Tracking COVID-19 vaccination intentions in a multiethnic overseas territory: evidence from repeated online surveys in French Guiana

Tracking COVID-19 vaccination intentions in a multiethnic overseas territory: evidence from repeated online surveys in French Guiana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Tracking COVID-19 vaccination intentions in a multiethnic overseas territory: evidence from repeated online surveys in French Guiana Cécile Sommen, Leïla Ramiz, Glwadys Forsans, Christelle Alves Sarmento, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8885506/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background. COVID-19 vaccine hesitancy was anticipated in French overseas territories, yet locally grounded, near–real-time evidence remained scarce during the pandemic. We aimed to monitor vaccination intentions over time and identify actionable determinants to inform outreach strategies in a young, geographically dispersed, and multiethnic setting. Methods. We conducted four repeated, territory-wide online cross-sectional surveys in French Guiana between March and October 2021. Post-stratification weights based on census data (age, sex, area of residence, occupational category) were applied to estimate vaccination coverage and intention. Weighted robust Poisson regression models were used to identify correlates of vaccination intention, adjusting for survey wave. Results. Estimated vaccination coverage increased from 12% to 54% over the study period, while the proportion of respondents firmly opposed to vaccination declined only modestly. Higher intention was strongly associated with perceived vaccine efficacy and safety, concern about COVID-19, trust in health authorities, and public-facing occupations, and was lower among inactive respondents and residents of the Maroni region. Reliance on traditional remedies and social media as information sources was associated with greater hesitancy. Coverage estimates broadly tracked official administrative data, despite systematic differences in absolute levels consistent with non-probability online sampling. Conclusions. In a complex, multiethnic territory, repeated low-cost online surveys provided timely, locally grounded insights into who remained hesitant, where, and for what reasons. Beyond individual beliefs, vaccination intention was closely linked to trust in authorities and information ecosystems, highlighting the need for locally adapted communication strategies and trusted intermediaries to support vaccine uptake. Such monitoring approaches can complement routine coverage indicators during future vaccine rollouts, provided that selection bias is explicitly addressed through weighting and triangulation. COVID-19 vaccination Vaccine hesitancy Repeated cross-sectional surveys Online surveys Trust in health authorities Health communication Multiethnic population French Guiana Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The COVID-19 pandemic highlighted substantial heterogeneity in vaccine acceptance both across and within countries. France has long ranked among European nations with comparatively high levels of vaccine hesitancy, a phenomenon that predates SARS-CoV-2 and was already evident in early 2020 national surveys, in which approximately one quarter of adults reported that they would refuse a future COVID-19 vaccine 1 , 2 . Vaccine refusal in these studies clustered along gradients of political engagement and institutional trust, underscoring the politicized nature of hesitancy and persistent concerns regarding vaccine safety and efficacy 1 – 6 . Similar determinants of COVID-19 vaccine hesitancy have been documented in mainland France and other European countries 7 . Importantly, higher levels of hesitancy have also been reported among individuals living in, or originating from, French overseas territories, as well as among populations born outside mainland France 8 , 9 . French Guiana differs markedly from mainland France in demographic, geographic, and socio-cultural terms. This Amazonian overseas territory combines a very young and multiethnic population with vast distances, limited transport infrastructure, and heterogeneous access to healthcare 10 – 12 . Health practices frequently include the use of traditional and herbal remedies, which coexist with biomedical care 11 . French Guiana also faces a distinct infectious-disease landscape, illustrated early in the pandemic by the co-circulation of dengue and SARS-CoV-2 13 . During the first year of the COVID-19 pandemic, the territory experienced intense viral transmission but relatively low disease severity, largely attributable to its youthful age structure 14 . Targeted curfews and localized lockdowns reduced the reproduction number from approximately 1.7 to 1.1, helping to avert hospital saturation 10 , while serological studies documented high population exposure by mid-2020 14 . By 2021, locally specific trust dynamics, the influence of community and political leaders, and the salience of traditional medicine were all likely to shape COVID-19 risk perception and vaccination decisions 11 . In this context, vaccine hesitancy represented a direct challenge to efforts aimed at reducing severe disease, hospitalizations, and COVID-19-related mortality. However, at the time this study was initiated, empirical data on COVID-19 vaccination intentions were largely unavailable for French overseas departments and regions. As a result, public health decision-making relied predominantly on evidence generated in mainland France, which was difficult to transpose to territories characterized by distinct demographic structures, cultural practices, and geographic constraints. This gap highlighted the need for rapidly generated, locally grounded, and actionable evidence to inform communication strategies, outreach activities, and services delivery during a rapidly evolving epidemic. In this article, we present a retrospective analysis of data prospectively collected through a series of repeated, low-cost, territory-wide online surveys conducted in near–real time in French Guiana in 2021. Our objectives are threefold: (i) to describe temporal trends in COVID-19 vaccination coverage and intentions during the vaccination rollout; (ii) to identify key, potentially actionable determinants of vaccination intention, including perceived vaccine efficacy and safety, trust in institutions, beliefs and misinformation, information sources, and use of traditional remedies; and (iii) to assess whether repeated online surveys, despite inherent limitations, can provide timely decision-relevant insights to support public health planning and communication in complex, underserved settings. Beyond the COVID-19 context, this work aims to inform the design of agile surveillance approaches capable of guiding targeted vaccination strategies during future vaccine rollouts in similarly heterogeneous territories. Methods Study design and setting We conducted CAP-COVID, a repeated cross-sectional online survey in French Guiana, an overseas territory of approximately 300,000 inhabitants, designed to generate rapid, low-cost, near–real-time evidence on COVID-19 vaccination coverage and intentions during the pandemic. Four survey waves were implemented in 2021 (8–21 March, 26 April–9 May, 21 June–4 July, and 4–17 October), covering the early vaccine rollout and subsequent policy phases, including the introduction of the health pass and mandatory vaccination measures. Survey timing in relation to epidemic dynamics and vaccination rollout is shown in Supplementary Fig. S1 . Study population and recruitment Eligible participants were adults (≥ 18 years) residing in French Guiana at the time of each survey wave. Non-probability online recruitment was conducted through social media platforms, messaging applications, and institutional communication channels. Recruitment aimed to reach approximately 1,000 respondents per wave, with geographic coverage across four predefined areas reflecting the territory’s heterogeneity: Cayenne Island, other coastal areas, the eastern interior (Oyapock), and the western interior (Maroni). Participation was voluntary, anonymous, and not incentivized. Data collection and variables Data were collected using an anonymous, self-administered questionnaire available in French, English, Portuguese, and Spanish. The questionnaire collected information on sociodemographic characteristics (sex, age group, education level, area of residence, place of birth, occupational category, public-facing work, and use of traditional remedies); perceptions and trust (concern about the COVID-19 pandemic, perceived vaccine efficacy and safety, perceived risk of side effects, trust in the French government and local authorities); beliefs and misinformation (beliefs about virus origin, perceived government–industry collusion, perceived contribution of science, perceived level of information regarding COVID-19 vaccination); information sources (scientific and press articles, official websites, healthcare professionals, family or friends, and social media); and reasons for accepting or refusing vaccination. Outcomes The primary outcome was intention to receive a COVID-19 vaccine, assessed by the question: “Do you intend to get vaccinated against the coronavirus at some point?” , with four response options. Respondents who reported being already vaccinated were classified as “Yes, definitely”. For regression analyses, vaccination intention was dichotomized into “Yes” (definitely or probably) versus “No” (probably not or definitely not). Weighting and representativeness To mitigate selection bias inherent to online, non-probability sampling, post-stratification weights were applied using population margins from the French National Institute of Statistics and Economic Studies (INSEE). Weights were calibrated on age group, sex, area of residence, and occupational category, selected a priori for their association with both survey participation and