Vladimira Varbanova ^1* Niel Hens ^1,2 Philippe Beutels ¹

• ¹ University of Antwerp, Antwerp, Belgium
• ² University of Hasselt, Hasselt, Limburg, Belgium

Introduction: In relatively wealthy countries, substantial between-country variability in COVID-19 vaccination coverage occurred. We aimed to identify influential national-level determinants of COVID-19 vaccine uptake at different COVID-19 pandemic stages in such countries. Methods: We considered over 50 macro-level demographic, healthcare resource, disease burden, political, socio-economic, labor, cultural, life-style indicators as explanatory factors and coverage with at least one dose by June 2021, completed initial vaccination protocols by December 2021, and booster doses by June 2022 as outcomes. Overall, we included 61 European or Organisation for Economic Co-operation and Development (OECD) countries. We performed 100 multiple imputations correcting for missing data and partial least squares regression for each imputed dataset. Regression estimates for the original covariates were pooled over the 100 results obtained for each outcome. Specific analyses focusing only on European Union (EU) or OECD countries were also conducted. Results: Higher stringency of countermeasures, and proportionately more elderly, female and urban area residents, were each strongly and consistently associated with higher vaccination rates. Surprisingly, socio-economic indicators such as gross domestic product (GDP), democracy, and education had limited explanatory power. Overall and in the OECD, greater perceived corruption related strongly to lower vaccine uptake. In the OECD, social media played a noticeable positive role. In the EU, right-wing government ideology exhibited a consistently negative association, while cultural differences had strong overall influence. Conclusion: Relationships between country-level factors and COVID-19 vaccination uptake depended on immunization stage and country reference group. Important determinants include stringency, population age, gender and urbanization, corruption, government ideology and cultural context.