Regional Differences in COVID-19 Vaccine Hesitancy in December 2020: A Natural Experiment in the French Working-Age Population

Fanny Velardo, Verity Watson, Pierre Arwidson, François Alla, Stéphane Luchini, Michaël Schwarzinger, CoVaMax Study Group

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It can be assumed that higher SARS-CoV-2 infection risk is associated with higher COVID-19 vaccination intentions, although evidence is scarce. In this large and representative survey of 6007 adults aged 18–64 years and residing in France, 8.1% (95% CI, 7.5–8.8) reported a prior SARS-CoV-2 infection in December 2020, with regional variations according to an East–West gradient (p < 0.0001). In participants without prior SARS-CoV-2 infection, COVID-19 vaccine hesitancy was substantial, including 41.3% (95% CI, 39.8–42.8) outright refusal of COVID-19 vaccination. Taking into account five characteristics of the first approved vaccines (efficacy, duration of immunity, safety, country of the vaccine manufacturer, and place of administration) as well as the initial setting of the mass vaccination campaign in France, COVID-19 vaccine acceptance would reach 43.6% (95% CI, 43.0–44.1) at best among working-age adults without prior SARS-CoV-2 infection. COVID-19 vaccine acceptance was primarily driven by vaccine characteristics, sociodemographic and attitudinal factors. Considering the region of residency as a proxy of the likelihood of getting infected, our study findings do not support the assumption that SARS-CoV-2 infection risk is associated with COVID-19 vaccine acceptance.
Original languageEnglish
Article number1364
Number of pages13
Issue number11
Early online date20 Nov 2021
Publication statusPublished - 20 Nov 2021

Bibliographical note

Funding: Online survey experiments were funded by Santé publique France. This research was funded by Agence Nationale de la Recherche (ANR-21-CO16-0006-01).
Acknowledgments: The Department of methodology and innovation in prevention (SSMIP) of the teaching hospital of Bordeaux is partially funded by Agence Régionale de Santé (ARS) NouvelleAquitaine, France. Health Economics Research Unit (HERU) is funded by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates. Centre de Calcul Intensif
d’Aix-Marseille is acknowledged for granting access to its high performance computing resources. The CoVaMax Study Group includes: François Alla, Angela Baron, Coline Bourreau, Léo Donzel Godinot, Michaël Schwarzinger, Fanny Velardo (Department of methodology and innovation in prevention, Bordeaux university hospital, 33000 Bordeaux, France); Marcela Benavides, Linda Cambon,
Laurence Kotobi, Elodie Richard (University of Bordeaux, Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France); Pierre Arwidson, Isabelle Bonmarin, Stéphanie Vandentorren (Santé Publique France, 94410 Saint Maurice, France); Stéphane Luchini (Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, AMSE, 13001 Marseille, France); Verity Watson (Health Economics Research Unit
(HERU), University of Aberdeen, Aberdeen AB25 2ZD, UK).


  • SARS-CoV-2
  • COVID-19
  • mass vaccination
  • anti-vaccinations behavior
  • vaccine hesitancy
  • survey experiment
  • discrete choice experiment
  • France


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