Differences in COVID-19 Vaccination Among Migrants and Non-Migrants in Germany: The Mediating Role of Psychological Factors of Vaccine Behavior

Understanding the underlying mechanisms for differences in COVID-19 vaccination between migrants and non-migrants in Germany is crucial in order to design targeted interventions encouraging vaccination. Hence, this study examined to what degree these disparities were mediated by psychological factors using the established 5C model of vaccine behavior (Confidence, Complacency, Constraints, Calculation, Collective Responsibility). Data were obtained from the German seroepidemiological study “Corona Monitoring Nationwide” (11/21-02/22). The association between vaccination and migration history considering the psychological factors was investigated using logistic regressions, while controlling for various sociodemographic and health-related characteristics. Lastly, a decomposition was conducted to uncover how much of the disparities in vaccine uptake could be explained by the 5C framework using the Karlson-Breen-Holm (KHB) method. People who immigrated themselves, were less likely to be vaccinated against COVID-19 compared to non-migrants, especially participants from the MENA region. The results of the mediation analysis showed that a substantial proportion of differences in vaccine uptake was mediated by the psychological factors (first generation: 61.2%, second generation: 64.2%). Confidence in safety of the COVID-19 vaccine and collective responsibility were the most relevant explanatory factors in the 5C framework. Furthermore, 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%. However, the indirect effect for the MENA region is not significant suggesting that the underlying mechanisms for the lower uptake need to be identified. Therefore, we investigated the effect of migration-specific characteristics on vaccination differences within the migrant population in an additional model. The study concluded with a discussion of possible explanations for the different attitudes towards vaccination (e.g. experiences of discrimination) and recommendations for targeted interventions to overcome potential barriers and to ensure equal access to healthcare.