Attitudes towards conventional and non-conventional medical approaches and their relation to COVID-19 vaccination: Insights from Germany

The main objective of this study is to investigate whether different medical attitudes relate to COVID-19 vaccination uptake and approval of vaccine mandates. The theory of planned behavior and the health belief model suggest that individual attitudes towards medical approaches are important for vaccination uptake. We use data from a German online cross-sectional study comprising 4065 respondents conducted between September and October in 2022 on the use and acceptance of five pre-defined medical approaches: conventional medicine, Traditional European Medicine (Naturheilkunde), complementary medicine, integrative medicine, and alternative medicine. The two main outcome measures are: (1) COVID-19 vaccination uptake, differentiating between (a) rejected, (b) socially pressured and (c) endorsed vaccination; (2) attitudes towards mandatory COVID-19 vaccination, i.e., whether or not individuals endorse vaccination mandates. We employ logistic and multinomial logistic regressions to calculate average marginal effects (AME) and to account for the influence of different medical attitudes and for confounding variables. While vaccination uptake in general is high (91.0 % in the analytical sample), our multivariate results reveal that individuals with a positive disposition towards Traditional European Medicine (AME = 0.05; p < 0.01) and alternative medicine (AME = 0.02; p < 0.10) were, comparatively, more likely to reject COVID-19 vaccination. A positive disposition towards conventional medicine is associated with higher vaccination uptake (AME = 0.17; p < 0.001). Positive attitudes towards alternative medicine correlate with increased levels of feeling socially pressured into accepting the vaccination (AME = 0.05; p < 0.01). Approval levels for universal mandatory vaccination are low (43.9 %). Positive attitudes towards alternative (AME = -0.03; p < 0.1) and Traditional European Medicine (AME = -0.04; p < 0.05) negatively correlate with approval of vaccination mandates, while positive attitudes towards conventional medicine (AME = 0.05; p < 0.01) increase approval. Our findings suggest that different medical attitudes are simultaneously associated with vaccination uptake and mandate approval. This provides important knowledge for policy makers when designing vaccination schemes and for health professionals when consulting their heterogeneous group of patients.