COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden

Abstract

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.

COVID-19 Vaccination and Predictive Factors in Immigrants to Europe: A Systematic Review and Meta-Analysis

“…The first determinant variable was sex. In contrast to the findings of Gram et al [21] (similar vaccination coverage between sexes), Bastola et al [18] (lower vaccine uptake in males from the total sample), and Page et al [28] (increased female willingness to be vaccinated), female immigrants were generally more hesitant and/or opposed to vaccination than male immigrants [16,19,22,25,27,29,30]. We believe that this female attitude may be influenced by a greater attachment to the culture of the country of origin, and, consequently, immigrant women have a greater fear/suspicion of accepting directions from the institution in the host country.…”

“…Specifically, five of these were carried out in Norway, two each in France, Germany, and Italy, one each in Finland, Denmark, Sweden, and Turkey, and one multicentric study in Switzerland, France, and Italy. Three studies (19%) were published in 2021 [23,25,29], four (25%) in 2023 [16,18,21,30], and the remaining nine studies (56%) in 2022 [17,[19][20][21][22]24,[26][27][28]. The earliest data collection was compiled in the period May 2020-June 2020 in Longchamps' study [25], which investigated the hesitancy to vaccinate, as the COVID-19 vaccine was not yet available; the latest one was compiled on COVID-19 vaccination status in February, March, and May 2022 by Aysit et al [16].…”

“…Ten studies aimed at vaccine uptake in immigrants (and in the host population, if investigated) [16][17][18][19][20][21]23,27,29,31], three studies aimed at the vaccine hesitancy [25,28,30], one study the attitude to vaccinate [24], one other [22] the vaccine intention, and the last remaining [26] the information access to preventive measures against COVID-19.…”

Vaccine Hesitancy among Immigrants: A Narrative Review of Challenges, Opportunities, and Lessons Learned

“…Contributing factors to vaccine hesitancy were misinformation, lack of knowledge, safety concerns, personal beliefs, language barriers, immigrant status, and vaccine access. Moreover, most of the studies presented interesting perspectives on vaccine hesitancy, including "social stigma", "loss of autonomy", "fatalism", "immigration status", "parental consent", "old age", and "lack of formal education" [12,20,21,23,24,27,29,[31][32][33]37,[39][40][41].…”

“…The WHO has implemented the Immunization Agenda 2030, a global strategy to maximize the impact of vaccines and save 50 million lives over the next decade [2]. However, some studies have shown disproportionate mortality rates and lower vaccine uptake among immigrant populations [12]. According to Guttmann et al, 2020 [8], nearly half (43.5%) of total COVID-19 cases in Canada involve immigrants although their immigrant population only makes up a quarter (25%) of the country.…”