Vaccine hesitancy in Europe during COVID-19: a systematic review of determinants
Abstract
Background: Vaccine hesitancy hindered COVID-19 control in Europe, with wide variation across countries. Social and political determinants, particularly trust in institutions, may explain these differences. This study synthesizes factors influencing vaccine acceptance and hesitancy in European populations.
Methods: A systematic review was conducted using PubMed, Embase, Scopus, Web of Science and Cochrane Library (Jan 2020–Dec 2024). Peer-reviewed studies in English including adults in Europe were selected. A total of 234 studies from 36 countries were analyzed. Determinants were grouped into sociodemographic, political (trust), informational and psychosocial factors.
Results: Acceptance ranged from 60–90% and hesitancy from 6–62%, lowest in Spain and highest in Bulgaria. Trust in government, institutions and science was the strongest determinant. Higher hesitancy in Eastern Europe was largely explained by lower trust and safety concerns. Lower acceptance was observed among younger individuals, women and those with lower socioeconomic status. Social media use was associated with hesitancy, while institutional sources increased acceptance. Subgroups with higher hesitancy included nurses, non-medical students and pregnant women.
Conclusions: Vaccine hesitancy in Europe is strongly shaped by social and political determinants, particularly institutional trust. Public health actions should prioritize trust-building, transparent communication and targeted interventions for vulnerable groups. These strategies can reduce inequalities in uptake and strengthen preparedness for future health crises.
Key messages: • Institutional trust is the strongest political determinant of vaccine acceptance across Europe.
• Addressing social inequalities and misinformation is key to reducing vaccine hesitancy.
Related
- Determinants of Herpes Zoster Vaccine Hesitancy: An Updated Systematic Review Based on the 5C Model
- H.4. Scientific session: Vaccine hesitancy in Europe: patterns, determinants and changing trends
- Factors influencing childhood vaccine hesitancy and interventions for parents and caregivers from ethnic minority backgrounds in the United Kingdom to encourage uptake: a systematic review
- Technological resources during the early dissemination of the smallpox vaccine in Europe and the Americas*
- A safety-first machine learning framework for precision public health: segmenting vaccine hesitancy among Iranian adults
BibTeX
@article{lebena2026vaccine,
title = {{Vaccine hesitancy in Europe during COVID-19: a systematic review of determinants}},
author = {A Lebena and T Faresjö and F Iredahl and T Timpka and ÅO Faresjö},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.806},
url = {https://doi.org/10.1093/eurpub/ckag169.806},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Vaccine hesitancy in Europe during COVID-19: a systematic review of determinants
AU - A Lebena
AU - T Faresjö
AU - F Iredahl
AU - T Timpka
AU - ÅO Faresjö
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.806
UR - https://doi.org/10.1093/eurpub/ckag169.806
AB - Background: Vaccine hesitancy hindered COVID-19 control in Europe, with wide variation across countries. Social and political determinants, particularly trust in institutions, may explain these differences. This study synthesizes factors influencing vaccine acceptance and hesitancy in European populations. Methods: A systematic review was conducted using PubMed, Embase, Scopus, Web of Science and Cochrane Library (Jan 2020–Dec 2024). Peer-reviewed studies in English including adults in Europe were selected. A total of 234 studies from 36 countries were analyzed. Determinants were grouped into sociodemographic, political (trust), informational and psychosocial factors. Results: Acceptance ranged from 60–90% and hesitancy from 6–62%, lowest in Spain and highest in Bulgaria. Trust in government, institutions and science was the strongest determinant. Higher hesitancy in Eastern Europe was largely explained by lower trust and safety concerns. Lower acceptance was observed among younger individuals, women and those with lower socioeconomic status. Social media use was associated with hesitancy, while institutional sources increased acceptance. Subgroups with higher hesitancy included nurses, non-medical students and pregnant women. Conclusions: Vaccine hesitancy in Europe is strongly shaped by social and political determinants, particularly institutional trust. Public health actions should prioritize trust-building, transparent communication and targeted interventions for vulnerable groups. These strategies can reduce inequalities in uptake and strengthen preparedness for future health crises. Key messages: • Institutional trust is the strongest political determinant of vaccine acceptance across Europe. • Addressing social inequalities and misinformation is key to reducing vaccine hesitancy.
SN - 1101-1262
SN - 1464-360X
ER -