Exploring the spatial clustering and spillover effects of COVID-19 vaccination uptake in Romania: an analysis at municipality level

Abstract This study investigates the spatial clustering and spillover effects of COVID-19 vaccine uptake in Romania, focusing on the municipality-level distribution of vaccine acceptance and hesitancy while considering the factors that influence it. The research uses the Spatial Durbin Error Model (SDEM) and identifies spatial clusterization, as well as significant contagion and diffusion processes in the vaccination behaviour conditioned by socioeconomic factors, labour market characteristics, social and religious attitudes, urban, and health indicators. We find evidence in favour of spatial spillover effects of the poverty rate, opposition to same-sex marriage, COVID-19 infection rate, peri-urban towns, and denser cities. Our findings contribute to the literature of the spatial distribution and determinants of vaccine uptake and carry practical implications for policy makers offering evidence-based insights that can inform targeted strategies and interventions to enhance vaccine acceptance and address hesitancy in specific locations.