# Cross-sectional study on COVID-19 vaccine hesitancy and determinants in healthcare students: interdisciplinary trainings on vaccination are needed

Sylvain Gautier, Domitille Luyt, Benjamin Davido, Marie Herr, Thomas

Cardot, Anne Rousseau, Djillali Annane, Elisabeth Delarocque-Astagneau,
Loïc Josseran

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## ► To cite this version:

Sylvain Gautier, Domitille Luyt, Benjamin Davido, Marie Herr, Thomas Cardot, et al.. Cross-sectional study on COVID-19 vaccine hesitancy and determinants in healthcare students: interdisciplinary trainings on vaccination are needed. BMC Medical Education, 2022, 22 (1), pp.299. 10.1186/s12909-022-03343-5 . inserm-03694279

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# Cross-sectional study on COVID-19 vaccine hesitancy and determinants in healthcare students: interdisciplinary trainings on vaccination are needed

Sylvain Gautier¹,²,³*, Domitille Luyt¹,², Benjamin Davido¹,⁴, Marie Herr¹,²,⁵, Thomas Cardot¹,², Anne Rousseau¹,⁶,⁷,⁸, Djillali Annane¹,⁹, Elisabeth Delarocque-Astagneau¹,²,⁵ and Loïc Josseran¹,²,³

**Abstract**

**Background:** To ensure the success of COVID-19 vaccination, public authorities need to have the support of the entire population and build vaccine confidence. Identifying and understanding the determinants of vaccine acceptance is essential for conducting vaccine strategy. The aim was to estimate vaccine hesitancy among healthcare students in France and to investigate the associated factors.

**Methods:** A web-based cross-sectional study was conducted in a large French University in greater Paris area, among 4927 healthcare students from the different training courses such as medicine studies, midwifery studies, physio-therapy studies, nurse studies and others health studies. The study was conducted between January 21 and February 8, 2021 based on a questionnaire including 25 single or multiple-choice questions, made using the free software Limesurvey. The link of the questionnaire was distributed to the students by the teachers and the student associations. The SAGE group definition of vaccine hesitancy was used. All estimates were weighted using the gender and training courses category of all healthcare students registered for the 2020-2021 year. Crude and adjusted weighted odds ratio (wOR) and 95% confidence interval (95%CI) were estimated using logistic regression.

**Results:** A total of 1465 healthcare students answered. A proportion of 44.5% (95%CI = [41.7–47.3]) of them were considered as hesitant. Women were more hesitant (50.9, 95%CI = [48.0–53.9]) than men (21.6, 95%CI = [15.2–28.0]). Vaccine hesitancy was significantly associated with gender (wOR = 0.27, 95%CI = [0.18–0.39]) and training courses: medical students were less likely to be hesitant than students in the common and first year of several health studies (wOR = 0.48, 95%CI = [0.33–0.70]) while nursing students were more than 5 times more likely to be hesitant (wOR = 5.20, 95%CI = [3.71–7.28]). Students who did an internship during the epidemic (wOR = 0.53, 95%CI = [0.41–0.69]) and who downloaded the mobile contact-tracing mobile app "TousAntiCovid" (wOR = 0.34, 95%CI = [0.26–0.44]) were significantly less likely to be hesitant.

<footnote>*Correspondence: sylvain.gautier@aphp.fr
³Inserm U1018, CESP, Primary Care and Prevention team, University of Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
Full list of author information is available at the end of the article</footnote>
**Conclusions:** Overall vaccine hesitancy among healthcare students was high, substantial differences were found between training courses. To reduce these disparities, interdisciplinary lectures on vaccines for all healthcare students may be implemented and evaluated.

**Keywords:** COVID-19, Vaccination, Education, medical, Universities

**Background**

The vaccination against COVID-19 represents an important hope to defeat the disease. WHO considers that all people should have access to safe and effective COVID-19 vaccines as quickly as possible, starting with those at high risk of severe disease or death [1]. Supply difficulties forced most countries around the world to first prioritize access to these vaccines for specific groups of populations highly vulnerable to COVID-19. The Strategic Advisory Group of Experts on Immunization (SAGE) has published two essential documents to help determine which groups should be vaccinated as a priority [2, 3]. Along with those having comorbidities (hypertension, heart disease, diabetes ...) or elderly people, healthcare workers were considered as top priority groups considering exposure. At the same time, healthcare students were not considered as a priority group although they are in contact with patients during their internship. In many countries, as immunization coverage of priority groups increases, new groups of population were being called upon to be vaccinated like young people and healthcare students as a part of them.

To ensure the success of vaccination, public authorities need to have the support of the population and build vaccine confidence. In this context, identifying and understanding the determinants of vaccine acceptance is essential for conducting vaccine strategy, developing campaigns to promote vaccination and convincing the most reluctant people [4]. This is all the more true in France where vaccine hesitancy was deemed to be high [5]. According to the SAGE Working Group, vaccine hesitancy is defined as a delay in acceptance or refusal of vaccines despite availability [6].

