Abstract
BACKGROUND: This study investigates vaccine hesitancy among the 50 + population in Europe during the COVID-19 pandemic, focusing on the role of national contexts alongside individual determinants. The framework is guided by the WHO’s Complacency, Convenience, and Confidence (3Cs) model to explore factors influencing vaccination intent. METHODS: Data from over 45,000 SHARE Corona Survey respondents aged 50 + from 26 European countries were analysed regarding their intent to receive the COVID-19 vaccine. Multilevel logistic regression models assessed associations with individual factors (socio-demographics, health, and economic conditions) and country-level indicators of complacency (mortality, containment policies), convenience (human development, health expenditure), and confidence (perceived vaccine safety and effectiveness, trust in authorities). RESULTS: Key findings suggest that higher COVID-19 mortality rates and stricter containment measures were tied to an increase in vaccine uptake by 2.8% points. Furthermore, trust in the vaccine itself, rather than in health authorities and governments, was associated with an increase in vaccination intent by 2.1% points. CONCLUSIONS: Our study reveals significant national disparities in vaccination attitudes and behaviours, linked to socio-economic factors and healthcare quality. The research highlights the interplay between individual and national factors, suggesting that successful vaccination campaigns require a holistic approach addressing both personal hesitations and systemic barriers. This research hence underscores the importance of public trust, robust healthcare systems, and targeted communication strategies to mitigate vaccine hesitancy and improve pandemic response outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26065-x.