Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland

Background Antimicrobial resistance (AMR) is a global health threat. Vaccines are a powerful tool to address AMR by preventing infections and reducing antimicrobial use. The World Health Organization (WHO) describe vaccine hesitancy as a growing challenge influenced by confidence. Research has highlighted belief and sociodemographic factors as predictors of hesitancy and confidence. However, little research has focused on AMR-related beliefs in this context across the island of Ireland. This study aimed to explore the sociodemographic and AMR-related belief determinants of vaccine hesitancy and confidence across the island of Ireland. Methods A cross-sectional, nationally representative online survey with adults in Northern Ireland (NI) and Ireland (IRL) assessed public knowledge, awareness, behaviours and beliefs related to antibiotics, AMR and vaccines. Bivariate analyses and hierarchical multiple linear regression tested eight sociodemographic and fourteen AMR-related belief predictors for vaccine hesitancy and confidence. Qualitative responses were analysed using inductive content analysis. Results Among 811 respondents (415 (51.2%) in NI, 396 (48.8%) in IRL), regression models showed consistency across jurisdictions for hesitancy ( F (43,729) = 11.19, p  = 0.16) and confidence ( F (43,729) = 12.89, p  = 0.54). AMR-related beliefs were the strongest predictors, accounting for 37.5% of the variance in hesitancy and 41.6% in confidence. Agreement with the importance of childhood vaccination was the strongest predictor of both lower vaccine hesitancy (B = -3.64, p < 0.001) and higher vaccine confidence; (B = 1.61, p < 0.001). Sociodemographic factors accounted for 6.2% of the variance in both outcomes. Being female (B=-1.58, p =  0.01) and having lower education (B=-1.24, p  = 0.05) significantly predicted higher hesitancy, while higher education predicted higher confidence (B = 0.93, p  < 0.001). Qualitative findings highlighted concerns around vaccine side effects and new vaccines. Conclusions Vaccine hesitancy and confidence scores across the two jurisdictions were promising, but can be improved, and support an all-island approach for addressors. This all-island comparison provides a unique perspective into AMR-related predictors and can be used to inform the tailoring of public health interventions which aim to promote vaccine uptake across the island of Ireland.