The role of misinformation in COVID-19 vaccine hesitancy in low- & middle-income countries

BACKGROUND: During the COVID-19 pandemic, timely vaccination was crucial in acquiring herd immunity. While high-income countries typically had better access to vaccines, interventions were implemented to improve accessibility for low and middle-income countries (LMICs). Vaccine uptake presented major barriers to achieving herd immunity globally and was more significant in LMICs. Vaccine hesitancy was amplified by misinformation, including but not limited to social media misinformation. This scoping review aims to: (1) explore the role of misinformation in COVID-19 vaccine hesitancy in LMICs and (2) identify primary sources, key themes, and dissemination channels of this misinformation, encompassing all relevant sources but with an emphasis on social media, given the infodemic context which proved to be particularly significant during the COVID-19 pandemic. METHODS: This scoping review was conducted using the Arksey and O'Malley framework and PRISMA-ScR guidelines. Five databases (Scopus, Embase, PubMed, CINAHL, and PsycINFO) were searched using predefined search terms. All identified articles underwent a rigorous screening process, and if eligible, proceeded to data extraction. RESULTS: In total, 119 studies were included in this review. Primary dissemination platforms included Facebook, WhatsApp, X, YouTube, Instagram, TikTok, Telegram, Pinterest, LinkedIn, and Zalo. Key themes of misinformation identified included (1) malicious intent, (2) fear of side effects, (3) concerns about vaccine development and safety, (4) religious and cultural beliefs, and (5) natural immunity. CONCLUSION: Overall, this scoping review addresses the literature gap in the role of misinformation pertaining to COVID-19 vaccine hesitancy and suggests investing in misinformation-mitigation interventions to reduce public harms and disruptions.