060661

Tankwanchi, A. S., Jaca, A., Ndlambe, A. M., Zantsi, Z. P., Bowman, B., Garrison, M. M., Larson, H. J., Vermund, S. H., & Wiysonge, C. S. (2022). Non-COVID-19 vaccine hesitancy among migrant populations worldwide: a scoping review of the literature, 2000-2020. Expert Review of Vaccines, 21(9), 1269-1287. https://doi.org/10.1080/14760584.2022.2084075

Urrunaga-Pastor, D., Bendezu-Quispe, G., Herrera-Añazco, P., Uyen-Cateriano, A., Toro-Huamanchumo, C. J., Rodriguez-Morales, A. J., Hernandez, A. V., & Benites-Zapata, V. A. (2021). Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean. Travel Medicine and Infectious Disease, 41. https://doi.org/10.1016/j.tmaid.2021.102059

World Health Organization. (2022). Imagining the future of pandemics and epidemics.