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Background In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. Methods Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. Results One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. Conclusions The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.

Background Over the last years, research interest in vaccine hesitancy has increased. Studies usually focus on perceptions of parents and have largely neglected the group of health care providers. However, doctors’ notions on vaccination have a major impact on the decision-making process of their patients. We were interested to understand the phenomenon of vaccine hesitancy among physicians, with a particular focus on the measles vaccine. Furthermore, we aimed to understand the underlying perceptions of measles that may be associated with vaccine hesitant decisions. Methods In order to get an in-depth view, semi-structured interviews with physicians were conducted. Doctors were eligible for the study if they articulated vaccine hesitant views and/or demonstrated vaccine hesitancy in their medical practice. Results We interviewed 12 physicians, of whom 11 had a medical practice with no contract with the Austrian social insurance (‘Wahlarzt’) and additional training in complementary and alternative medicine. We found perceptions of immunology, health and illness that were discordant with evidence-based medicine and closely related to alternative and complementary medicine. All participants argued for a delayed administration of the measles vaccine. We found a consistent inclination towards ‘individual vaccination’, which was explained as empowering parents and to strengthen their decision-making competencies. Most participants expressed doubts about the reliability of vaccine studies and were concerned with possible long-term effects. Conclusions Paying closer attention to doctors’ concerns on vaccination might help to design target-oriented interventions to specifically strengthen vaccine confidence.

Background Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19 compared to people who are not pregnant. Therefore, the CDC recommends COVID-19 vaccination for women who are pregnant, breastfeeding, and trying to become pregnant or who may become pregnant in the future. Despite this, low vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Determinants of vaccine compliance and options suggestedto address vaccine hesitancy were also analyzed. Methods Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (pregnan* OR post-partum OR breastfeeding OR lactating). Results The vaccine hesitation rate was 48.4% (95%CI=43.4-53.4%). In a sub analysis by study period, the pooled prevalence of vaccine hesitation was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events for both mother and fetus/child. Conclusions In order to achieve high vaccination coverage, a multifactorial approach is needed, requiring major social, scientific, and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented. Key messages • Vaccine hesitancy can be a determining factor in the success (or otherwise) of the anti-COVID-19 immunization campaign. • Vaccine hesitancy in pregnant and breastfeeding women is a genuine public health concern worldwide.

Vaccine hesitancy is a relatively new concept, developed by WHO's Strategic Advisory Group of Experts (SAGE) on Immunization in 2014 as a response to the growing awareness of the decline in global confidence in vaccination. Vaccine hesitancy is a context-specific behavioural phenomenon whose occurrence ranges between full acceptance and complete refusal of vaccines. Several studies have explored factors that influence people's decision to get vaccinated and in 2018 WHO and UNICEF conducted a joint study to explore the reasons for vaccine hesitancy. The study aimed to determine the reported rate of vaccine hesitancy across the globe and the reasons for hesitancy. In most studies three top reasons were identified. 1) vaccine safety concerns, 2) lack of knowledge and awareness of vaccine importance, and 3) religion, culture, gender and socio-economic issues regarding vaccines. Other factors contributing are negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, lived in a rural area, and self-identified as a racial/ethnic minority. Vaccine hesitancy is associated with the global crisis of trust in science and institutions, namely lack of political trust, which can be defined as public judgment that the system and its representatives are responsive and reliable. Furthermore, distrust in one institution is related to distrust in other, indicating the unidimensional phenomenon. This kind of distrust is exemplified by the appearance of infodemic - an overabundance of information. In addition, support for conspiracy theories related to COVID-19 which correlates with the scepticism towards vaccination has significantly higher rates among Balkans’ populations.

