Lack of lockdown, open borders, and no vaccination in sight: is Bosnia and Herzegovina a control group?

Abstract

Bosnia and Herzegovina is among ten countries in the world with the highest mortality rate due to COVID-19 infection. Lack of lockdown, open borders, high mortality rate, no herd immunity, no vaccination plan, and strong domestic anti-vaccination movement present serious COVID-19 concerns in Bosnia and Herzegovina. In such circumstances, we set out to study if the population is willing to receive the vaccine.
A cross-sectional study was conducted among 10,471 adults in Bosnia and Herzegovina to assess the attitude of participants toward COVID-19 vaccination. Using a logistic regression model, we assessed the associations of sociodemographic characteristics with vaccine rejection, reasons for vaccine hesitancy, preferred vaccine manufacturer, and information sources.
Surprisingly, only 25.7% of respondents indicated they would like to get a COVID-19 vaccine, while 74.3% of respondents were either hesitant or completely rejected vaccination. The vaccine acceptance increased with increasing age, education, and income level. Major motivation of pro-vaccination behaviour was intention to achieve collective immunity (30.1%), while the leading incentive for vaccine refusal was deficiency of clinical data (30.2%). The Pfizer-BioNTech vaccine is shown to be eightfold more preferred vaccine compared to the other manufacturers. For the first time, vaccine acceptance among health care professionals has been reported, where only 39.4% of healthcare professionals expressed willingness to get vaccinated.
With the high share of the population unwilling to vaccinate, governmental impotence in securing the vaccines supplies, combined with the lack of any lockdown measures suggests that Bosnia and Herzegovina is unlikely to put COVID-19 pandemic under control in near future.

Full text

Lack of lockdown, open borders, and no vaccination in sight: is Bosnia and Herzegovina a
control group?
Adnan Fojnica1, Ahmed Osmanovic2, Nermin Đuzic3, Armin Fejzic4, Ensar Mekic3, Zehra
Gromilic5, Imer Muhovic3, and Amina Kurtovic-Kozaric3,6*
1Institute of Biotechnology and Biochemical Engineering, Graz University of Technology, NAWI
Graz, 8010 Graz, Austria.
2Olawell Inc., Manchester, MA 01944, USA
3International Burch University, Francuske revolucije bb, Sarajevo, Bosnia and Herzegovina
4Department of Molecular biology, University of Vienna, Universitätsring 1, 1010 Vienna,
Austria
5Institute of Biochemistry, Graz University of Technology, Petersgasse 10-12/II, 8010 Graz,
Austria.
6Department of Pathology, Cytology and Human Genetics, University Clinical Center Sarajevo,
Sarajevo, Bosnia and Herzegovina,
Correspondence:
Amina Kozaric, PhD
Professor of Genetics
Bolnicka 25, 71 000 Sarajevo, Bosnia and Herzegovina
Phone: +387 62 621 423
Email: amina.kurtovic@gmail.com
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 3, 2021. ; https://doi.org/10.1101/2021.03.01.21252700doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Abstract
Bosnia and Herzegovina is among ten countries in the world with the highest mortality rate due
to COVID-19 infection. Lack of lockdown, open borders, high mortality rate, no herd immunity,
no vaccination plan, and strong domestic anti-vaccination movement present serious COVID-19
concerns in Bosnia and Herzegovina. In such circumstances, we set out to study if the population
is willing to receive the vaccine.
A cross-sectional study was conducted among 10,471 adults in Bosnia and Herzegovina to assess
the attitude of participants toward COVID-19 vaccination. Using a logistic regression model, we
assessed the associations of sociodemographic characteristics with vaccine rejection, reasons for
vaccine hesitancy, preferred vaccine manufacturer, and information sources.
Surprisingly, only 25.7% of respondents indicated they would like to get a COVID-19 vaccine,
while 74.3% of respondents were either hesitant or completely rejected vaccination. The vaccine
acceptance increased with increasing age, education, and income level. Major motivation of
pro-vaccination behaviour was intention to achieve collective immunity (30.1%), while the
leading incentive for vaccine refusal was deficiency of clinical data (30.2%). The
Pfizer-BioNTech vaccine is shown to be eightfold more preferred vaccine compared to the other
manufacturers. For the first time, vaccine acceptance among health care professionals has been
reported, where only 39.4% of healthcare professionals expressed willingness to get vaccinated.
