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Original article

Vol. 152 No. 1314 (2022)

Differences in COVID-19 vaccination uptake in the first 12 months of vaccine availability in Switzerland – a prospective cohort study

  • Sarah Heiniger
  • Melanie Schliek
  • André Moser
  • Viktor von Wyl
  • Marc Höglinger
Cite this as:
Swiss Med Wkly. 2022;152:w30162


BACKGROUND: Widespread vaccination uptake has been shown to be crucial in controlling the COVID-19 pandemic and its consequences on healthcare infrastructures. Infection numbers, hospitalisation rates and mortality can be mitigated if large parts of the population are being vaccinated. However, one year after the introduction of COVID-19 vaccines, a substantial share of the Swiss population still refrains from being vaccinated.

OBJECTIVES: We analysed COVID-19 vaccination uptake during the first 12 months of vaccine availability. We compared vaccination rates of different socioeconomic subgroups (e.g., education, income, migration background) and regions (urban vs rural, language region) and investigated associations between uptake and individual traits such as health literacy, adherence to COVID-19 prevention measures and trust in government or science.

METHODS: Our analysis was based on self-reported vaccination uptake of a longitudinal online panel of Swiss adults aged 18 to 79 (the “COVID-19 Social Monitor”, analysis sample n = 2448). The panel is representative for Switzerland with regard to age, gender, and language regions. Participants have been periodically surveyed about various public health issues from 30 March 2020, to 16 December 2021. We report uptake rates and age-stratified hazard ratios (HRs) by population subgroups without and with additional covariate adjustment using Cox regression survival analysis. 

RESULTS: Higher uptake rates were found for individuals with more than just compulsory schooling (secondary: unadjusted HR 1.39, 95% confidence interval [CI] 1.10–1.76; tertiary: HR 1.94, 95% CI 1.52–2.47), household income above CHF 4999 (5000–9999: unadj. HR 1.42, 95% CI 1.25–1.61; ≥10,000 HR 1.99, 95% CI 1.72–2.30), those suffering from a chronic condition (unadj. HR 1.38, 95% CI 1.25–1.53), and for individuals with a sufficient or excellent level of health literacy (sufficient: unadj. HR 1.13, 95% CI 0.98–1.29; excellent: HR 1.21, 95% CI 1.10–1.34). We found lower rates for residents of rural regions (unadj. HR 0.79, 95% CI 0.70–0.88), those showing less adherence to COVID-19 prevention measures, and those with less trust in government or science.

CONCLUSIONS: Vaccination uptake is multifactorial and influenced by sociodemographic status, health literacy, trust in institutions and expected risk of severe COVID-19 illness. Fears of unwanted vaccine effects and doubts regarding vaccine effectiveness appear to drive uptake hesitancy and demand special attention in future vaccination campaigns.


