Determinants of COVID-19 vaccine uptake in the Netherlands: A nationwide registry-based study

INTRODUCTION: By September 2022, uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies indicated lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination programme and generate hypotheses for research on drivers and barriers of vaccination. METHODS: A retrospective database study was performed including the entire Dutch population >18 years. Vaccination data (5 January 2021-18 November 2021) were at individual level linked to sociodemographic data. Voting proportions for political parties were added at neighbourhood level. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. RESULTS: The most important determinant for COVID-19 vaccine uptake was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years and 88% in those >80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower in individuals in the lowest income group (69%), receiving social benefits (56%), and individuals with two parents born abroad (59%). CONCLUSIONS: Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. Lower uptake was found in individuals with lower income, lower socioeconomic status and a migration background. How to best address these inequalities for future vaccination campaigns requires further research. KEY MESSAGES: • COVID-19 vaccination likely contributed to increasing health inequity in the Netherlands. • Targeting vaccination efforts towards elderly aiming to maximise the impact of vaccination in reducing the burden of COVID-19 seems to be effective.