vaccination outcomes. Weighted analyses aimed to improve the representativeness of population-level estimates; however, all inferences remain observational and non-causal. These weights were not intended to eliminate selection bias, but to improve comparability with population-level indicators and enhance the interpretability of temporal trends. Statistical analyses Analyses were performed using R (version 4.3.0). Participants with missing data for the primary outcome were excluded. Descriptive results are presented as raw counts, while weighted estimates and 95% confidence intervals (CIs) were computed using the survey package, with confidence intervals derived from robust standard errors. Vaccination coverage and intention were estimated by survey wave. To identify correlates of vaccination intention, we fitted robust Poisson regression models with sandwich variance estimators, reporting risk ratios (RRs) and 95% CIs. Covariates were specified a priori across multiple domains: sociodemographic factors (age, sex, socio-professional category, residence, place of birth, education, public-facing work); perceptions (concern about COVID-19, perceived vaccine efficacy and safety, perceived risk of side effects); trust in the French government and health authorities; beliefs and misinformation (virus origin, perceived collusion, contribution of science, perceived level of information, reliance on social media); and use of traditional remedies. Survey wave was included as an adjustment factor in all models. Model diagnostics assessed influential observations and multicollinearity using variance inflation factors. For visualization, cross-domain patterns by survey wave and vaccination intention group were summarized using radar and bar plots. Results Sample characteristics Fig. 1 illustrates the geographic distribution of respondents across the four survey waves by residential area (Cayenne Island, other coastal areas, Maroni, and Oyapock). Across all waves, Cayenne Island and other coastal areas were consistently overrepresented compared with census data (67–74% vs 53% and 20–25% vs 11%, respectively), whereas the Maroni region was markedly underrepresented (5–6% vs 34%). Table 1 presents the unweighted sociodemographic characteristics of participants. Compared with the general adult population of French Guiana, the sample included a high proportion of non–French Guianese nationals born in mainland France (42–59%), respondents with post-secondary education (Bac + 2 or higher: 50–68%), and women (61–65%). Conversely, men were underrepresented (35–40% vs 51% according to INSEE data), as were individuals with no formal schooling (1–2% vs 48.9%). Overall, sample composition remained relatively stable across survey waves in terms of age, sex, residential area, and place of birth. The third wave (June–July 2021) differed from the others, however with a lower proportion of respondents holding postgraduate degrees (14% vs 23–29%) and a higher proportion of unemployed individuals (13% vs 5–9%). These patterns motivated the use of post-stratification weights in subsequent analyses. [Insert Table 1 here] Vaccination coverage and trends in vaccination intention Table 2 reports the estimated number of vaccinated adults in French Guiana at each survey wave, alongside official figures from Santé publique France. Estimated coverage increased steadily over time, from 19,604 vaccinated adults (95% CI: 15,249–23,958) in March 2021 to 84,898 (67,561–102,235) in October 2021. Survey-based estimates broadly tracked official vaccination counts, although absolute levels were consistently higher than administrative data, particularly during the early phases of the rollout. [Insert Table 2 here] Fig. 2 shows the evolution of vaccination intentions across survey waves. The proportion of respondents firmly opposed to vaccination (“No, definitely not”) remained high and stable during the first three surveys (51–55%), before to 39% in the fourth wave, coinciding with changes in vaccination policy and access. Among respondents opposed to vaccination, “No, probably not” responses accounted for approximately 43–45% in surveys 1, 2, and 4, but peaked at 55% in survey 3, indicating temporal variation in the degree of opposition. Determinants of vaccination intention Table 3 summarizes factors associated with vaccination intention. In univariate analyses, all variables except sex were significantly associated with intention to vaccinate (global Wald test, p < 0.05). In multivariable robust Poisson regression, six factors remained independently associated with vaccination intention across survey waves. Respondents expressing concern about COVID-19 were more likely to intend to get vaccinated than those reporting no concern (adjusted RR = 1.32, 95% CI: 1.19–1.47). Inactive individuals showed lower vaccination intention compared with employed respondents (RR = 0.80, 95% CI: 0.68–0.93), and residents of the Maroni region were less likely to intend vaccination than those living in other coastal areas (RR = 0.80, 95% CI: 0.69–0.92). Public-facing workers were more likely to report vaccination intention than those without public contact (RR = 1.14, 95% CI: 1.02–1.26). Perceptions of vaccine efficacy and safety emerged as the strongest correlates. Individuals perceiving the vaccine as effective were nearly four times more likely to intend vaccination than those perceiving it as ineffective (RR = 3.72, 95% CI: 2.96–4.68). Perceived vaccine safety was also positively associated with intention (RR = 1.19, 95% CI: 1.01–1.41). Trust in health authorities independently increased vaccination intention by 25% (RR = 1.25, 95% CI: 1.09–1.44). [Insert Table 3 here] Motivations for vaccination Fig. 3a presents reasons for vaccination among respondents who were vaccinated or intended to be vaccinated. Across survey waves, the most frequently cited motivations were self-protection (mean 68%, 95% CI: 64–72), protection of relatives (67%, 63–71), return to normal life (59%, 55–63), and protection of vulnerable individuals (56%, 52–60). Economic recovery of the country was cited less frequently (28%, 24–32). Trust in institutions and authorities Fig. 4a presents trust indicators by vaccination intention and survey wave. Across all waves, trust in science, the government, and local authorities was consistently lower among respondents unwilling to be vaccinated than among those vaccinated or intending to be vaccinated, with little temporal variation. Only 15% (95% CI: 9–21) of respondents unwilling to be vaccinated reported trust in the French government, compared with 56% (51–60) among vaccinated or pro-vaccination respondents. Belief in government–pharmaceutical industry collusion was reported by nearly half of respondents unwilling to be vaccinated (49%, 45–54), versus 8% (5–11) among those intending vaccination. The largest contrasts between firmly opposed and firmly pro-vaccination respondents concerned perceived vaccine effectiveness (3% vs 79%) and perceived safety (4% vs 72%), highlighting the central role of confidence in vaccine performance. Figure 4b compares information sources by vaccination intention. Respondents unwilling to be vaccinated relied more heavily on social media (49%, 42–56 vs 29%, 25–34) and discussions with family and friends (38%, 31–45 vs 30%, 25–34). In contrast, respondents vaccinated or intending to be vaccinated more frequently reported consulting official websites, press articles, healthcare professionals, and scientific sources, with differences of 14–16 percentage points. Hesitant and resistant groups: reasons and dynamics Figure 3b summarizes reasons for non-vaccination. On average, uncertainty about vaccine effectiveness (62%, 56–68), concerns about protection against variants (52%, 45–58), fear of side effects (48%, 41–54), and preference for traditional remedies (32%, 26–37) were the most commonly cited barriers. These concerns declined modestly in the fourth survey wave. Figure 3c shows factors that might encourage vaccination among respondents unwilling to vaccinate. Over half reported that nothing would change their mind (52%, 45–58), while one third indicated that longer-term safety data (34%, 28–39) or additional information on effectiveness and adverse effects (23%, 18–28) could potentially influence their decision. The proportion citing reassurance on long-term safety decreased in the final survey wave. Discussion This repeated, territory-wide online survey provides, to our knowledge, the first population-level assessment of COVID-19 vaccination intentions conducted in a French overseas department during the pandemic. Implemented at a time when no empirical data on vaccination intention were available locally, the survey was deployed in near–real time and documented persistently high opposition to vaccination throughout most of 2021. Across the first three survey waves, the proportion of respondents opposed to vaccination remained stable at approximately 51–55%, before declining to 39% in October 2021, the only wave conducted after the introduction of the sanitary pass and mandatory vaccination policies. This 10–15 percentage-point reduction, while measurable, remained modest, suggesting that these policy measures were associated with increased uptake, with more limited changes in underlying attitudes 15 . Over the same period, estimated vaccination coverage increased substantially, from approximately 12% in March to around 54% in October, closely tracking official administrative data while confirming that French Guiana remained among the lowest-coverage French departments. Together, these findings highlight a key result: vaccination uptake increased largely through policy and access mechanisms, whereas the beliefs most strongly associated with acceptance evolved slowly. Determinants of vaccination intention aligned with well-established domains of vaccine decision-making. Intention was strongly associated with perceived vaccine efficacy and safety, trust in health