A study conducted in early 2021 of 1942 French working-age adults showed that 28.8% of respondents categorically refused COVID-19 vaccination. That vaccine hesitancy was associated with age with an inverted U-shaped relationship: the youngest and the oldest showed greater acceptance to COVID-19 vaccination [7]. Studies have also shown that acceptance of COVID-19 vaccination in the general population is socially determined [8]. Because of insufficient vaccination coverage in the French population, the government introduced a covid-health pass for access to cultural activities or restaurants, as it has been done in other European countries.

As young people, healthcare students are expected to be less hesitant, especially since as future healthcare professionals they should be particularly concerned about vaccine prevention [9] and patients protection. However, there are few studies that specifically focus on the vaccine hesitancy of students and healthcare students in particular. A survey of 237 college students at the University of Rhode Island, United States of America (USA), in November 2020 found that 50% of respondents said they wanted to receive a COVID-19 vaccine as soon as possible [10]. Another study of 248 dental students and 167 medical students in USA found that 45% of dental students and 23% of medical students were reluctant to receive a COVID-19 vaccine [11]. In Europe, studies covering the pre-mass-vaccination campaign period are scarce. In a cross-sectional survey conducted in both nurses and nursing students of five southern European countries, vaccine hesitancy among students was circa 60% [12]. However, these works did not cover the diversity of health training courses. In this context, it was necessary to document vaccine hesitancy among the different healthcare students. Therefore, the aim of this study was to estimate vaccine hesitancy among the different training courses of healthcare students in France and to investigate the associated factors in order to inform vaccine strategy and, if needed, to suggest options for rethinking training programs on vaccines preventable diseases at the University.

**Methods**

**Data collection**

We conducted a web-based cross-sectional study in a large French University in greater Paris area including the different training courses such as medicine studies, midwifery studies, physiotherapy studies, nurse studies and others health studies (including studies in occupational therapy, psychomotricity, pedicure-podology, medical electro-radiology manipulation and others). The online questionnaire was developed using the freeware Limesurvey and available online between January 21 and February 8, 2021. The questionnaire was pre-tested by several 4th year medical students to ensure comprehension and feasibility. These students were asked not to complete the questionnaire again during its release. This study relied on a non-probability sampling method: teachers of all training courses and students' associations were asked to
distribute the link of the pre-tested questionnaire to all the healthcare students. After providing informed consent on the initial screen, participants were invited to answer 25 single or multiple-choice questions including several conditional questions. The questionnaire (available on supplementary 1) included 4 questions about age, gender, curriculum, and current training courses followed by the participants, 10 about the history, exposures, and experience of the COVID-19 outbreak, 4 about vaccination in general and 6 about COVID-19 vaccination in particular including a question on vaccine intent for COVID-19 vaccines. Depending on the answer to this question, participants were asked about the reasons for which they intend to be vaccinated or, on the contrary, not to be vaccinated. The corresponding Cronbach alpha values to test the internal consistency were 0.93 and 0.75 respectively.

Considering the population surveyed (n = 4927) and an ideal random sampling strategy, the minimum sample size was 878 respondents with a margin of error of 3% and a level of confidence in the responses of 95% without any assumption on the estimated proportions.

## Statistical analysis

Participants' characteristics were described as numbers and percentages for all categorical variables and put next to the study population characteristics (Table 1). Considering the SAGE definition of vaccine hesitancy, we presented the vaccine hesitancy variable in 2 modalities instead of 5: "No hesitancy" (including "yes, definitely"

and "yes, probably" previous modalities) and "Hesitancy" (including "no, certainly not", "no, probably not" and "maybe" previous modalities). All population estimates were weighted: using the gender and training courses distribution of all the students registered for the 2020–2021 year, we calculated a posteriori weight for each responding student (Fig. 1). All variables are presented as unweighted numbers and weighted proportions in percent (Table 2).

Univariate weighted odds ratio (wOR) and 95% confidence interval (95%CI) were estimated using logistic regression in the population (Table 3). Variables with P values ≤0.2 in the univariate analysis were further assessed in the multivariable logistic regression model. A P value of ≤0.05 was considered statistically significant to keep a variable in the multivariable model after a step by step decrease. Multivariable weighted odds ratio (awOR) and 95% CI were estimated using logistic regression. All statistical analyses were carried out using the software R in version 4.0 with the libraries survey, svrepmisc and psy. This study followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines [13].

## Ethics

The study was approved by the Research Ethics Committee of Paris Saclay University, Paris, France (Polethis) (CER-Paris-Saclay-2021-014) and the French data protection authority (Commission Nationale de l'informatique et des Libertés [CNIL]) (registration number: 2220726).