  1. Omer SB, Benjamin RM, Brewer NT, Buttenheim AM, Callaghan T, Caplan A, et al. Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. Lancet. 2021 Dec;398(10317):2186–92.
  2. Strategic Advisory Group of Experts on Immunization SAGE. “WHO SAGE Roadmap for Prioritizing uses of Covid-19 Vaccines in the Context of Limited Supply.” World Health Organization, Oct. 20, 2020. Accessed: 24 Sep. 2021. Online. Available:
  3. Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. 2021 Mar;397(10278):1023–34.
  4. Our World in Data. “Israel: What share of the population has received at least one dose of the COVID-19 vaccine?” Israel: Coronavirus Pandemic Country Profile, Jul. 24, 2021. (accessed 26 Jul. 2021).
  5. Our World in Data. “Coronavirus (COVID-19) Vaccinations,” Our World in Data, Jul. 24, 2021. (accessed 26 Jul. 2021).
  6. Our World in Data. “Share of people vaccinated against COVID-19 Nov 30, 2021,” Our World in Data, Nov. 30, 2021. (accessed 02 Feb. 2021).
  7. Deml MJ, Jafflin K, Merten S, Huber B, Buhl A, Frau E, et al. Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme. BMJ Open. 2019 Nov;9(11):e032218.
  8. Johnson NF, Velásquez N, Restrepo NJ, Leahy R, Gabriel N, El Oud S, et al. The online competition between pro- and anti-vaccination views. Nature. 2020 Jun;582(7811):230–3.
  9. S. H. Adams, J. P. Schaub, J. M. Nagata, M. J. Park, C. D. Brindis, and C. E. Irwin, “Young Adult Perspectives on COVID-19 Vaccinations,” J. Adolesc. Health, p. S1054139X21002858, Jul. 2021, doi:
  10. Brandt EJ, Rosenberg J, Waselewski ME, Amaro X, Wasag J, Chang T. National Study of Youth Opinions on Vaccination for COVID-19 in the U.S. J Adolesc Health. 2021 May;68(5):869–72.
  11. Jennings W, Stoker G, Bunting H, Valgarðsson VO, Gaskell J, Devine D, et al. Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy. Vaccines (Basel). 2021 Jun;9(6):593.
  12. Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine. 2020 Sep;26:100495.
  13. Murthy BP, Sterrett N, Weller D, Zell E, Reynolds L, Toblin RL, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021. MMWR Morb Mortal Wkly Rep. 2021 May;70(20):759–64.
  14. Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine. 2021 Oct;40:101113.
  15. Robinson E, Jones A, Lesser I, Daly M. International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples. Vaccine. 2021 Apr;39(15):2024–34.
  16. Schweizer Radio und Fernsehen SRF. “Luzernerin erhält erste Impfung – auch weitere Kantone gestartet,” Schweizer Radio und Fernsehen SRF, Dec. 2020. (accessed 04 Oct. 2021).
  17. Federal Office of Public Health. “Covid-19-Impfstrategie: Besonders gefährdete Personen sollen zuerst geimpft werden,” Bundesamt für Gesundheit BAG, Dec. 17, 2020. (accessed 21 Jul. 2021).
  18. Federal Office of Public Health. “Coronavirus: Measures and ordinances,” Oct. 06, 2021. (accessed 02 Dec. 2021).
  19. Federal Office of Public Health. “Coronavirus: Federal Council plans new vaccination drive,” Bundesamt für Gesundheit BAG, Oct. 01, 2021. (accessed 02 Dec. 2021).
  20. Federal Office of Public Health. “COVID-⁠19 Switzerland Information on the current situation - Vaccinations,” Jan. 07, 2022. (accessed 07 Jan. 2022).
  21. Zürcher K, et al. “Vaccination willingness for COVID-19 among health care workers in Switzerland,” Jul. 2021. doi:
  22. Fadda M, Suggs LS, Albanese E. Willingness to vaccinate against Covid-19: A qualitative study involving older adults from Southern Switzerland. Vaccine X. 2021 Aug;8:100108.
  23. Leos-Toro C, Ribeaud D, Bechtiger L, Steinhoff A, Nivette A, Murray AL, et al. Attitudes Toward COVID-19 Vaccination Among Young Adults in Zurich, Switzerland, September 2020. Int J Public Health. 2021 May;66:643486.
  24. Moser A, Carlander M, Wieser S, Hämmig O, Puhan MA, Höglinger M. The COVID-19 Social Monitor longitudinal online panel: real-time monitoring of social and public health consequences of the COVID-19 emergency in Switzerland. PLoS One. 2020 Nov;15(11):e0242129.
