Kerstin-Gertrud Kärblane, a recent master's student at the University of Tartu, showed that education and income are important factors for the willingness of Estonians to be vaccinated. This is interesting, because surveys on this topic in other countries produce contrasting results, namely, with some indicating higher reluctance to be vaccinated among more educated and affluent individuals.

She sought to provide an evidence-based overview of the attitudes of the Estonian population toward COVID-19 vaccination in 2021. Kärblane also explored in depth the correlation between people's vaccine related attitudes and their socio-demographic, economic, and health aspects. In her research, Kärblane utilized survey data from the Institute for Health Development related to respondents aged 19 to 81.

Hesitation decreases with age

"We grouped the respondents into three categories based on the scientific literature: those who were against vaccination, those who were hesitant and those who were in favor," said Kärblane, adding that certainly there were more views, but that grouping of people was nevertheless necessary to facilitate the analysis.

In terms of percentages, the majority of respondents, 83 percent, were in favor of vaccination, while 7 percent were hesitant and 10 percent were against it.

Kärblane said that while it seems that many pro-vaccination individuals were included in the survey, it is also a natural consequence of polling: "In general, more higher educated people, who are frequently also in favor of vaccination, reply to the surveys," she said.

Respondents were instructed to assess the following claims: "Vaccines are effective in preventing serious diseases," "Vaccination is vital for the protection of others," "Vaccination is safe," "Official information on vaccination is reliable," and "On vaccination, I follow the advice of a doctor or other healthcare professional."

"It turned out that the respondents who disagreed with the above statements the most were the deniers and people reluctant to decide," Kärblane said. The statements regarding which she found the most disagreement by people who refused to vaccinate were "Vaccination is safe" and "Information about vaccines is reliable." However, even those in favor of vaccination, who were largely in agreement with all of the claims, were significantly less positive on the two above.

Kärblane was also interested in evaluating how respondents' gender, age, home language, population density in the area of residence, income, employment and any symptoms of depression relate to their vaccination attitudes. "It is mainly male respondents in the younger age group who hesitate most," she said, adding that with increasing age, however, the number of hesitant and reluctant attitudes significantly reduced.

The spoken at home language was also an important factor, as male respondents who did not speak Estonian at home were more likely to be hesitant and refuse to be vaccinated.

The other statistically significant factor in male respondents was their education, and not so much the population density of their area of residence.

"The lower the education level, the higher the hesitation and unwillingness to vaccinate," said Kärblane.

Also, men with lower income were more likely to reject vaccination, while the "employment status and depressive symptoms were not statistically significant factors for them," the researcher suggested.

Among women, Kärblane says, the picture was similar, although the density of their area of residence had a statistically significant effect on their attitudes. "Women who lived in more sparsely populated areas were more hesitant than those who lived in areas with more than 10,000 people per square kilometer," she said.

In contrast to men, depressive symptoms did influence women, namely, women with symptoms of depression were more likely to be vaccinated. Kärblane said that "depression came out as a protective factor in the study," describing it as an intriguing finding.

Making the dissemination of information more engaging

While one of the interesting results was the correlation between depressive symptoms in women and their willingness to be vaccinated, the other noteworthy observation was that there is no statistically significant association between a person's willingness to receive a dose of vaccine and their COVID-19 risk assessment: "The hypothesis was that people who see COVID-19 as a dangerous disease would be more willing to get vaccinated. Nevertheless, such a correlation was absent altogether," Kärblane said.

Because a new outbreak is possible come fall, the researcher draws the attention of authorities to the need for a more carefully considered vaccination information campaign. "There has been a great deal of press attention to the fact that younger people are hesitating and are unwilling to be vaccinated due to somewhat outdated information materials," Kärblane said, adding that the informational materials should be easier to access, more engaging and creative.

For example, in the United States, the HPV vaccine was introduced to the younger part of the population by using a customized game, which is an example of an innovative and creative approach, Kärblane said. "The player receives accurate information in an engaging way and in this way understands well why the vaccine is important or what HPV is."

Kärblane said that comparable surveys in other countries have shown that it is the overabundance of information that makes younger people hesitate more. "This was also the case in Estonia when information about COVID-19 was being rapidly updated as more facts continuously emerged," she said.

The survey data was obtained in the spring of 2021, when vaccination against COVID-19 in Estonia was limited to those aged 65 and above. "This meant that younger people didn't get too much why the information was constantly changing and what it meant," Kärblane explained, reiterating the need for a more clear communication of information.

Kärblane said that information materials should also be developed with non-native speakers in mind, as more respondents in this group were hesitant and reluctant to be vaccinated. One of the reasons could be that the information for them was not easily accessible.

In addition, she said that it was reassuring to see that Estonia's vaccination coverage in the spring of 2021 was not at all poor. "While there was a lot of discussion in the news that Estonia was falling behind while other countries were getting ahead, the actual situation was not so bad. It was actually fairly good," Kärblane suggested.

Kerstin-Gertrud Kärblane defended her master's thesis "Attitudes towards COVID-19 vaccination and the related factors in Estonia" at the University of Tartu. The thesis was supervised by Kersti Pärna, associate professor at the University of Tartu, Elisa Kender, analyst at the Institute of Health Development and Sigrid Vorobjov, head of the Department of Epidemiology of Drugs and Infectious Diseases at the Institute of Health Development.

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