authorities, concern about COVID-19, and public-facing occupations, and was lower among inactive individuals and residents of the Maroni region. These determinants help explain the limited temporal variation observed in intentions, as perceptions of efficacy, safety, and trust—central drivers of acceptance—remained largely stable over time. Consistently, respondents unwilling to vaccinate relied more heavily on social media and informal social networks, whereas those willing or already vaccinated more frequently consulted official sources, healthcare professionals, the press, and scientific information. Reasons for non-vaccination were dominated by doubts about effectiveness, concerns about variants, fear of side effects, and a preference for traditional remedies. Although more than half of hesitant respondents reported that nothing would change their mind, a substantial minority expressed a need for longer-term safety data and clearer explanations of benefits and risks, indicating actionable entry points for communication strategies. These population-level findings are consistent with contemporaneous studies conducted among healthcare workers in French Guiana 16 , 17 , which similarly identified concern about COVID-19 and trust in epidemic management as facilitators of acceptance, and fear of adverse events, distrust in authorities, and misinformation as barriers. Together, these convergent results suggest that trust is not a peripheral facilitator of vaccine uptake in this context, but a primary determinant of vaccination intention. Beyond individual beliefs and information sources, vaccination intentions in French Guiana must also be interpreted in light of broader governance and historical dynamics. As a French overseas territory with a colonial past, French Guiana has long experienced centrally designed public policies that may be perceived locally as insufficiently adapted to territorial realities. During the COVID-19 pandemic, key measures—including lockdowns, curfews, and communication strategies—were largely defined at the national level and implemented according to timelines and risk assessments primarily calibrated for mainland France. In a context marked by pronounced social, cultural, and geographic heterogeneity, this perceived may have contributed to mistrust and resistance, particularly among populations born in the territory. Our findings suggest that vaccine hesitancy cannot be understood solely as an informational deficit or an individual-level attitudinal stance, but also as a response to how public health decisions are produced, communicated, and enacted. Limited involvement of local actors in decision-making processes, combined with communication perceived as top-down or poorly contextualized, may have reinforced skepticism toward vaccination recommendations. From an operational perspective, the survey provided timely and actionable intelligence to local authorities by documenting persistent hesitancy, identifying its main correlates, and highlighting a consistent spatial gradient, particularly in the Maroni region. Such near–real-time, low-cost monitoring is especially valuable in geographically dispersed, multiethnic territories, where effective public health action requires understanding not only who remains hesitant, but also where and why. These findings should nevertheless be interpreted in light of several limitations. Online, non-probability sampling likely over-represented individuals who are more educated and digitally connected, while under-representing remote riverine populations despite broad dissemination efforts. Sample composition also varied across waves, and repeated participation cannot be excluded. Post-stratification weighting improved representativeness but cannot fully correct time-varying selection biases. Finally, vaccination intention was dichotomized to facilitate operational interpretation, and all associations should be interpreted as non-causal. Two main implications emerge. First, because vaccination intention in this setting is tightly linked to perceived efficacy, safety, and trust in authorities and scientific expertise, communication strategies should prioritize transparent benefit–risk framing and rely on credible messengers embedded within local trust networks, including healthcare professionals and community leaders. Second, the repeated identification of the Maroni region as a low-intention area indicates that mobile, linguistically and culturally adapted outreach models tailored to riverine contexts are likely to be essential rather than optional. In conclusion, this study illustrates how repeated, low-cost online surveys can provide decision-makers with timely, locally grounded insights during a rapidly evolving epidemic, allowing vaccination intentions to be monitored alongside coverage. By identifying who remains hesitant, where, and for what reasons, such approaches can inform more targeted and context-sensitive vaccination strategies. Although translating evidence into fully adapted interventions remains challenging, these findings are relevant beyond COVID-19 and can inform the design, monitoring and adaptation of future vaccination programs in similarly complex and heterogeneous settings. Conclusions In this multiethnic and geographically dispersed territory, repeated online cross-sectional surveys provided timely, population-level evidence on COVID-19 vaccination intentions and their determinants. Vaccination uptake increased substantially over time, yet persistent opposition and marked geographic disparities underscore the central role of trust, perceived vaccine safety and efficacy, and information ecosystems in shaping acceptance. Beyond individual attitudes, our findings highlight how governance context and local trust dynamics influence vaccine decision-making. When appropriately weighted and triangulated, repeated non-probability online surveys can complement routine administrative indicators by providing rapid, locally grounded insights to guide adaptive public health strategies. Such approaches offer a scalable and cost-effective tool for monitoring vaccine confidence and supporting preparedness during future vaccination campaigns, particularly in complex and heterogeneous settings. Abbreviations CI : Confidence Interval COVID-19 : Coronavirus Disease 2019 DPO : Data Protection Officer INSEE : Institut National de la Statistique et des Études Économiques RR : Risk Ratio Declarations Ethics approval and consent to participate Data collection complied with French and European regulations on data protection and privacy, including the General Data Protection Regulation (GDPR), and was conducted in accordance with the principles of the Declaration of Helsinki. Participants accessed the questionnaire through an introductory page presenting the study objectives, the nature of the sections and types of questions included, and information regarding data confidentiality. Informed consent was obtained electronically, as participants were required to confirm their agreement before proceeding to the survey. No directly identifiable information was collected. Questionnaire design and response modalities were reviewed by the Data Protection Officer (DPO) of the Institut Pasteur to ensure that combinations of responses would not allow participant re-identification. Re-identification through cross-referencing of responses was therefore considered not feasible. The study protocol was reviewed by the Institut Pasteur Institutional Review Board and determined to be exempt from formal ethical review under its applicable regulatory framework by equivalence with 45CFR46 (IRB00006966, 4 March 2021, N° IRB2021-C-Exempt). Consent for publication Not applicable. Availability of data and materials The dataset generated and analysed during the current study is available in the Zenodo repository at https://doi.org/10.5281/zenodo.18450266. Competing interests The authors declare that they have no competing interests. Funding This study was primarily supported by the Regional Health Agency of French Guiana through the CAPCOVID project. C.F. acknowledges additional support from l’Agence Nationale de la Recherche (French National Research Agency; grant agreement no. ANR-20-COVI-0014) and the European Regional Development Fund, European Union, European Union (grant agreement no. GY0027257), which contributed to secondary components of the study. G.F. acknowledges support from the Pierre Ledoux Foundation – International Youth Scholarship, under the partnership between the Fondation de France and the Institut Pasteur. The funders had no role in the study design, data collection, analysis, interpretation, or writing of the manuscript. Author contribution statement C.S. performed the data analysis and visualization and wrote the first draft of the manuscript. L.R. contributed to data collection, data curation and data analysis, and reviewed the manuscript. G.F. contributed to data curation and data analysis and reviewed the manuscript. C.A.S. contributed to project administration and data collection and reviewed the manuscript. N.P. contributed to data analysis and reviewed the manuscript. N.C. contributed to project administration and reviewed the manuscript. A.P. contributed to project administration and reviewed the manuscript. S.E. contributed to project administration and data collection and reviewed the manuscript. C.F. conceived the study, acquired funding, contributed to data analysis, supervised the project, wrote the first draft of the manuscript, and reviewed and edited the final version. Acknowledgements We gratefully acknowledge the residents of French Guiana who participated in the CAP-COVID surveys, as well as the local institutions and partners who supported survey dissemination across the territory. References Ward, J. K., Alleaume, C., Peretti-Watel, P., & COCONEL Group. The French public’s attitudes to a future COVID-19 vaccine: The politicization of a public health issue. Soc Sci Med 265 , 113414 (2020). Cambon, L., Schwarzinger, M. & Alla, F. Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: A challenge for one of the world’s most vaccine-hesitant countries. Vaccine 40 , 178–182 (2022). COCONEL Group. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. Lancet Infect Dis 20 , 769–770 (2020). Peretti-Watel, P. et al. Attitudes about COVID-19 Lockdown among General Population, France, March 2020. Emerg Infect Dis 27 , (2021). Bajos, N. et al. When Lack of Trust in the Government and in Scientists Reinforces Social Inequalities in Vaccination Against COVID-19. Front Public Health 10 , 908152 (2022). Jennings, W. et al. Trust and vaccine hesitancy during the COVID-19 pandemic: A cross-national analysis. Vaccine X 14 , 100299 (2023). Joshi, A. et al. Predictors of COVID-19 Vaccine Acceptance, Intention, and Hesitancy: A Scoping Review. Front Public Health 9 , 698111 (2021). Alarcón-Braga, E. A. et al. Acceptance towards COVID-19 vaccination in Latin America and the Caribbean: A systematic review and meta-analysis. Travel Med Infect Dis 49 , 102369 (2022). Urrunaga-Pastor, D. et al. Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean. Travel Med Infect Dis 41 , 102059 (2021). Andronico, A. et al. Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana. Nat Commun 12 , 1634 (2021). Forsans, G. et al. Use of Herbal Medicine in French Guiana: Influences and Challenges for Prevention Strategies in the Context of the COVID-19 Pandemic. Journal of Herbal Medicine 44 , 100848 (2024). Epelboin, L. et al. COVID-19 epidemic in remote areas of the French Amazon, March 2020 to May 2021: Another reality. Rev Soc Bras Med Trop 55 , e02742021 (2022). Nacher, M. et al. Simultaneous dengue and COVID-19 epidemics: Difficult days ahead? PLoS Negl Trop Dis 14 , e0008426 (2020). Flamand, C. et al. Seroprevalence of anti-SARS-CoV-2 IgG at the first epidemic peak in French Guiana, July 2020. PLoS Negl Trop Dis 15 , e0009945 (2021). Ward, J. K. et al. The French health pass holds lessons for mandatory COVID-19 vaccination. Nat Med 28 , 232–235 (2022). Vignier, N. et al. Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin. Vaccines 9 , 682 (2021). Douine, M. et al. Levers and Barriers to Vaccinate against COVID-19 in the Multicultural Context of French Guiana: A Qualitative Cross-Sectional Survey among Health Care Workers. Vaccines (Basel) 9 , 1216 (2021). Nacher, M. et al. The burden of COVID-19 in French Guiana: Vaccine-averted deaths, hospitalizations and costs. Vaccine: X 13 , 100271 (2023). Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files SupplementaryfilesVF1.docx Table123.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers invited by journal 18 Mar, 2026 Editor invited by journal 18 Feb, 2026 Editor assigned by journal 17 Feb, 2026 Submission checks completed at journal 17 Feb, 2026 First submitted to journal 15 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8885506","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626637143,"identity":"c384519e-83e8-4a09-99e4-9c4313c599f5","order_by":0,"name":"Cécile Sommen","email":"","orcid":"","institution":"Institut Pasteur du Cambodge, Epidemiology and Public Health Unit","correspondingAuthor":false,"prefix":"","firstName":"Cécile","middleName":"","lastName":"Sommen","suffix":""},{"id":626637144,"identity":"c9622fe9-5438-410f-bdc7-17aa0bd3f8bd","order_by":1,"name":"Leïla Ramiz","email":"","orcid":"","institution":"Institut Pasteur de la Guyane, Epidemiology Unit","correspondingAuthor":false,"prefix":"","firstName":"Leïla","middleName":"","lastName":"Ramiz","suffix":""},{"id":626637145,"identity":"ea9560c0-6ce0-4ed2-94a5-3da6e84e7e79","order_by":2,"name":"Glwadys Forsans","email":"","orcid":"","institution":"Institut Pasteur de la Guyane, Epidemiology Unit","correspondingAuthor":false,"prefix":"","firstName":"Glwadys","middleName":"","lastName":"Forsans","suffix":""},{"id":626637146,"identity":"d6667511-d0fa-41a7-a95c-b13970a9c5e6","order_by":3,"name":"Christelle Alves Sarmento","email":"","orcid":"","institution":"Institut Pasteur de la Guyane, Epidemiology Unit","correspondingAuthor":false,"prefix":"","firstName":"Christelle","middleName":"Alves","lastName":"Sarmento","suffix":""},{"id":626637147,"identity":"d9616470-9569-478c-8cff-30d191a56a8d","order_by":4,"name":"Nathalie Passard","email":"","orcid":"","institution":"Institut Pasteur du Cambodge, Epidemiology and Public Health Unit","correspondingAuthor":false,"prefix":"","firstName":"Nathalie","middleName":"","lastName":"Passard","suffix":""},{"id":626637148,"identity":"5451a840-7609-4674-8185-9a77401acfaf","order_by":5,"name":"Nathalie Clément","email":"","orcid":"","institution":"Institut Pasteur, Clinical Research Coordination Organisation (CR-CO)","correspondingAuthor":false,"prefix":"","firstName":"Nathalie","middleName":"","lastName":"Clément","suffix":""},{"id":626637149,"identity":"b0495b6b-6871-49b1-bf1a-baa109376e8c","order_by":6,"name":"Anaïs Perilhou","email":"","orcid":"","institution":"Institut Pasteur, Clinical Research Coordination Organisation (CR-CO)","correspondingAuthor":false,"prefix":"","firstName":"Anaïs","middleName":"","lastName":"Perilhou","suffix":""},{"id":626637150,"identity":"24471c1a-2b5a-48b7-a319-6a2f232748f2","order_by":7,"name":"Stéphanie Eustache","email":"","orcid":"","institution":"Institut Pasteur de la Guyane, Epidemiology Unit","correspondingAuthor":false,"prefix":"","firstName":"Stéphanie","middleName":"","lastName":"Eustache","suffix":""},{"id":626637151,"identity":"935891f6-1d77-4f3f-88dc-4f7c751c1885","order_by":8,"name":"Claude Flamand","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYDAC5sMNIIqxHy7Cw0NAC1siRMtMEHWAJC0bDhCrhb+NsfHTjZo7sptvNz/+/KHicD4Dz9kDDB/31OLUInGMsVk659gz4213jplJHDhz2LKBty+Bccaz4zi1GMg3NkjnsB1O3HYjwYzhYNthA/vzPAbMPAeO4dbCxtj8O+ff4cTNM9I/fzj477ABAz9hLW3SuW2HEzdI5BhIHGwAauHtAWmpweeXNuvcvsPGM+6cKZM4cyzdgIHnjMHBGQcO4NTC38Z8+HbOt8Oy/bPbN3+oqLEGaskxfPDhQB1OLUj2IbGBVhwmUQsQEGPLKBgFo2AUjBAAAFlhXiDoPsWuAAAAAElFTkSuQmCC","orcid":"","institution":"Institut Pasteur de la Guyane, Epidemiology Unit","correspondingAuthor":true,"prefix":"","firstName":"Claude","middleName":"","lastName":"Flamand","suffix":""}],"badges":[],"createdAt":"2026-02-15 11:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8885506/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8885506/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108491749,"identity":"d3364f79-a70d-4424-a9c1-9a77f3ff79e0","added_by":"auto","created_at":"2026-05-05 09:55:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":197577,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeographic distribution of survey respondents across four waves in French Guiana.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea, Number of survey participants by residential area for each survey wave. b, Map of French Guiana showing the four residential areas used in the analysis and the distribution of the adult population by area, based on INSEE census data (2022). Post-stratification weights were applied in the analyses to account for differential participation across areas.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/d24410dce5fed40174f59a34.png"},{"id":108231935,"identity":"bd096139-fd16-4190-a2b6-5104ee2fed30","added_by":"auto","created_at":"2026-04-30 17:50:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":137492,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of COVID-19 vaccination intentions across survey waves among adults in French Guiana.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/beb70ca87f30bdc8228911e1.png"},{"id":108231939,"identity":"5481daa4-0369-448a-bbe0-97444e2f1c11","added_by":"auto","created_at":"2026-04-30 17:50:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":213333,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReasons for COVID-19 vaccination and non-vaccination across four survey waves in French Guiana.\u003c/strong\u003e\u003cbr\u003e\n a, Reasons for vaccination among respondents who were vaccinated or intended to be vaccinated. b, Reasons for non-vaccination among respondents unwilling to be vaccinated. c,Factors that could encourage vaccination among respondents unwilling to be vaccinated\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/bd3c887ad11866ad53751fe7.png"},{"id":108231940,"identity":"bbad06a5-757e-4a7d-9fbb-896c49aea9a8","added_by":"auto","created_at":"2026-04-30 17:50:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":278182,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrust indicators and information sources by COVID-19 vaccination intention across survey waves in French Guiana.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ea,\u003c/em\u003e Trust-related indicators, including perceived vaccine effectiveness, perceived origin of the virus, perceived contribution of science, perceived government–pharmaceutical industry collusion, trust in health authorities, and trust in the French government.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eb,\u003c/em\u003e Main sources of information on COVID-19 vaccination, including scientific articles, social media, discussions with family and friends, discussions with healthcare professionals, official websites and government information, and press articles.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/3442ecd87d3f12d94bfde397.png"},{"id":108495082,"identity":"3245ff82-5624-4ff3-88f3-14f13b7a9fe4","added_by":"auto","created_at":"2026-05-05 10:08:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":940231,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/90ef5dac-1382-4303-b41e-1f8b215b5a4c.pdf"},{"id":108231938,"identity":"2ed15aa2-b654-4826-b90b-a9cb9320abb1","added_by":"auto","created_at":"2026-04-30 17:50:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":309003,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryfilesVF1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/2f74b3bbc2bf556d085f7b2c.docx"},{"id":108231936,"identity":"301374da-8bb3-4c3a-8ecd-fed58b74de59","added_by":"auto","created_at":"2026-04-30 17:50:28","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":38745,"visible":true,"origin":"","legend":"","description":"","filename":"Table123.docx","url":"https://assets-eu.researchsquare.com/files/rs-8885506/v1/62da3222e54deb18f54bc017.