With the high share of the population unwilling to vaccinate, governmental impotence in
securing the vaccines supplies, combined with the lack of any lockdown measures suggests that
Bosnia and Herzegovina is unlikely to put COVID-19 pandemic under control in near future.
2
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Introduction
On 1st March 2020, the World Health Organization (WHO) characterized the coronavirus
disease 2019 (COVID-19) as a pandemic
(https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-a
t-the-media-briefing-on-covid-19---11-march-2020). Since the first registered case of COVID-19
until now there were more than 100 million officially registered cases of COVID-19 and more
than 2 million persons have passed away due to COVID-19 infection
(https://www.worldometers.info/coronavirus/). Consequently, the rapid development of a
COVID-19 vaccine was a global imperative1. Now in 2021, there are currently a few vaccines
that passed the third phase of clinical trial and they are being distributed all over the world2. In
the majority of developed countries, the vaccination has already started, whereas in most
developing and less developed countries the vaccination has not yet started
(https://ourworldindata.org/covid-vaccinations).
Vaccination has already started in the United States (US) and the European Union (EU). In the
US and EU, Pfizer-BioNTech and Moderna vaccines have been approved
(https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-receive-auth
orization-european-union),while European Medicines Agency (EMA) has recommended the
approval of the AstraZeneca COVID-19 vaccine
(https://www.ema.europa.eu/en/news/ema-recommends-first-covid-19-vaccine-authorisation-eu).
Safety and efficiency of the COVID-19 vaccine has been also confirmed for the Sputnik V.3
Additionally, the National Medical Products Administration in China has given approval for the
COVID-19 vaccine made by Sinovac Biotech
(http://subsites.chinadaily.com.cn/nmpa/2021-02/07/c_588422.htm). Regarding the Balkans,
3
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vaccination has not started in Albania, Bosnia and Herzegovina (B&H), Kosovo, Montenegro,
and North Macedonia (Figure 1). In B&H, the media have reported that in Republika Srpska, an
entity of Bosnia and Herzegovina, around 2.000 doses of Sputnik V COVID-19 vaccine have
been distributed among healthcare workers.
In Bosnia and Herzegovina, ~120.000 cases of COVID-19 have been officially been registered
until February 2021 (3.4% of the whole population) and almost 5.000 deaths (4.16% of all
COVID-19 cases). The peak of infection was in October and November. Currently, in B&H
there are around 400 active cases, with ~93 new confirmed cases daily per million people and ~4
deaths daily per million people (https://ourworldindata.org/coronavirus-data-explorer). In
January 2021, B&H was 4th among the countries with the highest mortality rate due to
COVID-19 infection with 123 deaths reported per 100,000 people
(https://worldmapper.org/maps/coronavirus-cases-casemortality/).
Even though some COVID-19 measures are present (the curfew from 23:00 to 5:00 h, the ban of
public gatherings for >50 persons indoors and 100 persons outdoors), they are not enforced.
There is no lock-down, borders are open, schools and universities are partially opened, while
shopping centers, restaurants, ski centers, and bars are working as usual
(https://www.dw.com/bs/njema%C4%8Dki-mediji-gra%C4%91ani-bih-se-ne-pridr%C5%BEavaj
u-pravila/a-54047892).
The aim of this study was to collect data about the willingness of the adult population in Bosnia
and Herzegovina to be vaccinated and to examine the factors that affect vaccine rejection.
Additionally, we examined if vaccine rejection was correlated with education, income,
profession, and age.
4
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Materials and Methods
We conducted a cross-sectional electronic survey study about COVID-19 vaccine acceptance in
Bosnia and Herzegovina from January 26th to February 2nd, 2021 gathering answers from a total
of 10,471 participants. The study was approved by the Ethics Committee of the Faculty of
Engineering and Natural Sciences, International Burch University. Eligibility criteria included
being age 18 or older and currently living in Bosnia and Herzegovina. The survey was developed
in the local language and created using Google’s online survey platform. All the study
participants were informed that the data would be used only for research purposes and not
available to the public. According to Google’s privacy policy, all survey responses were
anonymous and confidential. It was delivered to respondents via e-mails, research and
employment-oriented online services (ResearchGate™ and LinkedIn™), and other social media
platforms such as Facebook™, Skype™, and Viber™).
