COVID-19 vaccination uptake in Belgium: socioeconomic and sociodemographic disparities

Abstract Background Recent studies have identified important social inequalities in SARS-CoV-2 infection and related COVID-19 outcomes in the Belgian population. This study aims to investigate socioeconomic and -demographic characteristics associated with the uptake of COVID-19 vaccine in Belgium. Methods We conducted a retrospective analysis of the uptake of the first dose of COVID-19 vaccine among 5,341,584 adults (≥ 18 years) tested for COVID-19 in Belgium until August 31, 2021. We integrated four national data sources: the Belgian vaccine registry (vaccination status), COVID-19 Healthdata (laboratory test results), STATBEL (socioeconomic/-demographic data) and the Common Base Registry for HealthCare Actors (people licensed to practice a healthcare profession in Belgium). Unvaccinated and vaccinated people (with at least one dose) were compared using multivariate logistic regression analysis. Results During the study period, 53,887 people (10%) did not receive the first COVID-19 vaccine dose in Belgium. Migrant background was associated with vaccine uptake (e.g., non-Europeans were almost three times [2.96-3.00] more likely to be unvaccinated compared to Belgian nationals). Single parents (OR 1.27 [1.26-1.28]) and people living alone (OR 1.18 [1.17-1.19]) were more likely to be unvaccinated compared to couples with children. Having a low or moderate education level (OR 1.36 [1.35-1.38] for low; OR 1.30 [1.29-1.32] for moderate) and income (OR 2.36 [2.34-2.38] for low; OR 1.54 [1.52-1.55] for moderate), being unemployed, (OR 1.50 [1.49-1.51), and having low health literacy (OR 1.41 [1.39-1.43]) led to a greater likelihood of being unvaccinated. Conclusions Migrants, people living alone, single parents or socioeconomically disadvantaged groups have lower uptake of COVID-19 vaccine in Belgium. The identification of these socioeconomic and -demographic disparities is critical to develop strategies guaranteeing a more equitable COVID-19 vaccination coverage in Belgium. Key messages • The study highlight important determinants in the uptake of the first dose of COVID-19 vaccine in Belgium. • These results highlight the importance to focus efforts on socioeconomically disadvantaged groups currently under-represented in COVID-19 vaccination uptake in Belgium.


Background:
Recent studies have identified important social inequalities in SARS-CoV-2 infection and related COVID-19 outcomes in the Belgian population. This study aims to investigate socioeconomic and -demographic characteristics associated with the uptake of COVID-19 vaccine in Belgium.

Methods:
We conducted a retrospective analysis of the uptake of the first dose of COVID-19 vaccine among 5,341,584 adults ( 18 years) tested for COVID-19 in Belgium until August 31, 2021. We integrated four national data sources: the Belgian vaccine registry (vaccination status), COVID-19 Healthdata (laboratory test results), STATBEL (socioeconomic/-demographic data) and the Common Base Registry for HealthCare Actors (people licensed to practice a healthcare profession in Belgium). Unvaccinated and vaccinated people (with at least one dose) were compared using multivariate logistic regression analysis.

Conclusions:
Migrants, people living alone, single parents or socioeconomically disadvantaged groups have lower uptake of COVID-19 vaccine in Belgium. The identification of these socioeconomic and -demographic disparities is critical to develop strategies guaranteeing a more equitable COVID-19 vaccination coverage in Belgium.

Key messages:
The study highlight important determinants in the uptake of the first dose of COVID-19 vaccine in Belgium. These results highlight the importance to focus efforts on socioeconomically disadvantaged groups currently underrepresented in COVID-19 vaccination uptake in Belgium.

Introduction:
The first wave of the ''Corona Monitoring bundesweit'' (RKI-SOEP) study showed that shortly before the start of the German vaccination program only about 2% of adults (> 18 years) had already experienced SARS-CoV-2 infection and more than half of these cases had been detected and notified. The objectives of the second wave of this study are to further investigate the spread of SARS-CoV-2 in Germanýs population aged over 14 years. It aims to determine the seroprevalence of infection-and vaccine-induced IgG antibodies against SARS-CoV-2. Finally, it examines health, demographic and socioeconomic risk and protective factors for infection and vaccine acceptance.

Methods:
From November 2021 to February 2022, the second wave of this cross-sectional study collected biospecimens (capillary blood samples) and interview data, including information on infection and vaccination, from a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). The dried self-collected blood samples were then analyzed for the detection of SARS-CoV-2 IgG antibodies by Euroimmun ELISA assay. Results: Based on preliminary, unweighted data of around 11,000 participants aged >14 years (52% response rate), we expect the final seroprevalence of SARS-CoV-2 antibodies to be in the range of 80 to 90%. Thus, around 10 to 20% of the German population may still be susceptible to a severe disease progression because they are neither infected nor vaccinated. Final results, weighted for non-response and adjusted for test sensitivity and specificity, will be presented.

Conclusions:
The RKI-SOEP-2 study will be pivotal in both, contributing to an improved understanding of SARS-CoV-2 propagation in different regional and sub-group settings and in identifying vulnerable target groups that need to be protected against future infections. Key messages: Dried blood self-sampling in a nationwide sample is a robust tool to estimate seroprevalence at a population level. As of February 2022, presumably 80 to 90% of the German population has previously been infected and/or vaccinated against SARS-CoV-2.