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Tracking COVID-19 vaccination intentions in a multiethnic overseas territory: evidence from repeated online surveys in French Guiana","fulltext":[{"header":"Background","content":"\u003cp\u003eThe COVID-19 pandemic highlighted substantial heterogeneity in vaccine acceptance both across and within countries. France has long ranked among European nations with comparatively high levels of vaccine hesitancy, a phenomenon that predates SARS-CoV-2 and was already evident in early 2020 national surveys, in which approximately one quarter of adults reported that they would refuse a future COVID-19 vaccine \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Vaccine refusal in these studies clustered along gradients of political engagement and institutional trust, underscoring the politicized nature of hesitancy and persistent concerns regarding vaccine safety and efficacy\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Similar determinants of COVID-19 vaccine hesitancy have been documented in mainland France and other European countries\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Importantly, higher levels of hesitancy have also been reported among individuals living in, or originating from, French overseas territories, as well as among populations born outside mainland France\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrench Guiana differs markedly from mainland France in demographic, geographic, and socio-cultural terms. This Amazonian overseas territory combines a very young and multiethnic population with vast distances, limited transport infrastructure, and heterogeneous access to healthcare\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Health practices frequently include the use of traditional and herbal remedies, which coexist with biomedical care\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. French Guiana also faces a distinct infectious-disease landscape, illustrated early in the pandemic by the co-circulation of dengue and SARS-CoV-2\u003csup\u003e13\u003c/sup\u003e. During the first year of the COVID-19 pandemic, the territory experienced intense viral transmission but relatively low disease severity, largely attributable to its youthful age structure\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Targeted curfews and localized lockdowns reduced the reproduction number from approximately 1.7 to 1.1, helping to avert hospital saturation\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, while serological studies documented high population exposure by mid-2020\u003csup\u003e14\u003c/sup\u003e. By 2021, locally specific trust dynamics, the influence of community and political leaders, and the salience of traditional medicine were all likely to shape COVID-19 risk perception and vaccination decisions\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In this context, vaccine hesitancy represented a direct challenge to efforts aimed at reducing severe disease, hospitalizations, and COVID-19-related mortality. However, at the time this study was initiated, empirical data on COVID-19 vaccination intentions were largely unavailable for French overseas departments and regions. As a result, public health decision-making relied predominantly on evidence generated in mainland France, which was difficult to transpose to territories characterized by distinct demographic structures, cultural practices, and geographic constraints. This gap highlighted the need for rapidly generated, locally grounded, and actionable evidence to inform communication strategies, outreach activities, and services delivery during a rapidly evolving epidemic.\u003c/p\u003e \u003cp\u003eIn this article, we present a retrospective analysis of data prospectively collected through a series of repeated, low-cost, territory-wide online surveys conducted in near\u0026ndash;real time in French Guiana in 2021. Our objectives are threefold: (i) to describe temporal trends in COVID-19 vaccination coverage and intentions during the vaccination rollout; (ii) to identify key, potentially actionable determinants of vaccination intention, including perceived vaccine efficacy and safety, trust in institutions, beliefs and misinformation, information sources, and use of traditional remedies; and (iii) to assess whether repeated online surveys, despite inherent limitations, can provide timely decision-relevant insights to support public health planning and communication in complex, underserved settings. Beyond the COVID-19 context, this work aims to inform the design of agile surveillance approaches capable of guiding targeted vaccination strategies during future vaccine rollouts in similarly heterogeneous territories.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eWe conducted CAP-COVID, a repeated cross-sectional online survey in French Guiana, an overseas territory of approximately 300,000 inhabitants, designed to generate rapid, low-cost, near\u0026ndash;real-time evidence on COVID-19 vaccination coverage and intentions during the pandemic. Four survey waves were implemented in 2021 (8\u0026ndash;21 March, 26 April\u0026ndash;9 May, 21 June\u0026ndash;4 July, and 4\u0026ndash;17 October), covering the early vaccine rollout and subsequent policy phases, including the introduction of the health pass and mandatory vaccination measures. Survey timing in relation to epidemic dynamics and vaccination rollout is shown in Supplementary Fig. \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and recruitment\u003c/h3\u003e\n\u003cp\u003eEligible participants were adults (\u0026ge;\u0026thinsp;18 years) residing in French Guiana at the time of each survey wave. Non-probability online recruitment was conducted through social media platforms, messaging applications, and institutional communication channels. Recruitment aimed to reach approximately 1,000 respondents per wave, with geographic coverage across four predefined areas reflecting the territory\u0026rsquo;s heterogeneity: Cayenne Island, other coastal areas, the eastern interior (Oyapock), and the western interior (Maroni). Participation was voluntary, anonymous, and not incentivized.\u003c/p\u003e\n\u003ch3\u003eData collection and variables\u003c/h3\u003e\n\u003cp\u003eData were collected using an anonymous, self-administered questionnaire available in French, English, Portuguese, and Spanish. The questionnaire collected information on sociodemographic characteristics (sex, age group, education level, area of residence, place of birth, occupational category, public-facing work, and use of traditional remedies); perceptions and trust (concern about the COVID-19 pandemic, perceived vaccine efficacy and safety, perceived risk of side effects, trust in the French government and local authorities); beliefs and misinformation (beliefs about virus origin, perceived government\u0026ndash;industry collusion, perceived contribution of science, perceived level of information regarding COVID-19 vaccination); information sources (scientific and press articles, official websites, healthcare professionals, family or friends, and social media); and reasons for accepting or refusing vaccination.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was intention to receive a COVID-19 vaccine, assessed by the question: \u003cem\u003e\u0026ldquo;Do you intend to get vaccinated against the coronavirus at some point?\u0026rdquo;\u003c/em\u003e, with four response options. Respondents who reported being already vaccinated were classified as \u0026ldquo;Yes, definitely\u0026rdquo;. For regression analyses, vaccination intention was dichotomized into \u0026ldquo;Yes\u0026rdquo; (definitely or probably) versus \u0026ldquo;No\u0026rdquo; (probably not or definitely not).\u003c/p\u003e\n\u003ch3\u003eWeighting and representativeness\u003c/h3\u003e\n\u003cp\u003eTo mitigate selection bias inherent to online, non-probability sampling, post-stratification weights were applied using population margins from the French National Institute of Statistics and Economic Studies (INSEE). Weights were calibrated on age group, sex, area of residence, and occupational category, selected a priori for their association with both survey participation and vaccination outcomes. Weighted analyses aimed to improve the representativeness of population-level estimates; however, all inferences remain observational and non-causal. These weights were not intended to eliminate selection bias, but to improve comparability with population-level indicators and enhance the interpretability of temporal trends.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eAnalyses were performed using R (version 4.3.0). Participants with missing data for the primary outcome were excluded. Descriptive results are presented as raw counts, while weighted estimates and 95% confidence intervals (CIs) were computed using the \u003cem\u003esurvey\u003c/em\u003e package, with confidence intervals derived from robust standard errors. Vaccination coverage and intention were estimated by survey wave. To identify correlates of vaccination intention, we fitted robust Poisson regression models with sandwich variance estimators, reporting risk ratios (RRs) and 95% CIs. Covariates were specified a priori across multiple domains: sociodemographic factors (age, sex, socio-professional category, residence, place of birth, education, public-facing work); perceptions (concern about COVID-19, perceived vaccine efficacy and safety, perceived risk of side effects); trust in the French government and health authorities; beliefs and misinformation (virus origin, perceived collusion, contribution of science, perceived level of information, reliance on social media); and use of traditional remedies. Survey wave was included as an adjustment factor in all models. Model diagnostics assessed influential observations and multicollinearity using variance inflation factors. For visualization, cross-domain patterns by survey wave and vaccination intention group were summarized using radar and bar plots.