The participants responded to a total of 11 items. The first part of the survey covered
demographic questions including gender, level of education, profession, age, and monthly
income. Gender was categorized as male, female or other. The level of education was defined as
elementary school, high school, undergraduate degree, and postgraduate degree (master or
doctorate). The profession was classified into five categories including medical professionals,
teachers, business sector, catering and service industry, and others. The age was categorized into
four different groups: 18-30, 31-50, 51-64, and 65 years or older. Monthly income was defined
as 250 EUR or less, 250-450 EUR, and 450 EUR or more.
The second part of the survey assessed a range of vaccine-related questions. Respondents were
asked to claim whether they will choose to vaccinate or not, and to corroborate their choice with
5
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rationale for or against vaccination having the ability to select multiple options. Furthermore,
participants were asked to state their major source of information about health implications of
COVID-19 vaccines. The respondents willing to be vaccinated were asked to indicate which
vaccine manufacturer(s) would be their personal choice: Pfizer – BioNTech (Germany),
Oxford-AstraZeneca (United Kingdom), Modern (USA), Sputnik V (Russia), or Sinovac
(China), and to choose one or more reasons for the choice.
Statistical analysis included descriptive statistics data regarding the frequencies calculated for
each category of demographic set of questions. Also, a univariate and multinomial logistic
regressions in R were employed to examine correlation between vaccine acceptability and a set
of demographics and variables of interest.
6
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Results
Table 1 summarizes the set of demographic data including age, gender, education, monthly
income, and profession. Women were 52.3% respondents of the survey and 53.9% were between
18 and 30 years old. More than half of the participants (53.1%) had monthly income of 450
EUR or more (average salary is about 450 EUR). About half of the respondents (51.9%) had a
university degree. Significant number of healthcare professionals (15%) took part in our study.
Overall, 25.7% (2,695 of 10,461) of respondents indicated they are willing to get a COVID-19
vaccine, while 74.3% of respondents hesitated to get vaccinated (37.4% would not vaccinate,
13.7% respondents would vaccinate only if obliged, and 23.2% will wait for additional clinical
studies to decide). Detailed breakdown of vaccine questions is available in Supplementary Table
1. We treated the three answers: 'No', 'Only if I will have to’ and 'Maybe later' as one group
because they show trends in their answers (Supplementary Table 2 and 3).
Table 2 summarizes 5 univariate regressions regarding vaccine acceptability against
demographics (age, gender, monthly income, education, and profession). Accordingly, age,
education, occupation and income significantly affected attitudes towards vaccination (p <.05),
while sex of the participant did not (p > .05). People aged 31–50, 51–64 and 65+ were more
likely to accept the vaccine than those who were aged 18–30. This difference was strongest (odds
ratio (OR) = 4.61; 95% confidence interval (CI) (2.74, 7.77)) when respondents aged 65+ were
compared to the youngest age cohort. The univariate regression suggests no significant
distinction in the response to vaccine acceptance based on the gender.
Higher income was positively associated with vaccine acceptance. People earning 450+ EUR per
month were 1.18 (95 CI% (1.04, 1.34)) times more likely to respond positively to the vaccine
7
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acceptance question than people earning 250 EUR and less. Higher levels of education were also
associated positively with vaccine acceptance. Respondents from the postgraduate group were
5.21 (95 CI% (3.14, 9.18)) times more likely to respond positively compared to participants
having only primary school education. Medical health professionals were more likely to get
vaccinated compared to other professions. In fact, educational workers had 60% lower odds of
vaccine acceptance compared to the health professionals.
Major determinants behind vaccination were achieving collective immunity (30.11%) and
concern regarding personal health (29.57%), following avoidance of “travel ban” (27.31%) and
employer request (13.00%). The Pfizer-BioNTech would be chosen by 50.62 % participants
willing to vaccinate, while Sinovac vaccines would be preferred for only 6.44 % of them.
Effectiveness shown in clinical trials is the main motive for Pfizer's vaccine choice. Most
objections to vaccination are due to insufficient clinical trials (30.11 %), 23.08 % respondents
perceive pharmaceutical companies as self-serving enterprises. Significant numbers recognize
vaccines as harmful (12.23%), 9.63% participants identify COVID-19 disease as harmless to
their health, while an identical portion of respondents reject vaccines due to religious motives.
For 9.19% participants SARS-CoV-2 virus is just a conspiracy theory, while 6.05% individuals
assessed vaccines as necessary only for clinically vulnerable citizens.
