342 Differences in COVID-19 vaccination among migrants and non-migrants in Germany: the mediating role of psychological factors of vaccination

Abstract

OP 25: Exclusion and Discrimination 3, B207 (FCSH), September 4, 2025, 14:45 - 15:45

Aim

Understanding the underlying mechanisms for differences in COVID-19 vaccine uptake between migrants and non-migrants is crucial in order to design targeted interventions encouraging vaccination. This study examined to what extent vaccine disparities were mediated by psychological factors using the established 5C model of vaccine behaviour (Confidence, Complacency, Constraints, Calculation, Collective Responsibility).

Methods

Data were obtained from the German study “Corona Monitoring Nationwide”(11/2021-02/2022). The association between COVID-19 vaccination and migration history considering the psychological factors was investigated using multivariable binary logistic regressions, while controlling for various sociodemographic and health-related characteristics. A decomposition (KHB method) was conducted to examine how much of the disparities in vaccine uptake could be explained by the 5C framework.

Results

People who immigrated themselves were less likely to be vaccinated against COVID-19 compared to non-migrants, especially participants from the Middle East and North Africa (MENA) region. The decomposition analysis showed that almost two thirds of the disparities in COVID-19 vaccine uptake between migrants and non-migrants were mediated by the psychological factors. Confidence in safety of the vaccine was the most relevant explanatory factor in the 5C framework. The results highlighted the importance of a differentiated consideration regarding the country of origin: While 19.4% of the effect for the MENA region is explained by the 5C model, the proportion for Eastern Europe is 73.5%, suggesting that the underlying mechanisms for the lower uptake in the MENA group still need to be identified.

Conclusion

Given our results showed the key explanatory factor of vaccine behaviour was confidence, there is a need for proactive health communication strategies to improve knowledge about and trust in vaccinations within the heterogeneous group of migrants. In addition, more in-depth research is needed with a health equity focus to explore the effect of structural inequities on the psychological factors of vaccine behaviour.