Background The vaccine hesitancy is a matter of global concern with inadequate global uptake postponing the moment of reaching herd immunity and bringing the COVID-19 pandemics under control. Countries in the Western Balkans struggle with vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus. Methods A cross-sectional study on vaccine hesitancy was conducted from July to September 2021 and included adult population from Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia (1605 individuals). Convenience sampling was applied using anonymized online questionnaire (shared through social media) measuring, among others, trust in societal factors, social responsibility and, the credibility of information sources about COVID-19 vaccines. Results The highest degree of trust in societal factors was found in North Macedonia (M = 3.65, SD = 1.06), followed by Montenegro (M = 3.50, SD = 1.19) and Serbia (M = 3.24, SD = 1.26). In Albania 44.7% respondents believed in reluctance of pharmaceutical companies to publish detailed research reports on the risks of adverse reactions to COVID-19 vaccines. The view that the health authorities when they encourage vaccination do so with the best intentions supported 66,3% respondents in North Macedonia and 49% in Albania and Serbia. The highest level of social responsibility (M = 4.12, SD = 1.09) was revealed in North Macedonia. Primary care physicians, health professionals in media, webpages of public health institutions, and scientific literature are the most trusted sources of information about COVID-19 in all countries. Conclusions The study demonstrated moderate trust in societal factors and moderately high level of social responsibility in all countries. The health professionals enjoy the greatest trust, which implies that medical doctors, especially physicians in primary health care should have a pivotal role in promoting vaccination and educating the general public in the Western Balkans.

Background About 35% of adult Europeans remain not fully vaccinated against COVID-19. Health literacy (HL), health consciousness (HC), and health locus of control (HLC) have been linked to different health behaviors, yet their role in COVID-19 vaccination uptake remains unclear. Here, we report preliminary findings from a cross-sectional survey conducted in Greece and Cyprus, aiming to elucidate the aforementioned associations. Methods Participant recruitment for the current analysis took place from January to June 2022, following proportional quota sampling. The current sample comprises 190 participants, with full information on COVID-19 vaccine hesitancy (composite scale outcome) and refusal (binary outcome), as well as HL (European Health Literacy Survey Questionnaire-Q16), HC (Health Consciousness Scale-G), and HLC (Multidimensional Health Locus of Control Form B). Linear and logistic regression analyses were used to determine associations between the aforementioned factors, using the standardized versions of the independent variables. Results After adjusting for sociodemographic factors and other predictors of vaccination status, HL (β, 95% CI: -2.56, -3.76; -1.36), ‘internal’ HLC (-2.76, -3.79; -1.73) and ‘health professionals’ HLC (-2.64, -3.66; -1.63) were strongly and negatively associated with vaccine hesitancy, while HC showed a weaker association in the same direction (-1.46, -2.58; -0.35). In contrast, ‘chance’ HLC was strongly and positively associated with vaccine hesitancy (4.40, 3.37; 5.43). Similar results were detected when vaccine refusal was used as a binary outcome. Conclusions Health literacy and locus of control and to a lesser extent health consciousness, are independent predictors of COVID-19 vaccine hesitancy and refusal. Increasing vaccination uptake via programs aiming at enhancing health literacy and shifting health locus of control, can have a significant impact on COVID-19 pandemic management internationally. Key messages • Health literacy, locus of control and to a lesser extent consciousness, are novel predictors of vaccine hesitancy and refusal in two Eastern Mediterranean European populations. • Increasing health literacy and shifting health locus of control could render programs aiming to increase COVID-19 vaccine uptake more targeted and effective, internationally.

Background Countries in the Western Balkans are facing vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus. Trust in science and institutions, namely political trust, plays an important role and can significantly affects vaccine acceptance. Methods Cross-sectional research was carried out from July to September 2021 in five countries of the Western Balkans (Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia) and included adult population aged 18 and older (1605 individuals). Convenience sampling was applied using anonymised online questionnaires and Likert scales, shared through online social media, and asking, among others, for trust in societal factors. Results In all countries people had more confidence in health authorities than in political officials. There are no gender differences found in showing trust in societal factors, except in Serbia where women compared to men showed greater trust in health authorities (50.6% vs. 34.4%), as well as in political officials (42.8% vs. 28.2%). The lowest trust in pharmaceutical companies was found in Albania where 34,9% respondents believe that vaccination against COVID-19 is largely promoted by pharmaceutical companies due to financial profits. People who put more trust in societal factors were vaccinated to a greater extent. In Serbia and Albania, the older respondents in general put more trust in societal factors. People who assessed themselves as more religious in Serbia and North Macedonia demonstrated less trust towards societal factors. Conclusions The study demonstrated moderate trust in societal factors in all countries, with greatest trust in health authorities. This implies that health authorities should have a pivotal role, together with physicians in primary health, in promoting vaccination and educating the general public in the Western Balkans. Key messages

