Determinants of COVID-19 immunisation uptake in a country with high mortality and a low vaccination rate

Background: Research concerned with attitudes towards COVID-19 vaccination in upper middle-income countries such as Bosnia and Herzegovina (B & H) is scarce. Currently, B & H has the lowest number of fully vaccinated adults in Europe, and the highest cumulative number of COVID-19 deaths and SARS-CoV-2 in-fected individuals. The aim of our study was to examine the factors associated with COVID-19 vaccination status in B & H.Methods: An online survey among 1304 B & H adults was conducted in October 2021 evaluating vaccine acceptance, together with socio-demographic variables, attitudes and beliefs related to COVID-19 vacci-nation.Results: The results from a binary logistic regression indicate that those who believed that the COVID-19 vaccine was effective were 45 times more likely to be vaccinated compared to those who did not. We also show that those who had received childhood immunisations were 41 times more likely to be vaccinated against COVID-19 compared to those who had never been previously immunised. Other significant factors were related to respondents' trust in government institutions and healthcare policymakers as well as trust in public healthcare workers.Conclusion: We suggest that future vaccination campaigns should be aimed at educating the public re-garding the importance and safety of vaccines, together with strengthening trust in the public health system.& COPY; 2023 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).

Automated summary

The COVID-19 vaccination rate is low in Bosnia and Herzegovina, where the COVID-19 situation is severe. This study found that people who believe in the effectiveness of the vaccine and have received childhood immunizations are more likely to be vaccinated against COVID-19. Trust in government institutions, healthcare policymakers, and public healthcare workers are also significant factors. Future vaccination campaigns should focus on educating the public and increasing trust in the public health system.