8
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Discussion
In this study, we report the lowest COVID-19 vaccine acceptance in the world, where only
25.7% participants demonstrated willingness to receive vaccination against SARS-CoV-2.
Lowest COVID-19 vaccination acceptance levels prior reported was in Poland (37 %), following
Slovakia (41 %), Romania (44 %) and Czech Republic (49 %)4-5. Understanding of vaccination
refusal and reasons for rejection among citizens in B&H is of great importance as reports from
the January 2021 list Bosnia and Herzegovina as fourth in the world in terms of deaths per
100,000 inhabitants, right after Slovenia, Belgium and San Marino
(https://worldmapper.org/maps/coronavirus-cases-casemortality/). Observed data should be used
to raise awareness among the population and reach those strongly advocating against COVID-19
vaccination programs.
Univariate regression outputs for vaccine acceptability demonstrate important discrepancies
across diverse categories in the survey. Participants with above average income were more likely
to accept vaccination compared to those having minimum wage. Findings suggest participants
with primary school education were more prone to reject vaccination compared to participants
having higher levels of education. Observed data are in accordance with studies previously
conducted4.
The univariate regression suggests no significant distinction in the response to vaccine
acceptance based on the gender. However, we see a trend where women seem to be more hesitant
regarding COVID-19 vaccines, while men are slightly more prone to vaccination, diverting from
the trend of higher medical care service utilization among women6. Additionally, we observed
age-related associations with vaccine acceptance. Older people were more likely to report that
9
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they would take a vaccine, whereas respondents aged 18‒30 years had the highest rate of
vaccination refusal5,7,8.
For the first time in B&H, vaccine acceptance among health care professionals has been
examined and compared to the other professions. Only 39.4 % of healthcare professionals are
willing to accept vaccination, while others are hesitant or strongly refusing vaccination. This
confirms concerns raised by Arapovic et al. in 2019, regarding lower vaccine acceptance among
healthcare workers in B&H, as they directly communicate with patients and shape their
perspective toward vaccination9. Similar vaccine acceptance was reported in a recent study
conducted among health care professionals in the United States10.
Major driver of pro-vaccination behaviour was intention to achieve collective immunity,
following health care and personal protection. Also, data clearly shows employer’s vaccination
requests would be insufficient incentive for vaccine acceptance among employees. The
participants willing to vaccinate prefer Pfizer-BioNTech vaccines up to eightfold more compared
to the other vaccine manufacturers, acknowledging high vaccine effectiveness reported in
clinical trials11-15. Confidence in system and governmental decisions is evidently low, as the
population witnesses various political and socio-economic crises in the post-war period.
Strong domestic anti-vaccination movement noticed in the last several years finally got better
understanding through cross-examination and common objections anti-vaccine advocates
expressed over the years are reported in our survey16,17. Anti-vaccination groups target local
media and online platforms to spread misleading health information and address controversial
arguments such as the economic benefit of pharmacies and tragic personal stories18. Reporting
educational programs, media platforms and social networks as main sources of information
during pandemic, high COVID-19 vaccine rejection among participants becomes utterly
10
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understandable. As the second major motivation for vaccine rejection, participants listed mistrust
in pharmaceutical companies, followed by assessment of vaccines as harmful. Scientific
community and health care professionals advocating vaccines, must be more presented on those
platforms to raise awareness and reach citizens looking for reliable information.
Most of the data used in this survey have been collected using online social networks, which
often excludes citizens in the category of age 65 and older19. Since they represent a high-risk
group and are more likely to accept vaccination, the acceptance rate may be larger than
presented4,5. Another limitation represents absence of information in case participants were
infected with SARS-CoV-2 virus and whether they consider acquired immunity to be sufficient
protection and adequate replacement for the vaccination. 23.2 % participants indicated hesitance
to the vaccination due to insufficient clinical trials conducted, therefore safe and effective mass
immunization around the globe could increase acceptance rate as time passes. Finally, rejection
was assessed using a hypothetical vaccine, which may differ from the respondents' preferences
encountering real life situations once COVID 19 vaccines become widely available.
According to current studies, herd immunity benefits are achievable if 65%–70% of the
population is vaccinated20. With the high share of the population unwilling to vaccinate,
governmental impotence in securing the vaccines’ supplies, combined with the number of people
unable to receive the COVID-19 vaccine (e.g., allergies), herd immunity is out of reach for the
B&H population in the near future. In order to increase awareness regarding health benefits of
vaccination and the historical role immunization had in eradication of many deadly diseases,
people must be reached through main informing sources - educational programs and media.