Background Vaccine hesitancy threatens public health. Some evidence suggests that vaccine hesitancy in Europe may be linked with the success of populist parties, but more systematic analysis is needed. Methods We examine the prevalence of individual-level vaccine hesitancy across the European Union (EU) and its association with political orientations. We also analyze whether success of populist parties is linked with vaccine hesitancy and uptake. We draw on individual-level Eurobarometer data from 2019, with a total of 27 524 respondents across the EU. We also rely on national and regional-level populist party vote shares. Finally, for a time-series analysis, we rely on aggregated populist party support as measured in the European Social Survey waves 1–9 (2002–18), and national immunization coverage rates from the WHO from 2002 to 2018. Results While vaccine hesitancy is confined to a minority of the population, this group is large enough to risk herd immunity. Political orientations on a left-right dimension are not strongly linked to vaccine hesitancy. Instead, vaccine hesitancy is associated with anti-elite world views and culturally closed rather than cosmopolitan positions. Conclusions Vaccine hesitancy is not only present in all EU member states but also maps on broader dimensions of cultural conflict. Hesitancy is rooted in a broader worldview, rather than misperceptions about health risks. Pro-vaccine interventions need to consider the underlying worldview, rather than simply targeting misperceptions.

Background The COVID-19 pandemic placed a call for action worldwide. Based on scientific investigation, governments need to assess strategic priorities. Health system capacity constraints and failures in response to the pandemic have social, medical, productivity, and economic implications. It compounds health equity issues and confronts with excess mortality, higher chronic disease prevalence, and risk factors. Despite initial progress in vaccination against COVID-19 and attempts to speed up vaccination, the Western Balkan lags behind. Infodemic and low trust in institutions are among the main factors associated with low success and adverse effects on other vaccination programs. This presentation aims to shed light on the importance of health literacy in resilient communities supported by inclusive governance. Methods A narrative review based on literature on inclusive governance, health literacy, and resilient communities during COVID-19 and other emergencies. Primary sources are databases, scientific articles, Health System Response Monitor, and observations by ECDC and OECD. Results Results show that characteristics of resilient communities in possessing knowledge and ability to assess risk, manage an emergency, monitor change, and address threats stand out. Many studies highlight the interconnectedness of community members with the wider external environment and their participation in decision-making to improve health services. Examples include interventions for developing future vaccination programs in program planning, conducting sound evaluations, transferring results to those who need to know, and receiving feedback. The key to this success is enhancing digital and health literacy. Conclusions COVID-19 requires cross-sectional strategies to reinforce collaborative gains and build resilient communities, ready to apply population strategies for prevention. Inclusive governance and a bottom-up approach will be essential to optimize the response to future challenges.

Background Vaccine hesitancy (VH) remains worldwide a reason of concern. Most of the vaccination education strategies followed a ‘fact-based' approach, based on the assumption that decision making is a rational process, without considering the influence of cognitive biases and heuristics. Our study aimed at identifying factors involved in the parents' vaccination choice to inform and shape communication interventions. Methods We conducted an online national survey among parents between November 2020 and April 2021. The questionnaire consisted of 59 items organised in 5 parts: personal information, cognitive biases, risk aversion, conspiracy mentality, and VH. Exploratory factor analysis was conducted to identify latent variables underlying the 19 items related to the 6 cognitive biases. Factors were categorised in quintiles and the corresponding pseudo-continuous variables used as predictors of the VH. Logistic regression model was applied to assess the association of the VH with factors, conspiracy mentality and risk propension. We adjusted for age, gender, economic status, and education levels. Results The study included 939 parents, 764 women (81.4%), 69.8% had a degree or higher level of education. Considering cognitive biases, four factors explaining 54% of the total variance were identified and characterised as: fear of the side effects of vaccines (scepticism factor); carelessness of the risk and consequences of infections (denial factor); optimistic attitude (optimistic bias factor); preference for natural products (naturalness bias factor). All factors were positively associated with VH (p < 0.001) as were conspiracy mentality (p = 0.007) and risk propension (p = 0.002). Conclusions This study confirmed the need to amplify the model used to analyse the VH considering cognitive biases as an important factor affecting the parents' decision making. These results may be useful to design personalised communication interventions regarding vaccines and vaccination. Key messages The model used to analyse the vaccine hesitancy needs to be extended including the evaluation of cognitive biases and heuristics. Communication interventions to promote vaccine acceptance should be tailored and personalized on the basis of the drivers of choice of the parents.

