What Drives COVID-19 Vaccine Resistance? A Nationwide Linkage Study from Czechia

Abstract Background Vaccination has been a key preventive measure during the COVID-19 pandemic. Despite availability in Europe, notable differences in vaccination coverage remain, even within countries. This study aims to identify factors affecting access to vaccination. Recognising vulnerable groups at risk due to inadequate access or distrust in this health tool is essential for formulating targeted health policies and communication strategies. Methods The research uses a Czech Ministry of Health database with administrative data on 6,398,754 individuals aged 26 and over as of December 31, 2023. It links individual-level information from four national registers capturing demographics (age, sex), health status, socioeconomic level, or healthcare use. Results are reported as odds ratios (OR) comparing vaccine resistance risk across categories. Results Analysis revealed significant differences in COVID-19 vaccination across variables, particularly socioeconomic status - OR for the lowest versus highest income quintile was 2.52 (2.51-2.54), rising to 3.89 (3.84-3.93) for the lowest quintile among social benefit recipients. Unemployment increased vaccine resistance by 1.52 times (1.50-1.53). Individuals with a Deyo-Charlson Comorbidity Index ≥3 (five years pre-vaccination) were less likely to resist vaccination (OR: 0.67 (0.66-0.67)) compared to healthy individuals. The analysis confirmed spatial differences in vaccination coverage. Conclusions Using a uniquely detailed dataset, this analysis reveals socioeconomic disparities in COVID-19 vaccination uptake. Individuals in the lowest income quintile, especially those on social benefits, faced major access barriers. Targeting preventive campaigns at socially disadvantaged individuals and improving health literacy is essential for future health crises. The findings provide insights into vaccination strategies in Central and Eastern Europe, where pandemics heavily impacted populations despite universal vaccination availability. Key messages • Clear socioeconomic disparities in COVID-19 vaccination uptake were identified. • Unemployed individuals and those relying on social benefits faced significantly higher levels of vaccine hesitancy.