Background: Malaria is a life-threatening disease caused by Plasmodium parasites, transmitted through the bites of infected female Anopheles mosquitoes. It remains a major global health issue, with 263 million cases and 597,000 deaths in 2023, primarily affecting young children and pregnant women. This review evaluates awareness, acceptance, hesitancy, and willingness to pay (WTP) for the RTS,S/AS01 malaria vaccine, along with the key factors influencing these outcomes.

Methods: A comprehensive literature search was conducted in Web of Science, PubMed, and Embase, covering publications up to 18 June 2024. Observational studies assessing awareness, acceptance, hesitancy, and WTP for the malaria vaccine in endemic regions were included. Two independent reviewers screened the studies. Data extraction was performed using Nested Knowledge software and analyzed with R v.4.4. Pooled prevalences were estimated using random-effects models, and heterogeneity was assessed with the I² statistic.

Results: Eighteen studies with 21,975 participants provided insights into malaria vaccine dynamics: 32% awareness (95% CI, 18%-50%), 83% acceptance (95% CI, 75%-89%), 14% hesitancy (95% CI, 7%-26%), and 58% WTP (95% CI, 34%-79%). Key determinants of acceptance included age, where younger adults (18-24 years) showed lower acceptance (OR = 0.64, 95% CI, 0.35-0.93). Employment, particularly farmers, had higher acceptance rates (OR = 3.20, 95% CI, 1.00-7.40). Lower socioeconomic status and larger family sizes were associated with decreased acceptance (OR = 0.18, 95% CI, 0.02-0.38).

Conclusion: This review revealed an 83% acceptance rate for the malaria vaccine, with variability in awareness (32%), hesitancy (14%), and willingness to pay (58%). Age, employment, and socioeconomic status were significant determinants of acceptance. However, due to potential publication bias and high heterogeneity, these findings should be cautiously interpreted. The results highlight the necessity for targeted interventions to enhance vaccine acceptance. Further research is required to elucidate factors that influence vaccine acceptance.

Keywords: acceptance; awareness; hesitancy; malaria vaccine; systematic review; willingness to pay.

© 2025 The Author(s). Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.

背景：

疟疾是由恶性疟原虫引起的威胁生命的疾病，通过受感染的雌性按蚊叮咬传播。它仍然是一个主要的全球健康问题，在2023年有2.63亿例病例和59.7万例死亡，主要是影响年轻儿童和孕妇。本综述评估了RTS,S/AS01疟疾疫苗的认知度、接受度、犹豫态度以及愿意支付（WTP）情况，并分析了影响这些结果的关键因素。

方法：

在Web of Science、PubMed 和 Embase 中进行了全面的文献检索，涵盖了截至2024年6月18日的所有出版物。纳入评估疟疾疫苗认知度、接受度、犹豫态度及WTP 的观察性研究，并且重点关注疫区的研究。两位独立评审员筛选了这些研究。使用Nested Knowledge 软件进行数据提取，并用R v.4.4 进行分析。通过随机效应模型估计合并的流行率，并用I² 统计量评估异质性。

结果：

十八项研究，涉及21,975名参与者，提供了有关疟疾疫苗动态的信息：认知度为32%（95% CI，18%-50%），接受度为83%（95% CI，75%-89%），犹豫态度为14%（95% CI，7%-26%），愿意支付率为58%（95% CI，34%-79%）。影响接受度的关键因素包括年龄，在18-24岁年龄段的年轻成年人中显示较低接受率（OR = 0.64，95% CI，0.35-0.93）。就业状况，特别是农民，具有较高的接受率（OR = 3.20，95% CI，1.00-7.40）。较低的社会经济地位和较大的家庭规模与较低的接受度相关联（OR = 0.18，95% CI，0.02-0.38）。

结论：

本综述揭示了疟疾疫苗有83% 的接受率，在认知度（32%）、犹豫态度（14%）和愿意支付率（58%）方面存在差异。年龄、就业状况和社会经济地位是影响接受度的重要因素。然而，由于潜在的发表偏差和较高的异质性，应谨慎解读这些发现。结果强调了提高疫苗接受度的针对性干预措施的重要性，并且需要进一步研究以阐明影响疫苗接受度的因素。

关键词：

接受度；认知度；犹豫态度；疟疾疫苗；系统综述；愿意支付