Suzanna Awang BonoEdlaine Faria de Moura VillelaChing Sin SiauWon Sun ChenSupa PengpidM. Tasdik HasanPhilippe SessouJohn D. DitekemenaBob Omoda AmodanMina C. HosseinipourHousseini DoloJoseph Nelson Siewe FodjoWah Yun LowRobert ColebundersUniversite de KinshasaUNC Project-MalawiUniversity of Abomey-CalaviUniversity of Bamako Faculty of Medicine, Pharmacy and Odonto-StomatologySwinburne University of TechnologyUniversiti MalayaUniversidade Federal de GoiásUniversity of LiverpoolUNC School of MedicineUniversiteit AntwerpenMahidol UniversityUniversiti Kebangsaan MalaysiaUniversiti Sains MalaysiaUganda Public Health Fellowship ProgramBrain Research Africa Initiative (BRAIN)Public Health FoundationHealth State Agency of São Paulo2022-08-042022-08-042021-05-01Vaccines. Vol.9, No.5 (2021)2076393X2-s2.0-85106929800https://repository.li.mahidol.ac.th/handle/20.500.14594/77291Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low-and Middle-Income Countries (LMICs; N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness.Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs.Mahidol UniversityImmunology and MicrobiologyMedicinePharmacology, Toxicology and PharmaceuticsArticleSCOPUS10.3390/vaccines9050515