Introduction Vaccination against pertussis in pregnancy is the main strategy to prevent the disease in the first trimester of life of new-borns. Effective communication is essential to successfully engage pregnant women. The use of digital devices within the outpatient setting may be helpful to engage patients before and during the consultation. The aim of this study was to develop and test an e-health tool to assess vaccine hesitancy and to deliver tailored information and education interventions to raise awareness and promote vaccine acceptance. Methods One-hundred-and-five participants were recruited in 4 ob-gyn clinics. Participants were invited to complete a self-administered psychometric questionnaire to assess vaccine hesitancy, disease beliefs and self-efficacy perception on health behaviours on a tablet. Participants were randomly allocated to three communication-format types providing equivalent content: 1)a single video simulating a patient-doctor conversation on the topic; 2)an interactive platform with five infographics videos; 3)a paper leaflet followed by a brief consultation with the physician. The intention to get vaccinated during pregnancy was assessed through a specific question before and after the intervention. Results In the pre-intervention phase there was no difference observed between groups in terms of the variable “intention” to get vaccinated. After the intervention, participants of groups 1 and 3 showed a higher intention to get vaccinated than group 2 at the Kruskal-Wallis test (H(2)=6.008, p < 0.05). Post-intervention intention to vaccinate correlated with Individual Self-Efficacy (rs(105)=0.30, p < 0.001) and was inversely associated with vaccine hesitancy (rs(105)=0.34, p < 0.001). Conclusions We implemented and assessed the impact of different communication strategies to promote vaccine uptake among pregnant women. Our results suggest comparable effect may be obtained using simulated versus live patient-physician communication. Key messages The use of digital devices allows an effective and manageable communication about vaccination to pregnant women. In the present study, the implementation of digital forms of communication allowed a comparison with standard procedures of information towards vaccination, demonstrating their equivalence.

Background The WHO defines vaccine hesitancy (VH) as ‘a delay in acceptance or refusal of vaccines despite the availability of vaccine services'. In spite of the models explaining VH and the tools used to address it, VH still represents a current problem and has been declared one of the top ten global health threats by WHO in 2019. This is mainly true for the adolescents who represents 25% of the global population. This systematic review aims to address the determinants of VH in this target population. Methods PubMed, Web of Science and Scopus were searched to retrieve articles, published in English, assessing adolescents' attitudes and confidence towards vaccinations with any study design (qualitative or quantitative) from the inception until Dec 2020. A methodological quality assessment of the articles was performed based on the study designs. Results Out of 14,704 articles, 20 studies were included in the qualitative analysis. Ten out of 20 studies were evaluated as of “good quality”, while nine had “moderate quality” and only one had “poor quality”. Factors associated to a positive attitude towards vaccination included knowledge of vaccine preventable diseases, the awareness of vaccines, their efficacy, safety and free of charge, higher education level and active involvement in decision-making. An association between VH and socio-economic conditions was also highlighted. Conclusions This systematic review elucidated a better understanding of the determinants of VH among the adolescent population. Adolescence represents a crucial phase of life in which boys and girls begin to make significant choices about their health and develop attitudes and behaviours that continue into adulthood. Indeed, their concerns and needs in respect to vaccination should be widely examined and taken into consideration to plan tailored interventions to promote vaccination and reduce VH. Key messages Vaccine hesitancy among adolescents is a major global health priority. This problem is little studied and further studies and initiatives aimed at increasing awareness of the problem should be deserved.

