Differences in non-positive intention to accept the COVID-19 booster vaccine between three countries in the cross-border region Meuse-Rhine Euroregion: The Netherlands, Belgium, and Germany

C. line J. A. van Bilsen, Christina Stabourlos, Chrissy P. B. Moonen, Stephanie Brinkhues, Stefaan Demarest, Daniëlle A. T. Hanssen, Inge H. M. van Loo, Paul H. M. Savelkoul, Dirk Philippsen, Brigitte A. M. van der Zanden, Nicole H. T. M. Dukers-Muijrers, Christian J. P. A. Hoebe

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COVID-19 booster vaccination has shown to add to the protection against infection with SARS-CoV2 and subsequent severe disease. This longitudinal cross-border study aimed to identify factors associated with COVID-19 booster vaccine intentions in an initially vaccinated adult population living in the Meuse-Rhine Euroregion (EMR; including the Netherlands, Belgium, and Germany) and differences between countries. Data collection took place in autumn of 2021 and consisted of online questionnaires sent to a random sample of the population based on governmental registries. Data from 3,319 fully and partially vaccinated adults were used to examine determinants of non-positive intention for a booster vaccination (i.e., uncertain or do not want), using multivariable logistic regression analyses weighted by age group, sex, and country. Compared to German residents, Dutch residents (OR = 2.4) and Belgian residents (OR = 1.4) were more likely to be uncertain or not want to receive a booster vaccine in September-October 2021. Factors independently associated with non-positive intention were female sex (OR = 1.6), absence of comorbidities (OR = 1.3), time since last vaccination less than 3 months ago for those fully vaccinated (OR = 1.6), being partially vaccinated (OR = 3.6), a negative experience with communication of COVID-19 measures (OR = 2.2), and regarding measures as ineffective (OR = 1.1). Results indicate that booster vaccine intentions differ between countries in the cross border Meuse-Rhine Euroregion. Non-positive intention for the booster vaccine is prevalent in all three countries of the EMR, but to a different extent, as shown in this study. Cross-border collaboration and sharing information and knowledge about vaccination strategies could play a role in limiting the impact of COVID-19.
Original languageEnglish
Article number100306
JournalVaccine: X
Publication statusPublished - 1 Aug 2023


  • COVID-19
  • COVID-19 vaccines
  • Intention
  • Logistic models
  • Pandemics
  • Surveys and questionnaires

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