Vaccines are an essential public health strategy to curb viral infection spreading that hinge on vaccine uptake (1, 2). Vaccine hesitancy may however greatly threaten this. Vaccine hesitancy is defined by the WHO as either delayed acceptance or refusal of a vaccine despite its availability. It has been addressed as one of top ten major global health threats which may undermine global efforts to control the viral spreading of disease and efforts to reach sufficient immunization, referred to as herd immunity (3, 4). Vaccine hesitancy is however a complex problem as it continuously evolves across context, time, place, and different vaccines (2, 5).
Previous literature has identified several sociodemographic factors contributing to vaccine hesitancy. Overall, women show more vaccine hesitancy than men (6–16). As public health messages have emphasized the increased vulnerability for severe COVID-19 outcomes for older adults (especially 60+) and those with underlying health conditions compared to others (17–19), vaccine hesitancy is mostly found among younger age groups (7, 10–12, 14, 15, 20, 21). Increased vaccine hesitancy is also found among ethnic minorities even though they have shown prone to disproportionate suffering from COVID-19 (12–14, 16, 21–26). Additionally, the majority of literature has found associations between vaccine hesitancy and low education (7, 9–11, 13–16, 21, 25, 27–29), as well as low-income levels (7, 12–14, 16, 25, 28, 29). Moreover, both low education and income are associated with low health literacy which may contribute to vaccine hesitancy. Still, many inconsistent results across studies demonstrate that sociodemographic predictors of vaccine hesitancy cannot be assumed (5).
The WHO’s Strategic Advisory Group of Experts (SAGE) developed the “3Cs” model which categorizes reasons for vaccine hesitancy among three main factors: confidence, complacency, and convenience (2, 3). Confidence barriers refer to worries about the safety and effectiveness of the vaccine. Complacency encompasses individuals with low self-perceived risk of a disease that may be prevented by vaccination where other life or health values weigh heftier (2). Self-efficacy may be high, where individuals may have high confidence in personal abilities for prevention, viewing vaccines as an unnecessary preventive measure (30). Matters such as availability, accessibility, affordability, and the widespread reach and understanding of health messages (health literacy) from authorities about the vaccine contribute to vaccine convenience. Although COVID-19 vaccines have been actively offered to all Norwegian residents free of charge, convenience barriers resulting from low health literacy or language barriers cannot be excluded due to the high migrant density in eastern Oslo (3, 30, 31).
As current literature has primarily focused on measuring hypothetical vaccine intention, few studies have assessed sociodemographic predictors of vaccine hesitancy after the arrival of the COVID-19 vaccines. Due to its continuous evolution, research across- and within countries on a subnational and regional level is crucial to identify predictors and address specific barriers in vaccine uptake to identify vulnerable population groups and react deftly with more tailored and nuanced approaches (2, 12–14, 24). In March 2021, several municipalities in Norway received extra vaccine doses due to consistent high COVID-19 infection rates (31, 32). In Oslo, these were mostly assigned to six eastern districts with high infection pressure. Although vaccine acceptance is expected to be high in Norway due to generally high levels of trust in Norwegian authorities (33–36), eastern Oslo is known as a deprived area relative to other parts of the city with high ethnic minority density where vaccine hesitancy is suspected (37). Therefore, by using survey data collected during the COVID-19 pandemic from these prioritized districts, this study aims to investigate sociodemographic predictors of vaccine hesitancy, explore what main reasons for vaccine hesitancy are, and how these reasons are predicted by sociodemographic characteristics. This may enable the identification of vulnerable subgroups and in turn aid the development of tailored public health strategies targeted accordingly to increase vaccine uptake (11, 14, 20, 21, 24, 27, 38). Furthermore, this study shall address vaccine hesitancy after the arrival of the vaccines, thus adding to the current underrepresentation of Norway in related literature. This may be of substantial importance for public health responses in the current and forthcoming pandemics.