Lund University Publications

Differences in COVID-19 vaccine acceptance and uptake according to region of birth: findings from a cross-sectional survey in Sweden

• Mark

Hassan, Mariam ^LU ; Mitchell, Adam ^LU ; Inghammar, Malin ^LU ; Björk, Jonas ^LU and Bennet, Louise ^LU

Abstract

Introduction: High vaccine uptake was crucial in preventing morbidity and mortality during the COVID-19 pandemic. The study aimed to investigate barriers and drivers of vaccination in Sweden across birth region groups with varying COVID-19 vaccine uptake.

Methods: A cross-sectional anonymous survey was distributed non-randomly among individuals born in Sweden and immigrants from Western and non-Western countries (n = 3,281). Six domains, 'trust in vaccines', 'benefit-risk balance', 'trust in institutions', 'injunctive norms', 'descriptive norms', and 'accessibility' were generated, with vaccine acceptance scores (range 1-5), and summary vaccine scores (range 6-30). Linear regression analysis was performed to investigate the... (More)

Introduction: High vaccine uptake was crucial in preventing morbidity and mortality during the COVID-19 pandemic. The study aimed to investigate barriers and drivers of vaccination in Sweden across birth region groups with varying COVID-19 vaccine uptake.

Methods: A cross-sectional anonymous survey was distributed non-randomly among individuals born in Sweden and immigrants from Western and non-Western countries (n = 3,281). Six domains, 'trust in vaccines', 'benefit-risk balance', 'trust in institutions', 'injunctive norms', 'descriptive norms', and 'accessibility' were generated, with vaccine acceptance scores (range 1-5), and summary vaccine scores (range 6-30). Linear regression analysis was performed to investigate the associations between the summary acceptance score and vaccine uptake, overall and by region of birth. Associations between the specific domains and vaccine uptake were modelled using logistic regression (odds ratios (OR) and 95% confidence intervals (CI)), stratified by region of birth.

Results: The associations between vaccine acceptance and uptake were generally strong, but weaker among individuals from non-Western countries. Vaccinated individuals from Sweden and Western countries had 9.5 (95% CI: 9.2-9.7) and 8.9 (95% CI: 8.1-9.7), respectively, higher average vaccine acceptance score than their unvaccinated counterparts, compared with only 2.8 (95% CI: 2.0-3.6) higher average score among vaccinated individuals from non-Western countries. Among individuals from Sweden and Western countries, 'descriptive norms' (OR = 2.6; 95% CI: 2.0-3.4; and OR = 3.6; 95% CI: 1.5-8.7, respectively) and 'trust in vaccines' (OR = 2.5; 95% CI: 1.9-3.2; and OR = 4.2; 95% CI: 2.0-8.8, respectively) had the strongest associations with vaccine uptake. Among individuals from non-Western countries, associations with vaccine uptake were only observed for 'trust in vaccines' (OR = 1.6; 95% CI: 1.1-2.3) and 'benefit-risk balance' (OR = 1.7; 95% CI: 1.2-2.4).

Conclusion: There were significant differences across region groups in the impact of BeSD factors on vaccination. The weaker associations observed among individuals from non-Western countries suggest that these factors may not explain vaccine uptake in this group, where vaccine acceptance was moderately high regardless of vaccination status.

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