Abstract

Vaccine hesitancy remains a significant barrier to achieving optimal immunization coverage in low- and middle
income countries (LMICs), despite the proven effectiveness of vaccines in reducing morbidity and mortality from 
vaccine-preventable diseases. This meta-synthesis examines the determinants of vaccine hesitancy and evaluates 
evidence-based interventions aimed at improving vaccine acceptance in LMIC settings. The review draws on 
studies published between 2011 and 2021 and identifies multi-level factors influencing vaccination decisions, 
including individual beliefs, sociocultural norms, health system constraints, structural barriers, and 
misinformation within the information environment. Key determinants include concerns about vaccine safety and 
side effects, distrust in health authorities, limited health literacy, poor access to vaccination services, and the 
influence of social networks and community perceptions. At the system level, issues such as inadequate service 
delivery, long waiting times, vaccine shortages, and financial or geographic barriers further exacerbate hesitancy. 
Misinformation, particularly through social media and informal networks, significantly undermines vaccine 
confidence. The synthesis also highlights intervention strategies such as community engagement, strengthening 
health systems, risk communication, and supportive policy frameworks. However, evidence on intervention 
effectiveness in LMICs remains limited and uneven. Overall, vaccine hesitancy in LMICs is a complex, context
specific phenomenon requiring integrated, multi-sectoral approaches to improve trust, access, and communication 
in immunization programs.