  25. Moser A, von Wyl V, Höglinger M. Health and social behaviour through pandemic phases in Switzerland: regional time-trends of the COVID-19 Social Monitor panel study. PLoS One. 2021 Aug;16(8):e0256253.
  26. A. Speierer et al., “Original article: The Corona Immunitas digital follow-Up eCohort to monitor impacts of the SARS-CoV-2 pandemic in Switzerland: Study protocol and first results,” Int. J. Public Health, vol. online first, 2022, doi:
  27. Finbråten HS, Wilde-Larsson B, Nordström G, Pettersen KS, Trollvik A, Guttersrud Ø. Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis. BMC Health Serv Res. 2018 Jun;18(1):506.
  28. S. M. De Gani, R. Jaks, U. Bieri, and J. Ph. Kocher, “Health Literacy Survey Schweiz 2019-2021,” Careum Stiftung, Zürich, Sep. 2021.
  29. V. Von Wyl and Corona Immunitas Research Group, “Report on status of vaccination in Switzerland,” Swiss School of Public Health (SPPH+), Zürich, Dec. 2021.
  30. Riesen M, Konstantinoudis G, Lang P, Low N, Hatz C, Maeusezahl M, et al. Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey. BMJ Open. 2018 May;8(5):e021006.
  31. Richard JL, Mäusezahl M, Basler S, Eckert N. Approaching measles elimination in Switzerland: changing epidemiology 2007-2018. Swiss Med Wkly. 2019 Jun;149(Jun):w20102.
  32. Zürcher K, Zwahlen M, Berlin C, Egger M, Fenner L. Losing ground at the wrong time: trends in self-reported influenza vaccination uptake in Switzerland, Swiss Health Survey 2007-2017. BMJ Open. 2021 Feb;11(2):e041354.
  33. Federal Office of Public Health. “Die HPV-Impfung in der Schweiz: Resultate einer nationalen Befragung im Jahr 2014,” Federal Office of Public Health, Bulletin 23, 2015. Accessed: 11 Oct. 2021. Online. Available:
  34. Lang P, Sinniger P, Spaar A, Born R, Hatz C. “Evolution of the HPV vaccination coverage in Switzerland, 2008-2016,” presented at the Poster 4441, presented at the Swiss Public Health Conference 2017, Basel 22–23 November 2017, 2017. Online. Available:
  35. Tarr PE, Deml MJ, Huber BM. Measles in Switzerland - progress made, but communication challenges lie ahead. Swiss Med Wkly. 2019 Jun;149(Jun):w20105.
  36. European Centre for Disease Prevention and Control. “Data on COVID-19 vaccination in the EU/EEA,” Jan. 07, 2022. (accessed 07 Jan. 2022).
  37. Montagni I, Ouazzani-Touhami K, Mebarki A, Texier N, Schück S, Tzourio C ; CONFINS group. Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health (Oxf). 2021 Dec;43(4):695–702.
  38. Carrieri V, Madio L, Principe F. Vaccine hesitancy and (fake) news: quasi-experimental evidence from Italy. Health Econ. 2019 Nov;28(11):1377–82.
  39. Lorini C, Santomauro F, Donzellini M, Capecchi L, Bechini A, Boccalini S, et al. Health literacy and vaccination: A systematic review. Hum Vaccin Immunother. 2018 Feb;14(2):478–88.
  40. Munzert S, Selb P, Gohdes A, Stoetzer LF, Lowe W. Tracking and promoting the usage of a COVID-19 contact tracing app. Nat Hum Behav. 2021 Feb;5(2):247–55.
  41. Klüver H, Hartmann F, Humphreys M, Geissler F, Giesecke J. Incentives can spur COVID-19 vaccination uptake. Proc Natl Acad Sci USA. 2021 Sep;118(36):e2109543118.
  42. Mills MC, Rüttenauer T. The effect of mandatory COVID-19 certificates on vaccine uptake: synthetic-control modelling of six countries. Lancet Public Health. 2021 Dec;0(0):
  43. Masserey Spicher V, Weiss MG. Policy and socio-cultural differences between cantons in Switzerland with high and low adolescent vaccination coverage for hepatitis B and HPV. Vaccine. 2019 Dec;37(52):7539–46.
  44. Wood S, Schulman K. Beyond Politics - Promoting Covid-19 Vaccination in the United States. N Engl J Med. 2021 Feb;384(7):e23.
  45. Höglinger M, Jann B, Diekmann A. Sensitive Questions in Online Surveys: An Experimental Evaluation of Different Implementations of the Randomized Response Technique and the Crosswise Model. Surv Res Methods. 2016 Dec;10(3):171–87.

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