Factors Affecting Influenza-vaccine Acceptance, Hesitancy, And Refusal In The 2023/2024 Seasonal Campaign

• By: RODRIGUES, Teresa (National Association of Pharmacies (CEDIME/IF, ANF), Portugal)
• Co-author(s): Ms Sara Moura (Public Health Unit, Entre Douro e Vouga Health Local Unit, Santa Maria da Feira, Portugal)
  Mr José Pedro Guerreiro (Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR/IF, ANF), Lisbon, Portugal)
  Ms Sónia Romano (Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR/IF, ANF), Lisbon, Portugal)
  Ms Teresa Almeida (National Association of Pharmacies, Lisbon, Portugal)
  Ms Ema Paulino (National Association of Pharmacies, Lisbon, Portugal)
  Mr António Rodrigues (Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR/IF, ANF), Lisbon, Portugal / Life and Health Sciences Research Institute [ICVS], School of Medicine, University of Minho,, Braga, Portugal / ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal)
  
• Abstract:

  Background: According to the World Health Organization, vaccine hesitancy stands as a significant concern within the realm of global public health, ranking among the top ten threats. Despite Portugal's historical propensity towards vaccination, the burgeoning global prevalence of this phenomenon requires careful consideration. The anticipated decline in vaccination coverage for the seasonal vaccination campaign against Influenza and COVID-19 urges for the identification and better understanding of factors and causes associated with vaccine hesitancy. Better knowledge on this topic allows for the development of strategies and interventions that mitigate the impact of this phenomenon on public health through the promotion of more robust and adequate vaccination campaigns.
  This research aims to assess the factors affecting Influenza vaccine acceptance, hesitancy, and refusal during the 2023/2024 season among individuals aged 60 years or older.
  Methods: Prospective cohort-nested cross-sectional study regarding the 2023/2024 seasonal vaccination campaign (Influenza and COVID-19). Data used in this study was retrieved from the first of two telephone questionnaires (CATI methodology), which was administered before the beginning of the campaign (September 2023). A cohort of 1400 individuals representative of the Portuguese population aged 60 years or over, residing in mainland Portugal was randomly sampled. Dimensions assessed included sociodemographic, health status, and past experiences with vaccines. Intention regarding Influenza vaccine uptake during the 2023/2024 campaign was assessed using a score from 0 to 10 (0 to 2: vaccine refusal; 3 to 7: hesitancy; 8 to 10: acceptance). An exploratory analysis was performed using a multinominal logistic regression to identify factors associated with Influenza vaccine uptake intention.
  Results: Individuals aged 65 and over presented a lower risk for refusal (OR= 0.183, CI95%:0.095-0.350) and hesitancy (OR= 0.608, CI95%: 0.408-0.907) compared to those aged 60-64 years.
  Among those with chronic disease, individuals with diabetes had the highest proportion of refusal (9.2%) and cardiovascular disease had the highest proportion of hesitancy (14.8%). Individuals with respiratory disease and renal and/or hepatic disease were the ones presenting the highest proportion of acceptance (86.8% and 88.0%, respectively). Living in the north region of Portugal is associated with lower hesitancy.
  Males report lower hesitancy compared to females. The highest education level presented a higher proportion of refusal, while the least educated group showed the highest hesitancy (p>0.05).
  
  Conclusions: An important amount of individuals with chronic disease reporting refusal and/or hesitancy can translate as perceptions of low susceptibility for Influenza or as this disease not being perceived as severe. Individuals aged from 60 to 64 years old are more hesitant towards Influenza vaccination. This was the first campaign where this group was eligible for free-of-charge vaccination. Higher hesitancy in this group could be due to lower risk perception or unawareness of the possibility of free vaccination. For future campaigns, it would be of interest to develop strategies to promote vaccination targeting specific age and region subpopulations.