Additional efforts must be made to organize scientific panels and conferences for healthcare
workers and physicians, as only 39,4% of them are willing to accept vaccination. Ideally,
11
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frontline medical professionals should make strong recommendations for vaccination, as well as
share their personal experiences with COVID-19 vaccines. Finally, preparation for public
acceptance of a COVID-19 vaccine must be carefully conducted before a vaccine becomes
widely available. Based on this study, we urge the Bosnian government to develop strategies and
COVID-19 vaccination implementation plans that would encourage citizens to accept a
vaccination21.
12
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Contributions
A.F. and A.O. conceived and designed the study. N.Đ. and A.F. managed and performed data
collection. E.M. and I.M. statistically analyzed and interpreted the data. A.F., A.O., N. Đ., A.F.,
Z.G., and A.K. drafted the manuscript. A.K. edited and approved the final version for
submission.
Competing Interest
The authors declare no competing financial or personal interests that could influence the work
reported in this paper.
Ethical approval
This study was approved by Burch University Ethics Commission and informed consent
obtained from all participants.
13
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Figure Legends
Figure 1 The number of vaccine doses given to people, not the number of people fully
vaccinated. Since some vaccines require more than one dose, the number of fully vaccinated
people is likely to be lower. Retrieved from Our World in Data on 2/3/2021.
17
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Table 1 Summary of participants’ demographic data
Overall
n
10,471
Gender (%)
Male
4,965 (47.4)
Female
5,476 (52.3)
Other
30 (0.3)
Level of education (%)
Elementary school
159 (1.5)
High school
4,878 (46.6)
Undergraduate degree
3,757 (35.9)
Postgraduate degree (Master or Doctoral degree)
1,677 (16)
Profession (%)
Medical professionals
1,570 (15)
Education sector
936 (8.9)
Economic sector
1,639 (15.7)
Catering and service industry
721 (6.9)
Other
5,605 (53.5)
Age group in years (%)
18-30
5,649 (53.9)
31-50
4,210 (40.2)
51-64
544 (5.2)
65+
68 (0.6)
Total monthly income
250 EUR or less
2,522 (24.1)
250-450 EUR
2,384 (22.8)
450 EUR or more
5,565 (53.1)
18
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Table 2 Beta coefficients and odds ratios of predictors of attitude towards vaccination when
comparing the answers 'Yes' with 'No / Only if I will have to / Maybe later'
Variable
Level comparison
Beta coefficients (95%
CIs)
Odds ratios (95%
CIs)
Age
31–50 vs 18–30
0.52 (0.42, 0.62)***
1.69 (1.53, 1.87)***
51–64 vs 18–30
1.10 (1.00, 1.30)***
3.15 (2.59, 3.82)***
65 or more vs 18-30
1.50 (1.00, 2.10)***
4.61 (2.74, 7.77)***
Sex
Female vs male
-0.01 (-0.10, 0.09)
0.99 (0.90, 1.10)
Other vs male
-0.71 (-1.70, 0.18)
0.49 (0.17, 1.20)
Education
High school vs primary school
0.68 (0.18, 1.20)*
1.97 (1.20, 3.44)*
Graduate vs primary school
1.50 (1.00, 2.10)***
4.57 (2.78, 8.01)***
Postgraduate vs primary school
1.70 (1.10, 2.20)***
5.21 (3.14, 9.18)***
Profession
Economic sector vs medical
worker
-0.59 (-0.75, -0.44)***
0.55 (0.47, 0.65)***
Service sector vs medical worker
-0.70 (-0.94, -0.47)***
0.50 (0.39, 0.63)***
Educational vs medical worker
-0.93 (-1.10, -0.74)***
0.40 (0.33, 0.48)***
Other vs medical worker
-0.62 (-0.75, -0.49)***
0.54 (0.47, 0.61)***
Income
250-450 EUR vs 250 EUR or less
-0.31 (-0.45, -0.16)***
0.74 (0.63, 0.85)***
450 EUR or more vs 250 EUR or
less
0.17 (0.04, 0.29)**
1.18 (1.04, 1.34)**
*, p < .05; **, p < .01; ***, p < .001
19
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Supplementary Table 1 Summary of descriptive statistics results
Research Questions
n=10,471
Will most of the people
reject the COVID-19
vaccine?
