Multilevel analysis of COVID-19 vaccination intention: the moderating role of economic and cultural country characteristics

Background Predictors of COVID-19 (coronavirus) vaccination have been extensively researched; however, the contextual factors contributing to understanding vaccination intention remain largely unexplored. The present study aimed to investigate the moderating role of economic development (Gross domestic product - GDP per capita), economic inequality (Gini index), the perceived corruption index and Hofstede’s measurements of cultural values—index of individualism/collectivism and power distance index—in the relationship between determinants of satisfaction with the healthcare system, trust in political institutions, conspiracy beliefs and COVID-19 vaccination intention. Methods A multilevel modelling approach was employed on a sample of approximately 51 000 individuals nested within 26 countries. Data were drawn from the European Social Survey Round 10. The model examined the effect of individual- and country-level predictors and their interaction on vaccination intention. Results Satisfaction with the healthcare system had a stronger positive effect on intention to get vaccinated in countries with lower perceived corruption and more individualistic countries. Trust in political institutions had a stronger positive effect on vaccination intention in countries with higher economic development and lower perceived corruption, while a negative effect of conspiracy beliefs on vaccination intention was stronger in countries with lower economic development, higher perceived corruption and a more collectivistic cultural orientation. Conclusion Our findings highlight the importance of considering individual and contextual factors when addressing vaccination intention.