Differences in COVID-19 vaccine acceptance and uptake according to region of birth in Sweden

Background

High and equal vaccination coverage is important to prevent mortality and morbidity related to vaccine-preventable diseases. We aimed to elucidate context-specific barriers and drivers to COVID-19 vaccination, with special attention to potential differences and similarities across regions of birth groups.

Methods

A cross-sectional anonymous survey was distributed in Skåne, Sweden, during the spring of 2023-2024, non-randomly among individuals born in Sweden and individuals from Western and non-Western countries. Six domains with vaccine acceptance scores (VAS) (range 1-5) were created: ‘trust in vaccines’, ‘benefit-risk balance’, ‘trust in institutions’, ‘injunctive norms’, ‘descriptive norms’, and ‘accessibility’. A summary VAS was also generated. Linear regression analysis was performed to investigate the associations between the summary VAS and vaccine uptake, overall and by region of birth. Associations between the specific domains and vaccine uptake were modelled using logistic regression.

Results

In total, 3,281 individuals responded to the questionnaire. The associations between vaccine acceptance and uptake were, on average, strong, but weaker among individuals from non-Western countries. Among individuals of 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).

Conclusions

In the non-Western group, the associations between VAS and vaccine uptake were weaker than in Western populations, suggesting that these factors may not explain vaccine uptake in this group. Theoretical frameworks and measurements may need to be improved.

Key messages

• Associations between COVID-19 vaccine uptake and behavioural and social drivers to vaccinations differ in relevance and importance across regions of birth groups in Sweden.

• Factors based on the behavioural and social drivers framework do not seem to explain vaccine uptake among individuals from non-Western countries and may need to be improved.