37.40% does not want to receive COVID-19 vaccine
23.18% will be waiting for additional clinic studies
13.69% will receive only if obliged to
What are the main motives
for vaccination?
30.11% Acquiring collective immunity and preventing spread of virus
29.57% Healthcare and self protection
27.31% Travel possibility and avoidance of „travel ban“
13.00% Employer’s request and preservation of working position
What are the reasons for
vaccination refusal?
30.19% Insufficient clinical trials of vaccination
23.08% Lack of trust to pharmacy
12.23% Vaccines perceived as harmful
9.63% COVID-19 disease is not dangerous for my health
9.63% Vaccines’ compositions are against my ethical and religious
principles
9.19% SARS-CoV-2 does not exist - it is conspiracy theory
6.05% Only most vulnerable categories shall receive the vaccines
What are the main sources
of information about
health-related implication
vaccines have?
27.70% Educational and documentary shows
26.16% Media and information portals
20.10% Social networks (Facebook™, Twitter™ etc.)
15.90% Scientific books and papers
10.14% Recommendations of family physicians
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Which vaccines are more
likely to be accepted by
citizens of Bosnia and
Herzegovina?
No1: Pfizer–BioNTech (Germany), by 50.62%
No2: Oxford-AstraZeneca (United Kingdom), by 16.16%
No3: Moderna (USA), by 15.30%
No4: Sputnik V (Russia), 11.48%
No5: Sinovac (China), by 6.44%
What are the reasons to
choose a specific vaccine
manufacturer?
52.37% Effectiveness reported through studies
21.69% International politics states’ manufacturers have
19.92% Physician’s or medical staff’s advice
6% Following governmental decisions
21
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Supplementary Table 2 Beta coefficients and odds ratios of predictors of attitude towards
vaccination when comparing the vaccine answers using multinomial logistic regression
Characteristic
Beta
95% CI
Odds Ratio
95% CI
p-value
Yes vs. No
Female vs. Male
0.10
-0.01, 0.21
1.11
0.99, 1.23
0.074
Other vs. Male
-1.10
-2.10, -0.14
0.32
0.12, 0.87
0.025
Postgraduate vs. primary school
2.20
1.60, 2.70
8.72
5.01, 15.2
<0.001
Graduate vs. primary school
1.90
1.40, 2.50
6.99
4.06, 12.0
<0.001
High school vs. primary school
0.87
0.33, 1.4
2.38
1.38, 4.08
0.002
Economic sector vs. medical
worker
-0.63
-0.81, -0.44
0.53
0.44, 0.64
<0.001
Other vs. medical worker
-0.74
-0.89, -0.59
0.48
0.41, 0.55
<0.001
Service sector vs. medical
worker
-0.81
-1.10, -0.55
0.45
0.35, 0.58
<0.001
Educational worker vs. medical
worker
-1.00
-1.20, -0.73
0.39
0.31, 0.48
<0.001
65 or more vs 18-30
1.50
0.85, 2.1
4.27
2.33, 7.81
<0.001
51-64 vs 18-30
1.30
1.10, 1.60
3.81
3.01, 4.82
<0.001
31-50 vs 18-30
0.59
0.48, 0.70
1.81
1.62, 2.02
<0.001
450 EUR or more vs 250 EUR
or less
0.09
-0.05, 0.23
1.10
0.95, 1.26
0.200
250 EUR - 450 EUR vs 250
EUR or less
-0.43
-0.59, -0.27
0.65
0.55, 0.76
<0.001
22
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Only if having to vs. No
Female vs. Male
-0.04
-0.17, 0.09
0.96
0.85, 1.10
0.600
Other vs. Male
-11.00
-11.00,
-11.00
0.00
0.00, 0.00
<0.001
Postgraduate vs. primary school
0.39
