Covid-19 and influenza vaccine hesitancy insights from France, Italy and Hungary: A mixed-methods study

Since the Covid-19 pandemic entered its endemic phase, France, Italy, and Hungary, as well as many other European countries, have observed a rise in vaccine hesitancy. This study employs a mixed-methods approach to understand the reasons behind this trend by linking statistical observations with in-depth view of vaccine hesitancy. A total of 3,021 adults were surveyed from France, Italy, and Hungary via nationally representative surveys, examining views toward these vaccines. We employed both pooled and un-pooled linear regression analyses. In each country, 20 semi-structured interviews were conducted. Our pooled survey analysis reveals that hesitancy toward Covid-19 and influenza vaccines was higher among respondents reporting mistrust in healthcare providers [95% CI = -0.26,-0.17; <i>P</i> < .001] and lower among those with underlying health conditions. Additionally, older adults were less likely to receive Covid-19 vaccines but more likely to receive an influenza vaccine. Those without a Covid-19 vaccination were 18% points more likely to be unvaccinated against influenza [95% CI = 0.11,0.24; <i>P</i> < .001]. The interviews highlight that these broader patterns reflect a post-pandemic landscape characterised by heightened ambivalence and complexity in vaccine decisions, in which people find it difficult to decide independently and rely more on experts. The interviews also revealed various influences on vaccine hesitancy, including safety concerns, diminished fear of disease, and online misinformation. These indicate that post-pandemic vaccine hesitancy reflects shifting attitudes shaped by shared pandemic experiences across countries, underscoring the need for continued research and monitoring in light of how post-pandemic vaccine hesitancy differs from pre-pandemic forms.