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003ch3\u003e\u003cstrong\u003eSample characteristics\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFig. 1 illustrates the geographic distribution of respondents across the four survey waves by residential area (Cayenne Island, other coastal areas, Maroni, and Oyapock). Across all waves, Cayenne Island and other coastal areas were consistently overrepresented compared with census data (67\u0026ndash;74% vs 53% and 20\u0026ndash;25% vs 11%, respectively), whereas the Maroni region was markedly underrepresented (5\u0026ndash;6% vs 34%).\u003c/p\u003e\n\u003cp\u003eTable 1 presents the unweighted sociodemographic characteristics of participants. Compared with the general adult population of French Guiana, the sample included a high proportion of non\u0026ndash;French Guianese nationals born in mainland France (42\u0026ndash;59%), respondents with post-secondary education (Bac + 2 or higher: 50\u0026ndash;68%), and women (61\u0026ndash;65%). Conversely, men were underrepresented (35\u0026ndash;40% vs 51% according to INSEE data), as were individuals with no formal schooling (1\u0026ndash;2% vs 48.9%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, sample composition remained relatively stable across survey waves in terms of age, sex, residential area, and place of birth. The third wave (June\u0026ndash;July 2021) differed from the others, however with a lower proportion of respondents holding postgraduate degrees (14% vs 23\u0026ndash;29%) and a higher proportion of unemployed individuals (13% vs 5\u0026ndash;9%). These patterns motivated the use of post-stratification weights in subsequent analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Insert Table 1 here]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eVaccination coverage and trends in vaccination intention\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eTable 2 reports the estimated number of vaccinated adults in French Guiana at each survey wave, alongside official figures from Sant\u0026eacute; publique France. Estimated coverage increased steadily over time, from 19,604 vaccinated adults (95% CI: 15,249\u0026ndash;23,958) in March 2021 to 84,898 (67,561\u0026ndash;102,235) in October 2021. Survey-based estimates broadly tracked official vaccination counts, although absolute levels were consistently higher than administrative data, particularly during the early phases of the rollout.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Insert Table 2 here]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFig. 2 shows the evolution of vaccination intentions across survey waves. The proportion of respondents firmly opposed to vaccination (\u0026ldquo;No, definitely not\u0026rdquo;) remained high and stable during the first three surveys (51\u0026ndash;55%), before to 39% in the fourth wave,\u0026nbsp;coinciding with changes in vaccination policy and access.\u0026nbsp;Among respondents opposed to vaccination, \u0026ldquo;No, probably not\u0026rdquo; responses accounted for approximately 43\u0026ndash;45% in surveys 1, 2, and 4, but peaked at 55% in survey 3, indicating temporal variation in the degree of opposition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminants of vaccination intention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes factors associated with vaccination intention. In univariate analyses, all variables except sex were significantly associated with intention to vaccinate (global Wald test, p \u0026lt; 0.05). In multivariable robust Poisson regression, six factors remained independently associated with vaccination intention across survey waves.\u003c/p\u003e\n\u003cp\u003eRespondents expressing concern about COVID-19 were more likely to intend to get vaccinated than those reporting no concern (adjusted RR = 1.32, 95% CI: 1.19\u0026ndash;1.47). Inactive individuals showed lower vaccination intention compared with employed respondents (RR = 0.80, 95% CI: 0.68\u0026ndash;0.93), and residents of the Maroni region were less likely to intend vaccination than those living in other coastal areas (RR = 0.80, 95% CI: 0.69\u0026ndash;0.92). Public-facing workers were more likely to report vaccination intention than those without public contact (RR = 1.14, 95% CI: 1.02\u0026ndash;1.26).\u003c/p\u003e\n\u003cp\u003ePerceptions of vaccine efficacy and safety emerged as the strongest correlates. Individuals perceiving the vaccine as effective were nearly four times more likely to intend vaccination than those perceiving it as ineffective (RR = 3.72, 95% CI: 2.96\u0026ndash;4.68). Perceived vaccine safety was also positively associated with intention (RR = 1.19, 95% CI: 1.01\u0026ndash;1.41). Trust in health authorities independently increased vaccination intention by 25% (RR = 1.25, 95% CI: 1.09\u0026ndash;1.44).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Insert Table 3 here]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMotivations for vaccination\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFig. 3a presents reasons for vaccination among respondents who were vaccinated or intended to be vaccinated. Across survey waves, the most frequently cited motivations were self-protection (mean 68%, 95% CI: 64\u0026ndash;72), protection of relatives (67%, 63\u0026ndash;71), return to normal life (59%, 55\u0026ndash;63), and protection of vulnerable individuals (56%, 52\u0026ndash;60). Economic recovery of the country was cited less frequently (28%, 24\u0026ndash;32).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrust in institutions and authorities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFig. 4a presents trust indicators by vaccination intention and survey wave. Across all waves, trust in science, the government, and local authorities was consistently lower among respondents unwilling to be vaccinated than among those vaccinated or intending to be vaccinated, with little temporal variation. Only 15% (95% CI: 9\u0026ndash;21) of respondents unwilling to be vaccinated reported trust in the French government, compared with 56% (51\u0026ndash;60) among vaccinated or pro-vaccination respondents. Belief in government\u0026ndash;pharmaceutical industry collusion was reported by nearly half of respondents unwilling to be vaccinated (49%, 45\u0026ndash;54), versus 8% (5\u0026ndash;11) among those intending vaccination. The largest contrasts between firmly opposed and firmly pro-vaccination respondents concerned perceived vaccine effectiveness (3% vs 79%) and perceived safety (4% vs 72%), highlighting the central role of confidence in vaccine performance.\u003c/p\u003e\n\u003cp\u003eFigure 4b compares information sources by vaccination intention. Respondents unwilling to be vaccinated relied more heavily on social media (49%, 42\u0026ndash;56 vs 29%, 25\u0026ndash;34) and discussions with family and friends (38%, 31\u0026ndash;45 vs 30%, 25\u0026ndash;34). In contrast, respondents vaccinated or intending to be vaccinated more frequently reported consulting official websites, press articles, healthcare professionals, and scientific sources, with differences of 14\u0026ndash;16 percentage points.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHesitant and resistant groups: reasons and dynamics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 3b summarizes reasons for non-vaccination. On average, uncertainty about vaccine effectiveness (62%, 56\u0026ndash;68), concerns about protection against variants (52%, 45\u0026ndash;58), fear of side effects (48%, 41\u0026ndash;54), and preference for traditional remedies (32%, 26\u0026ndash;37) were the most commonly cited barriers. These concerns declined modestly in the fourth survey wave.\u003c/p\u003e\n\u003cp\u003eFigure 3c shows factors that might encourage vaccination among respondents unwilling to vaccinate. Over half reported that nothing would change their mind (52%, 45\u0026ndash;58), while one third indicated that longer-term safety data (34%, 28\u0026ndash;39) or additional information on effectiveness and adverse effects (23%, 18\u0026ndash;28) could potentially influence their decision. The proportion citing reassurance on long-term safety decreased in the final survey wave.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis repeated, territory-wide online survey provides, to our knowledge, the first population-level assessment of COVID-19 vaccination intentions conducted in a French overseas department during the pandemic. Implemented at a time when no empirical data on vaccination intention were available locally, the survey was deployed in near\u0026ndash;real time and documented persistently high opposition to vaccination throughout most of 2021.\u003c/p\u003e \u003cp\u003eAcross the first three survey waves, the proportion of respondents opposed to vaccination remained stable at approximately 51\u0026ndash;55%, before declining to 39% in October 2021, the only wave conducted after the introduction of the sanitary pass and mandatory vaccination policies. This 10\u0026ndash;15 percentage-point reduction, while measurable, remained modest, suggesting that these policy measures were associated with increased uptake, with more limited changes in underlying attitudes\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Over the same period, estimated vaccination coverage increased substantially, from approximately 12% in March to around 54% in October, closely tracking official administrative data while confirming that French Guiana remained among the lowest-coverage French departments. Together, these findings highlight a key result: vaccination uptake increased largely through policy and access mechanisms, whereas the beliefs most strongly associated with acceptance evolved slowly.