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. 2021 Nov 20;9(11):1364.
doi: 10.3390/vaccines9111364.

Regional Differences in COVID-19 Vaccine Hesitancy in December 2020: A Natural Experiment in the French Working-Age Population

Fanny Velardo  1   2 , Verity Watson  3 , Pierre Arwidson  4 , François Alla  1   2 , Stéphane Luchini  5 , Michaël Schwarzinger  1   2 , CoVaMax Study Group
Affiliations

Regional Differences in COVID-19 Vaccine Hesitancy in December 2020: A Natural Experiment in the French Working-Age Population

Fanny Velardo et al. Vaccines (Basel). .

Abstract

It can be assumed that higher SARS-CoV-2 infection risk is associated with higher COVID-19 vaccination intentions, although evidence is scarce. In this large and representative survey of 6007 adults aged 18-64 years and residing in France, 8.1% (95% CI, 7.5-8.8) reported a prior SARS-CoV-2 infection in December 2020, with regional variations according to an East-West gradient (p < 0.0001). In participants without prior SARS-CoV-2 infection, COVID-19 vaccine hesitancy was substantial, including 41.3% (95% CI, 39.8-42.8) outright refusal of COVID-19 vaccination. Taking into account five characteristics of the first approved vaccines (efficacy, duration of immunity, safety, country of the vaccine manufacturer, and place of administration) as well as the initial setting of the mass vaccination campaign in France, COVID-19 vaccine acceptance would reach 43.6% (95% CI, 43.0-44.1) at best among working-age adults without prior SARS-CoV-2 infection. COVID-19 vaccine acceptance was primarily driven by vaccine characteristics, sociodemographic and attitudinal factors. Considering the region of residency as a proxy of the likelihood of getting infected, our study findings do not support the assumption that SARS-CoV-2 infection risk is associated with COVID-19 vaccine acceptance.

Keywords: COVID-19; France; SARS-CoV-2; anti-vaccination behavior; discrete choice experiment; mass vaccination; survey experiment; vaccine hesitancy.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Choice task example in the discrete choice experiment used in December 2020.
Figure 3
Figure 3
Prevalence of detected SARS-CoV-2 infection in the French working-age population (December 2020). Figure legend: Auvergne-Rhône-Alpes (ARA), Bourgogne-Franche-Comté (BFC), Bretagne (BRE), Cen-tre-Val de Loire (CVL), Grand Est (GES), Hauts-de-France (HDF), Ile-de-France (IDF), Normandie (NOR), Nouvelle-Aquitaine (NAQ), Occitanie (OCC), Pays-de-la-Loire (PDL), and Provences-Alpes-Côte-d’Azur (PAC).
Figure 4
Figure 4
Acceptance of BioNTech vaccine predicted in the French working-age population, overall and by region (December 2020). Figure legend: Auvergne-Rhône-Alpes (ARA), Bourgogne-Franche-Comté (BFC), Bretagne (BRE), Cen-tre-Val de Loire (CVL), Grand Est (GES), Hauts-de-France (HDF), Ile-de-France (IDF), Normandie (NOR), Nouvelle-Aquitaine (NAQ), Occitanie (OCC), Pays-de-la-Loire (PDL), and Provences-Alpes-Côte-d’Azur (PAC). French regions of residency are ordered by detected SARS-CoV-2 prevalence.
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