# Spatial Analysis of Determinants of COVID-19 Vaccine Hesitancy in Portugal

## TL;DR

The study finds that vaccine hesitancy in Portugal is higher in certain areas, especially those with more migrants, despite overall high vaccination acceptance.

## Contribution

This study identifies spatial clusters of vaccine hesitancy in Portugal and links hesitancy to migrant proportions, not social deprivation or gender.

## Key findings

- High vaccine hesitancy clusters were found in Lisbon and the southwest of Portugal.
- Municipalities with higher migrant proportions had an 8-fold increased risk of vaccine hesitancy.
- Social deprivation and gender were not significantly associated with vaccine hesitancy.

## Abstract

Vaccine hesitancy tends to exhibit geographical patterns and is often associated with social deprivation and migrant status. We aimed to estimate COVID-19 vaccination hesitancy in a high-vaccination-acceptance country, Portugal, and determine its association with sociodemographic risk factors. We used the Registry of National Health System Users to determine the eligible population and the Vaccination Registry to determine individuals without COVID-19 vaccine doses. Individuals older than five with no COVID-19 vaccine dose administered by 31 March 2022 were considered hesitant. We calculated hesitancy rates by municipality, gender, and age group for all municipalities in mainland Portugal. We used the spatial statistical scan method to identify spatial clusters and the Besag, Yorke, and Mollié (BYM) model to estimate the effect of age, gender, social deprivation, and migrant proportion across all mainland municipalities. The eligible population was 9,852,283, with 1,212,565 (12%) COVID-19 vaccine-hesitant individuals. We found high-hesitancy spatial clusters in the Lisbon metropolitan area and the country’s southwest. Our model showed that municipalities with higher proportions of migrants are associated with an increased relative risk (RR) of vaccine hesitancy (RR = 8.0; CI 95% 4.6; 14.0). Social deprivation and gender were not associated with vaccine hesitancy rates. We found COVID-19 vaccine hesitancy has a heterogeneous distribution across Portugal and has a strong association with the proportion of migrants per municipality.