Determinants of COVID-19 vaccine uptake in the Netherlands: an ecological analysis

Background While overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations. Aim We aimed to identify determinants associated with COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. We focused on those aged 50 years and older, since they are at highest risk of severe disease. Methods We performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake. Results In those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant. Conclusion We identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity between different subpopulations. Since the goal of the vaccination campaign is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on these hard-to-reach populations.