-0.12, 0.90
1.48
0.89, 2.47
0.130
Graduate vs. primary school
0.45
-0.03, 0.94
1.57
0.97, 2.56
0.068
High school vs. primary school
0.15
-0.33, 0.63
1.16
0.72, 1.87
0.600
Economic sector vs. medical
worker
0.00
-0.23, 0.24
1.00
0.79, 1.27
>0.900
Other vs. medical worker
-0.24
-0.44, -0.04
0.79
0.65, 0.96
0.018
Service sector vs. medical
worker
-0.07
-0.35, 0.21
0.93
0.70, 1.23
0.600
Educational worker vs. medical
worker
0.31
0.05, 0.58
1.37
1.05, 1.78
0.020
65 or more vs 18-30
-0.85
-2.10, 0.38
0.43
0.13, 1.46
0.200
51-64 vs 18-30
-0.06
-0.41, 0.28
0.94
0.67, 1.32
0.700
31-50 vs 18-30
0.04
-0.09, 0.17
1.04
0.91, 1.18
0.600
450 EUR or more vs 250 EUR
or less
0.05
-0.11, 0.22
1.06
0.90, 1.24
0.500
250 EUR - 450 EUR vs 250
EUR or less
0.01
-0.17, 0.19
1.01
0.85, 1.20
>0.900
Maybe later vs. No
Female vs. Male
0.33
0.22, 0.44
1.39
1.25, 1.56
<0.001
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Other vs. Male
-0.64
-1.6, 0.31
0.53
0.20, 1.36
0.200
Postgraduate vs. primary school
1.50
1.00, 1.90
4.39
2.75, 7.02
<0.001
Graduate vs. primary school
1.20
0.77, 1.7
3.39
2.15, 5.34
<0.001
High school vs. primary school
0.66
0.21, 1.1
1.94
1.23, 3.03
0.004
Economic sector vs. medical
worker
-0.08
-0.28, 0.11
0.92
0.75, 1.12
0.400
Other vs. medical worker
-0.22
-0.38, -0.05
0.81
0.69, 0.95
0.009
Service sector vs. medical
worker
-0.27
-0.51, -0.02
0.77
0.60, 0.98
0.035
Educational worker vs. medical
worker
-0.26
-0.49, -0.03
0.77
0.61, 0.97
0.028
65 or more vs 18-30
0.10
-0.65, 0.85
1.10
0.52, 2.34
0.800
51-64 vs 18-30
0.56
0.31, 0.81
1.75
1.36, 2.25
<0.001
31-50 vs 18-30
0.19
0.07, 0.30
1.20
1.08, 1.35
0.001
450 EUR or more vs 250 EUR
or less
-0.25
-0.39, -0.12
0.78
0.68, 0.89
<0.001
250 EUR - 450 EUR vs 250
EUR or less
-0.38
-0.53, -0.24
0.68
0.59, 0.79
<0.001
24
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Supplementary Table 3 Beta coefficients and odds ratios of predictors of attitude towards
vaccination when comparing the answers 'Yes / Only if I will have to' vs. 'No / Maybe later'
Variable
Level comparison
Beta coefficients (95%
CIs)
Odds ratios (95%
CIs)
Age
31–50 vs 18–30
0.31 (0.23, 0.40)***
1.37 (1.25, 1.49)***
51–64 vs 18–30
0.66 (0.48, 0.85)***
1.94 (1.62, 2.33)***
65 or more vs 18-30
0.84 (0.34, 1.30)**
2.31 (1.40, 3.84)***
Sex
Female vs male
-0.08 (-0.17, 0.00)
0.92 (0.84, 1.00)
Other vs male
-1.2 (-2.2, -0.35)*
0.30 (0.11, 0.71)*
Education
High school vs primary school
0.33 (-0.03, 0.72)
1.39 (0.97, 2.05)
Graduate vs primary school
0.91 (0.54, 1.30)***
2.48 (1.72, 3.66)***
Postgraduate vs primary school
0.94 (0.56, 1.30)***
2.56 (1.75, 3.80)***
Profession
Economic sector vs medical
worker
-0.40 (-0.55, -0.26)***
0.67 (0.58, 0.77)***
Service sector vs medical worker
-0.44 (-0.64, -0.25)***
0.64 (0.53, 0.78)***
Educational vs medical worker
-0.42 (-0.59, -0.26)***
0.65 (0.55, 0.77)***
Other vs medical worker
-0.51 (-0.62, -0.39)***
0.60 (0.54, 0.68)***
Income
250-450 EUR vs 250 EUR or less
-0.09 (-0.21, 0.04)
0.92 (0.81, 1.04)
450 EUR or more vs 250 EUR or
less
0.19 (0.08, 0.30)***
1.21 (1.09, 1.35)***
*, p < .05; **, p < .01; ***, p < .001
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