Background Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors. Methods A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine literacy. Chi square test and student's t test were used to identify knowledge and attitudes associated with COVID-19 vaccine hesitancy. A p value equal or less than 0.05 was considered statistically significant. Results Two hundred cancer patients were included with a mean age of 54.4±12.7 and a gender ratio equal to 0.5. Sixty-five percent reported that they would not receive the COVID-19 vaccine. Vaccine hesitancy was associated with lower interactive vaccine literacy score (1.6±0.8 vs 2.0, p = 0.002), skepticism regarding COVID-19 vaccine efficacy and safety (73.8% vs 38.5%, p < 0.001) and believing that health authorities will not be able to vaccinate the majority of the population (71,2% vs 55.7% p = 0.037). Conclusions The proportion of COVID-19 vaccine hesitancy among cancer patients is high. Mass media campaigns for vaccine promotion should be enhanced. Physicians and health care workers play a key role in increasing acceptance and uptake of COVID-19 vaccine among high risk patients. Key messages Majority of cancer patients were unwilling to receive the COVID-19 vaccine. Patient education about the benefits of vaccination against SARS-CoV-2 should be an integral part of oncology visits.

Background Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants. Methods A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328). Results Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively. Conclusions Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies. Key messages Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance.

BACKGROUND Parents' reluctance to vaccinate their children undermines the effectiveness of vaccination programmes in Western Europe. There is anecdotal evidence suggesting a connection between the rise of political populism and vaccine hesitancy. METHODS This paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe and effective according to data from the Vaccine Confidence Project (2015). RESULTS There is a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669). CONCLUSIONS Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts. It is necessary for public health scholars and actors to work to build trust with parents that are reluctant to vaccinate their children, but there are limits to this strategy. The more general popular distrust of elites and experts which informs vaccine hesitancy will be difficult to resolve unless its underlying causes-the political disenfranchisement and economic marginalisation of large parts of the Western European population-are also addressed.

Background With the availability of COVID-19 vaccines, vaccine hesitancy (VH) poses a great challenge to achieving herd immunity. Since young adults are usually asymptomatic, they may be less inclined to follow social distancing and mask-wearing guidelines. This study aimed at (i) quantifying VH among university students and (ii) investigating its determinants to identify barriers and predisposing factors to COVID-19 vaccination. Methods Students physically attending Sapienza University of Rome during April 2021 were invited to take part in an online survey. The questionnaire explored sociodemographic variables, COVID-19 experience, attitude towards preventive measures, and COVID-19 vaccination. Hesitancy was measured as the complement to 10 of students' intention to get vaccinated and was modeled through zero-inflated negative binomial regression analysis. Results Overall, 1949 students were surveyed. Most were females (59.9%) and aged 23.8±4.9 years on average. A great proportion reported no (76.8%) or slight hesitancy (15.7%). At multivariable analysis, in the count part, being more scared for the pandemic (IRR=0.94, 95%CI: 0.89-0.98), rating COVID-19 as more severe (IRR=0.93, 95%CI: 0.89-0.98) and being Italian rather than non-Italian (IRR=0.68, 95%CI: 0.54-0.85) were associated with lower VH, but no influence was found for age, sex, self-perceived risk of infection, and being a medical student. In the logit part, rating the vaccines as safe (b: 0.92, 95%CI: 0.75-1.10) or effective (b: 0.30, 95%CI: 0.14-0.45) decreased the likelihood of being hesitant. Conclusions A few factors seemed to influence the intention to get vaccinated against COVID-19, including vaccine safety and effectiveness. Hence, attention should be given to planning effective communication about the vaccine profile in order to maintain and improve the public's confidence. Also, partnerships should be established among the stakeholders to ensure coordinated information sharing and dissemination. Key messages Almost one-quarter of the surveyed students reported VH to some extent, and a few factors seemed to play a role in the vaccination decision-making process. Among others, the perceived vaccine safety and effectiveness seemed to influence VH. Attention should be given to planning effective communication about the vaccines’ profile.