Year: 2026
Type: article
Study design: Systematic Review
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.
Authors: A Lebena, T Faresjö, F Iredahl, T Timpka, ÅO Faresjö
Institutions: Linköping University, Region Östergötland
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,181
OpenAlex ID: W7223687042