The lower rates of COVID-19 vaccination in Western Balkans countries could be partially explained by societal distrust of its citizens, jeopardizing the sustainability of COVID-19 vaccination programs. The aim of the study was to determine the level and predictors of societal trust in five countries of the region. Using an online questionnaire, data were obtained from 1157 respondents from Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, and Serbia. The instrument included a socio-demographic questionnaire, a measure of vaccination behavior, and a scale measuring societal trust. Being a significant determinant of the COVID-19 vaccination behavior in all countries, societal trust considerably varied from country to country (F (24, 4002) = 7.574, p < 0.001). It was highest in North Macedonia (Mean = 3.74, SD = 0.99), and lowest in Albania (Mean = 3.21, SD = 1.03). Younger, female, less religious, and higher educated tended to have more pronounced societal trust in Serbia. In North Macedonia, younger age and lower health literacy predicted societal trust, while in Bosnia and Herzegovina, educational level was the single predictor. In Montenegro and Albania, higher societal trust was significantly predicted by lower health literacy only. The results provide evidence that the determinants of societal trust in Western Balkans vary across countries, indicating the need for different approaches in communication campaigns.

Background: Introduction of vaccines against COVID-19 has not encountered expected acceptance. The uptake of COVID-19 vaccines in Western Balkans countries is lagging behind the European Union average. The aim of our study was to assess the intention to get vaccinated against COVID-19 in the population of unvaccinated adult citizens of five Western Balkans countries, and to explore factors that influence the vaccination intention. Methods: Cross-sectional study was conducted in the period from July to October 2021. The questionnaire was shared through online social media. Intention to get vaccinated against COVID-19 was measured by a single item assessing the likelihood of getting vaccinated on a 5-points Likert scale. Linear regressions were conducted with socio-demographic characteristics, presence of chronic diseases and attitudes towards COVID-19 vaccination as independent factors. Results: The largest proportion of unvaccinated respondents willing to get vaccinated in the future was observed in Montenegro and Albania (40.4% in each country), while in the Serbian sample, the willingness to get vaccinated was the lowest (22.6%). Socio-demographic characteristics were not significantly associated with the intention to get vaccinated against COVID-19 in most of the countries. In Albania, Bosnia and Herzegovina, North Macedonia and Serbia the strongest determinant of COVID-19 vaccination intention was the higher sense of social responsibility. Conclusions: Vaccination interventions and campaigns aiming to improve the COVID-19 vaccine uptake should be focussed on specific set of factors in each country, appealing to social responsibility as most prevalent determinant of vaccination intention in Western Balkans.

Background: The vaccine hesitancy is a matter of global concern with inadequate global uptake postponing the moment of reaching herd immunity and bringing the COVID-19 pandemics under control. Countries in the Western Balkans struggle with vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus. Methods: A cross-sectional study on vaccine hesitancy was conducted from July to September 2021 and included adult population from Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia (1605 individuals). Convenience sampling was applied using anonymized online questionnaire (shared through social media) measuring, among others, trust in societal factors, social responsibility and, the credibility of information sources about COVID-19 vaccines. Results: The highest degree of trust in societal factors was found in North Macedonia (M = 3.65, SD = 1.06), followed by Montenegro (M = 3.50, SD = 1.19) and Serbia (M = 3.24, SD = 1.26). In Albania 44.7% respondents believed in reluctance of pharmaceutical companies to publish detailed research reports on the risks of adverse reactions to COVID-19 vaccines. The view that the health authorities when they encourage vaccination do so with the best intentions supported 66,3% respondents in North Macedonia and 49% in Albania and Serbia. The highest level of social responsibility (M = 4.12, SD = 1.09) was revealed in North Macedonia. Primary care physicians, health professionals in media, webpages of public health institutions, and scientific literature are the most trusted sources of information about COVID-19 in all countries. Conclusions: The study demonstrated moderate trust in societal factors and moderately high level of social responsibility in all countries. The health professionals enjoy the greatest trust, which implies that medical doctors, especially physicians in primary health care should have a pivotal role in promoting vaccination and educating the general public in the Western Balkans.

Background: Countries in the Western Balkans are facing vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus. Trust in science and institutions, namely political trust, plays an important role and can significantly affects vaccine acceptance. Methods: Cross-sectional research was carried out from July to September 2021 in five countries of the Western Balkans (Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia) and included adult population aged 18 and older (1605 individuals). Convenience sampling was applied using anonymised online questionnaires and Likert scales, shared through online social media, and asking, among others, for trust in societal factors. Results: In all countries people had more confidence in health authorities than in political officials. There are no gender differences found in showing trust in societal factors, except in Serbia where women compared to men showed greater trust in health authorities (50.6% vs. 34.4%), as well as in political officials (42.8% vs. 28.2%). The lowest trust in pharmaceutical companies was found in Albania where 34,9% respondents believe that vaccination against COVID-19 is largely promoted by pharmaceutical companies due to financial profits. People who put more trust in societal factors were vaccinated to a greater extent. In Serbia and Albania, the older respondents in general put more trust in societal factors. People who assessed themselves as more religious in Serbia and North Macedonia demonstrated less trust towards societal factors. Conclusions: The study demonstrated moderate trust in societal factors in all countries, with greatest trust in health authorities. This implies that health authorities should have a pivotal role, together with physicians in primary health, in promoting vaccination and educating the general public in the Western Balkans. Key messages:

Background and Objectives: COVID-19 vaccines represent a life-saving solution for the pandemic which has resulted in millions of deaths around the world, but vaccine uptake has remained low in Western Balkan countries. Vaccine hesitancy is the result of a plethora of factors which are usually...

Background and Objectives: The uptake of COVID-19 vaccines in Western Balkan countries is lagging far behind the European Union average, with vaccine hesitancy as a serious threat and reason for the insufficient vaccination coverage and suboptimal herd immunity. Understanding factors that...