Trends in COVID-19 Vaccination Intent, Determinants and Reasons for Vaccine Hesitancy: Results from Repeated Cross-Sectional Surveys in the Adult General Population of Greece during November 2020–June 2021

  1. Vana Sypsa
  2. Sotirios Roussos
  3. Vasiliki Engeli
  4. Dimitrios Paraskevis
  5. Sotirios Tsiodras
  6. Angelos Hatzakis

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Abstract

Vaccine hesitancy is a major barrier to achieving large-scale COVID-19 vaccination. We report trends in vaccination intention and associated determinants from surveys in the adult general population in Greece. Four cross-sectional phone surveys were conducted in November 2020 and February, April and May 2021 on nationally representative samples of adults in Greece. Multinomial logistic regression was used on the combined data of the surveys to evaluate independent predictors of vaccination unwillingness/uncertainty. Vaccination intention increased from 67.6% in November 2020 to 84.8% in May 2021. Individuals aged 65 years or older were more willing to be vaccinated (May 2021: 92.9% vs. 79.5% in 18–39 years, p < 0.001) but between age-groups differences decreased over time. Vaccination intention increased substantially in both men and women, though earlier among men, and was higher in individuals with prograduate education (May 2021: 91.3% vs. 84.0% up to junior high). From multivariable analysis, unwillingness and/or uncertainty to be vaccinated was associated with younger age, female gender (in particular in the April 2021 survey), lower educational level and living with a child ≤12 years old. Among those with vaccine hesitancy, concerns about vaccine effectiveness declined over time (21.6% in November 2020 vs. 9.6% in May 2021, p = 0.014) and were reported more often by men; safety concerns remained stable over time (66.3% in November 2020 vs. 62.1% in May 2021, p = 0.658) and were reported more often by women. In conclusion, vaccination intention increased substantially over time. Tailored communication is needed to address vaccine hesitancy and concerns regarding vaccine safety.

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  1. Version published to 10.3390/vaccines10030470
  2. ScreenIT

    SciScore for 10.1101/2021.06.23.21259376: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical issues: The protocol of the surveys was approved by the Institutional Review Board of the Hellenic Scientific Committee for the Study of AIDS and STDs.
    Consent: Participants provided oral informed consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations. First, selection bias could exist in the phone surveys. Interviewers informed the persons who picked up the phone that they were going to ask questions about COVID-19. It is possible that people with negative attitudes towards the pandemic would be more probable to decline. Second, responses might be affected by social desirability bias; for example, respondents might answer questions about vaccination intention in a manner that would be viewed favourably by the interviewers. Both these biases might result in overestimating vaccination intention. However, the findings concerning trends in vaccination intention over time and associated determinants should not be affected by this limitation. Third, the findings on vaccination intention over time and associated determinants could be influenced by the disease burden in the country, social distancing measures or media coverage during the specific survey period. This is not necessarily a limitation as, for example, it allowed us to assess the impact of news on vaccine-linked blood clots on vaccination intention among women. A strength of this study is that vaccination intention and its determinants have been evaluated through four repeated cross-sectional surveys implemented over a period extending from before vaccination was available until it was offered to all the adults in the country. As persons aged 18 years or older constitute approximately 83% of the population in Greece, a vaccination intent...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.06.23.21259376v1 on medRxiv