\u003c/p\u003e \u003cp\u003eDeterminants of vaccination intention aligned with well-established domains of vaccine decision-making. Intention was strongly associated with perceived vaccine efficacy and safety, trust in health authorities, concern about COVID-19, and public-facing occupations, and was lower among inactive individuals and residents of the Maroni region. These determinants help explain the limited temporal variation observed in intentions, as perceptions of efficacy, safety, and trust\u0026mdash;central drivers of acceptance\u0026mdash;remained largely stable over time. Consistently, respondents unwilling to vaccinate relied more heavily on social media and informal social networks, whereas those willing or already vaccinated more frequently consulted official sources, healthcare professionals, the press, and scientific information. Reasons for non-vaccination were dominated by doubts about effectiveness, concerns about variants, fear of side effects, and a preference for traditional remedies. Although more than half of hesitant respondents reported that nothing would change their mind, a substantial minority expressed a need for longer-term safety data and clearer explanations of benefits and risks, indicating actionable entry points for communication strategies.\u003c/p\u003e \u003cp\u003eThese population-level findings are consistent with contemporaneous studies conducted among healthcare workers in French Guiana\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, which similarly identified concern about COVID-19 and trust in epidemic management as facilitators of acceptance, and fear of adverse events, distrust in authorities, and misinformation as barriers. Together, these convergent results suggest that trust is not a peripheral facilitator of vaccine uptake in this context, but a primary determinant of vaccination intention.\u003c/p\u003e \u003cp\u003eBeyond individual beliefs and information sources, vaccination intentions in French Guiana must also be interpreted in light of broader governance and historical dynamics. As a French overseas territory with a colonial past, French Guiana has long experienced centrally designed public policies that may be perceived locally as insufficiently adapted to territorial realities. During the COVID-19 pandemic, key measures\u0026mdash;including lockdowns, curfews, and communication strategies\u0026mdash;were largely defined at the national level and implemented according to timelines and risk assessments primarily calibrated for mainland France. In a context marked by pronounced social, cultural, and geographic heterogeneity, this perceived may have contributed to mistrust and resistance, particularly among populations born in the territory.\u003c/p\u003e \u003cp\u003eOur findings suggest that vaccine hesitancy cannot be understood solely as an informational deficit or an individual-level attitudinal stance, but also as a response to how public health decisions are produced, communicated, and enacted. Limited involvement of local actors in decision-making processes, combined with communication perceived as top-down or poorly contextualized, may have reinforced skepticism toward vaccination recommendations.\u003c/p\u003e \u003cp\u003eFrom an operational perspective, the survey provided timely and actionable intelligence to local authorities by documenting persistent hesitancy, identifying its main correlates, and highlighting a consistent spatial gradient, particularly in the Maroni region. Such near\u0026ndash;real-time, low-cost monitoring is especially valuable in geographically dispersed, multiethnic territories, where effective public health action requires understanding not only who remains hesitant, but also where and why.\u003c/p\u003e \u003cp\u003eThese findings should nevertheless be interpreted in light of several limitations. Online, non-probability sampling likely over-represented individuals who are more educated and digitally connected, while under-representing remote riverine populations despite broad dissemination efforts. Sample composition also varied across waves, and repeated participation cannot be excluded. Post-stratification weighting improved representativeness but cannot fully correct time-varying selection biases. Finally, vaccination intention was dichotomized to facilitate operational interpretation, and all associations should be interpreted as non-causal.\u003c/p\u003e \u003cp\u003eTwo main implications emerge. First, because vaccination intention in this setting is tightly linked to perceived efficacy, safety, and trust in authorities and scientific expertise, communication strategies should prioritize transparent benefit\u0026ndash;risk framing and rely on credible messengers embedded within local trust networks, including healthcare professionals and community leaders. Second, the repeated identification of the Maroni region as a low-intention area indicates that mobile, linguistically and culturally adapted outreach models tailored to riverine contexts are likely to be essential rather than optional.\u003c/p\u003e \u003cp\u003eIn conclusion, this study illustrates how repeated, low-cost online surveys can provide decision-makers with timely, locally grounded insights during a rapidly evolving epidemic, allowing vaccination intentions to be monitored alongside coverage. By identifying who remains hesitant, where, and for what reasons, such approaches can inform more targeted and context-sensitive vaccination strategies. Although translating evidence into fully adapted interventions remains challenging, these findings are relevant beyond COVID-19 and can inform the design, monitoring and adaptation of future vaccination programs in similarly complex and heterogeneous settings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this multiethnic and geographically dispersed territory, repeated online cross-sectional surveys provided timely, population-level evidence on COVID-19 vaccination intentions and their determinants. Vaccination uptake increased substantially over time, yet persistent opposition and marked geographic disparities underscore the central role of trust, perceived vaccine safety and efficacy, and information ecosystems in shaping acceptance.\u003c/p\u003e \u003cp\u003eBeyond individual attitudes, our findings highlight how governance context and local trust dynamics influence vaccine decision-making. When appropriately weighted and triangulated, repeated non-probability online surveys can complement routine administrative indicators by providing rapid, locally grounded insights to guide adaptive public health strategies.\u003c/p\u003e \u003cp\u003eSuch approaches offer a scalable and cost-effective tool for monitoring vaccine confidence and supporting preparedness during future vaccination campaigns, particularly in complex and heterogeneous settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCI : Confidence Interval\u003c/p\u003e\n\u003cp\u003eCOVID-19 : Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003eDPO : Data Protection Officer\u003c/p\u003e\n\u003cp\u003eINSEE : Institut National de la Statistique et des \u0026Eacute;tudes \u0026Eacute;conomiques\u003c/p\u003e\n\u003cp\u003eRR : Risk Ratio\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection complied with French and European regulations on data protection and privacy, including the General Data Protection Regulation (GDPR), and was conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;Participants accessed the questionnaire through an introductory page presenting the study objectives, the nature of the sections and types of questions included, and information regarding data confidentiality. Informed consent was obtained electronically, as participants were required to confirm their agreement before proceeding to the survey.\u003c/p\u003e\n\u003cp\u003eNo directly identifiable information was collected. Questionnaire design and response modalities were reviewed by the Data Protection Officer (DPO) of the Institut Pasteur to ensure that combinations of responses would not allow participant re-identification. Re-identification through cross-referencing of responses was therefore considered not feasible.\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed by the Institut Pasteur Institutional Review Board and determined to be exempt from formal ethical review under its applicable regulatory framework by equivalence with 45CFR46 (IRB00006966, 4 March 2021, N\u0026deg; IRB2021-C-Exempt).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analysed during the current study is available in the Zenodo repository at https://doi.org/10.5281/zenodo.18450266.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study was primarily supported by the Regional Health Agency of French Guiana through the CAPCOVID project. C.F. acknowledges additional support from l\u0026rsquo;Agence Nationale de la Recherche (French National Research Agency; grant agreement no. ANR-20-COVI-0014) and the European Regional Development Fund, European Union, European Union (grant agreement no. GY0027257), which contributed to secondary components of the study. G.F. acknowledges support from the Pierre Ledoux Foundation \u0026ndash; International Youth Scholarship, under the partnership between the Fondation de France and the Institut Pasteur. The funders had no role in the study design, data collection, analysis, interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthor contribution statement\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eC.S. performed the data analysis and visualization and wrote the first draft of the manuscript.