Factors Affecting Covid-19-vaccine Hesitancy, Acceptance And Refusal In The 2023/2024 Seasonal Campaign

• By: RODRIGUES, António (National Association of Pharmacies (CEDIME/IF, ANF), Portugal)
• Co-author(s): Ms. Sara Moura (Public Health Unit, Entre Douro e Vouga Local Health Unit, Santa Maria da Feira, Portugal)
  Ms Sónia Romano (Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR/IF, ANF), Lisbon, Portugal)
  Mr José Guerreiro (Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR/IF, ANF), Lisbon, Portugal)
  Ms Ema Paulino (Board of the Portuguese 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 COVID-19 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 retrieves 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 with 60 years or over, residing in mainland Portugal was randomly sampled. Dimensions assessed included sociodemographic, health status, and past experiences with vaccines. Intention of COVID-19 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 COVID-19 vaccine uptake intention.
  
  Results: Individuals aged 65 and over represent lower risk for refusal (OR=0.234, CI95%: 0.152-0.360) and hesitancy (OR=0.419, CI95%: 0.310-0.565) compared to those aged 60-64 years. Males report lower hesitancy compared to females. Individuals with diabetes had the highest proportion of refusal (8.50%) and hesitancy (17.0%). Individuals with renal and/or hepatic disease were the ones presenting higher proportion of acceptance (93.5%). Living in the north region of Portugal is associated with lower hesitancy. The highest education level presented a higher proportion of vaccine refusal (p>0.05). Individuals with no previous SARS-CoV-2 infection report higher acceptance towards COVID-19 vaccination.
  
  Conclusions: Individuals aged from 60 to 64 years old are more hesitant towards COVID-19 vaccination than those aged 65 years or older. Higher hesitancy in this group could be due to lower risk perception or COVID-19 vaccine fatigue. For the next campaigns it would be of interest to target and promote vaccination in this age population. This effort should be national but also adapted to each region. Noteworthy, individuals with higher education and therefore presumably with higher health literacy are the ones reporting lower acceptance.