\u003c/p\u003e\n\u003cp\u003eL.R. contributed to data collection, data curation and data analysis, and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eG.F. contributed to data curation and data analysis and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eC.A.S. contributed to project administration and data collection and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eN.P. contributed to data analysis and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eN.C. contributed to project administration and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eA.P. contributed to project administration and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eS.E. contributed to project administration and data collection and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eC.F. conceived the study, acquired funding, contributed to data analysis, supervised the project, wrote the first draft of the manuscript, and reviewed and edited the final version.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe gratefully acknowledge the residents of French Guiana who participated in the CAP-COVID surveys, as well as the local institutions and partners who supported survey dissemination across the territory.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWard, J. K., Alleaume, C., Peretti-Watel, P., \u0026amp; COCONEL Group. The French public\u0026rsquo;s attitudes to a future COVID-19 vaccine: The politicization of a public health issue. \u003cem\u003eSoc Sci Med\u003c/em\u003e \u003cstrong\u003e265\u003c/strong\u003e, 113414 (2020).\u003c/li\u003e\n\u003cli\u003eCambon, L., Schwarzinger, M. \u0026amp; Alla, F. Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: A challenge for one of the world\u0026rsquo;s most vaccine-hesitant countries. \u003cem\u003eVaccine\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 178\u0026ndash;182 (2022).\u003c/li\u003e\n\u003cli\u003eCOCONEL Group. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. \u003cem\u003eLancet Infect Dis\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 769\u0026ndash;770 (2020).\u003c/li\u003e\n\u003cli\u003ePeretti-Watel, P. \u003cem\u003eet al.\u003c/em\u003e Attitudes about COVID-19 Lockdown among General Population, France, March 2020. \u003cem\u003eEmerg Infect Dis\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, (2021).\u003c/li\u003e\n\u003cli\u003eBajos, N. \u003cem\u003eet al.\u003c/em\u003e When Lack of Trust in the Government and in Scientists Reinforces Social Inequalities in Vaccination Against COVID-19. \u003cem\u003eFront Public Health\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 908152 (2022).\u003c/li\u003e\n\u003cli\u003eJennings, W. \u003cem\u003eet al.\u003c/em\u003e Trust and vaccine hesitancy during the COVID-19 pandemic: A cross-national analysis. \u003cem\u003eVaccine X\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 100299 (2023).\u003c/li\u003e\n\u003cli\u003eJoshi, A. \u003cem\u003eet al.\u003c/em\u003e Predictors of COVID-19 Vaccine Acceptance, Intention, and Hesitancy: A Scoping Review. \u003cem\u003eFront Public Health\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 698111 (2021).\u003c/li\u003e\n\u003cli\u003eAlarc\u0026oacute;n-Braga, E. A. \u003cem\u003eet al.\u003c/em\u003e Acceptance towards COVID-19 vaccination in Latin America and the Caribbean: A systematic review and meta-analysis. \u003cem\u003eTravel Med Infect Dis\u003c/em\u003e \u003cstrong\u003e49\u003c/strong\u003e, 102369 (2022).\u003c/li\u003e\n\u003cli\u003eUrrunaga-Pastor, D. \u003cem\u003eet al.\u003c/em\u003e Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean. \u003cem\u003eTravel Med Infect Dis\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 102059 (2021).\u003c/li\u003e\n\u003cli\u003eAndronico, A. \u003cem\u003eet al.\u003c/em\u003e Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana. \u003cem\u003eNat Commun\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 1634 (2021).\u003c/li\u003e\n\u003cli\u003eForsans, G. \u003cem\u003eet al.\u003c/em\u003e Use of Herbal Medicine in French Guiana: Influences and Challenges for Prevention Strategies in the Context of the COVID-19 Pandemic. \u003cem\u003eJournal of Herbal Medicine\u003c/em\u003e \u003cstrong\u003e44\u003c/strong\u003e, 100848 (2024).\u003c/li\u003e\n\u003cli\u003eEpelboin, L. \u003cem\u003eet al.\u003c/em\u003e COVID-19 epidemic in remote areas of the French Amazon, March 2020 to May 2021: Another reality. \u003cem\u003eRev Soc Bras Med Trop\u003c/em\u003e \u003cstrong\u003e55\u003c/strong\u003e, e02742021 (2022).\u003c/li\u003e\n\u003cli\u003eNacher, M. \u003cem\u003eet al.\u003c/em\u003e Simultaneous dengue and COVID-19 epidemics: Difficult days ahead? \u003cem\u003ePLoS Negl Trop Dis\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, e0008426 (2020).\u003c/li\u003e\n\u003cli\u003eFlamand, C. \u003cem\u003eet al.\u003c/em\u003e Seroprevalence of anti-SARS-CoV-2 IgG at the first epidemic peak in French Guiana, July 2020. \u003cem\u003ePLoS Negl Trop Dis\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, e0009945 (2021).\u003c/li\u003e\n\u003cli\u003eWard, J. K. \u003cem\u003eet al.\u003c/em\u003e The French health pass holds lessons for mandatory COVID-19 vaccination. \u003cem\u003eNat Med\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 232\u0026ndash;235 (2022).\u003c/li\u003e\n\u003cli\u003eVignier, N. \u003cem\u003eet al.\u003c/em\u003e Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin. \u003cem\u003eVaccines\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 682 (2021).\u003c/li\u003e\n\u003cli\u003eDouine, M. \u003cem\u003eet al.\u003c/em\u003e Levers and Barriers to Vaccinate against COVID-19 in the Multicultural Context of French Guiana: A Qualitative Cross-Sectional Survey among Health Care Workers. \u003cem\u003eVaccines (Basel)\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1216 (2021).\u003c/li\u003e\n\u003cli\u003eNacher, M. \u003cem\u003eet al.\u003c/em\u003e The burden of COVID-19 in French Guiana: Vaccine-averted deaths, hospitalizations and costs. \u003cem\u003eVaccine: X\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 100271 (2023).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19 vaccination, Vaccine hesitancy, Repeated cross-sectional surveys, Online surveys, Trust in health authorities, Health communication, Multiethnic population, French Guiana","lastPublishedDoi":"10.21203/rs.3.rs-8885506/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8885506/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e \u003cp\u003eCOVID-19 vaccine hesitancy was anticipated in French overseas territories, yet locally grounded, near\u0026ndash;real-time evidence remained scarce during the pandemic. We aimed to monitor vaccination intentions over time and identify actionable determinants to inform outreach strategies in a young, geographically dispersed, and multiethnic setting.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eWe conducted four repeated, territory-wide online cross-sectional surveys in French Guiana between March and October 2021. Post-stratification weights based on census data (age, sex, area of residence, occupational category) were applied to estimate vaccination coverage and intention. Weighted robust Poisson regression models were used to identify correlates of vaccination intention, adjusting for survey wave.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eEstimated vaccination coverage increased from 12% to 54% over the study period, while the proportion of respondents firmly opposed to vaccination declined only modestly. Higher intention was strongly associated with perceived vaccine efficacy and safety, concern about COVID-19, trust in health authorities, and public-facing occupations, and was lower among inactive respondents and residents of the Maroni region. Reliance on traditional remedies and social media as information sources was associated with greater hesitancy. Coverage estimates broadly tracked official administrative data, despite systematic differences in absolute levels consistent with non-probability online sampling.\u003c/p\u003e\u003ch2\u003eConclusions.\u003c/h2\u003e \u003cp\u003eIn a complex, multiethnic territory, repeated low-cost online surveys provided timely, locally grounded insights into who remained hesitant, where, and for what reasons. Beyond individual beliefs, vaccination intention was closely linked to trust in authorities and information ecosystems, highlighting the need for locally adapted communication strategies and trusted intermediaries to support vaccine uptake. Such monitoring approaches can complement routine coverage indicators during future vaccine rollouts, provided that selection bias is explicitly addressed through weighting and triangulation.\u003c/p\u003e","manuscriptTitle":"Tracking COVID-19 vaccination intentions in a multiethnic overseas territory: evidence from repeated online surveys in French Guiana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 17:50:23","doi":"10.21203/rs.3.rs-8885506/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-06T21:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87488909463702701553823822395284021594","date":"2026-03-26T10:49:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234396354202507745127417446891606892938","date":"2026-03-25T12:31:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147437198430308137904395598305060337358","date":"2026-03-23T12:09:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T11:15:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-18T09:40:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-18T03:48:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-18T03:45:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-15T10:54:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ca8e71e-ae9c-4301-a910-e1fafdd0281d","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T17:50:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 17:50:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8885506","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8885506","identity":"rs-8885506","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}