<table><caption>**Table 1** Characteristics of the participants and the study population. COVID-19 vaccine hesitancy study among healthcare students, France, January–February 2021 (n = 1465)</caption><thead><tr><th>n (%)</th><th>Sample N = 1465</th><th>Study population<sup>1</sup> N = 4927</th></tr></thead><tbody><tr><td>Gender</td><td></td><td></td></tr><tr><td>Female</td><td>1219 (83.2)</td><td>3842 (78.0)</td></tr><tr><td>Male</td><td>246 (16.8)</td><td>1085 (22.0)</td></tr><tr><td>Age</td><td></td><td></td></tr><tr><td>&lt; 20 years</td><td>491 (33.5)</td><td>N.A.<sup>2</sup></td></tr><tr><td>[20–22] years</td><td>623 (42.5)</td><td></td></tr><tr><td>&gt; 22 years</td><td>351 (24.0)</td><td></td></tr><tr><td>Training courses</td><td></td><td></td></tr><tr><td>Common and first year of several health studies</td><td>334 (22.8)</td><td>814 (16.5)</td></tr><tr><td>Medical studies (2nd year to 6th year)</td><td>349 (23.8)</td><td>745 (15.1)</td></tr><tr><td>Midwifery studies (2nd year to 5th year)</td><td>97 (6.6)</td><td>295 (6.0)</td></tr><tr><td>Physiotherapy studies (2nd year to 5th year)</td><td>174 (11.9)</td><td>952 (19.3)</td></tr><tr><td>Nursing studies (1st year to 3rd year)</td><td>342 (23.3)</td><td>1694 (34.4)</td></tr><tr><td>Other health studies<sup>3</sup></td><td>169 (11.5)</td><td>427 (8.7)</td></tr></tbody></table>

<footnote n="1">¹ All healthcare students of the Faculty of Health, University of Versailles Saint-Quentin-en-Yvelines</footnote>

<footnote n="2">² Not available</footnote>

<footnote n="3">³ Including students in occupational therapy, psychomotricity, pedicure-podology, medical electro-radiology manipulation and others</footnote>
<figure><img src="image_4.png" /></figure>

Reading note: The number of years of each health training course varies. Medical, midwifery and physiotherapy training courses shared a first common year. After this common and first year, medical students pursue their training courses until their 6th year before beginning their specialization. Midwifery and physiotherapy students have an over-all study duration of 5 years. Finally, other students in health studies, including nurses, have a study duration of 3 years.

<caption>**Fig. 1** Description of the health training courses. COVID-19 vaccine hesitancy study among healthcare students, France, January–February 2021 (n = 1465)</caption>

# Results

## Study sample

A total of 1465 healthcare students completed the online questionnaire, bringing the participation rate to 29.7% (Table 1). Amongst them, a large majority were female. Women outnumbered men by almost 5 to 1 (sex ratio = 4.96) in the sample, whereas they represented slightly less than 4 out of 5 students in the study population (sex ratio = 3.54). The mean age is 21.2 years (± 3.2); 33.5% of respondents are under 20 years old and 24.0% over 22 years old. Health studies in France are organized in distinct training courses but a first year of study is common to several of these ("common and first year of several health studies") (Fig. 1). This first year of study is the same for the medicine, midwifery, and physiotherapy studies. In contrast, nursing studies and other health studies start with an independent first year. Thus, among the respondents, 334 (22.8%) declared that they were in the common and first year of several health studies. There were 342 (23.3%) students in the first year of nursing studies. There were also 349 (23.8%) students in medicine studies (2nd year or more), 174 (11.9%) students in physiotherapy studies (2nd year or more) and 97 (6.6%) students in midwifery studies (2nd year or more). The vast majority of the respondents (n = 1103) had

done an internship during the epidemic period. During these internships, 58.5% of them took care of COVID-19 patients (Table 2, weighted percentage). Slightly more than one in four healthcare students (26.7%) said they had been vaccinated against influenza during the winter 2020–2021.

## Healthcare students experience of the COVID-19 pandemic

Nearly 15% of healthcare students reported having been infected with COVID-19 during the 2020 epidemic waves or in January 2021 (Table 2, weighted percentages). More than two thirds of them (68.1%) indicated that they had had cases of COVID-19 among their relatives. For 12.9% of them, their relatives were hospitalized for COVID-19. Concerning healthcare students' feelings during the COVID-19 epidemic, 74.9% said they were worried about the health of their relatives, 71.0% said they had difficulty following the courses online, 57.2% felt isolated and 34.4% felt anxious. About one in 6 students (16.5%) declared they are concerned about their own health. Nearly one in three students (31.3%) reported having downloaded the contact-tracing mobile app entitled "TousAntiCovid".

To inform themselves about COVID-19 vaccines, 88.4% of healthcare students used mass media such as television, radio or 24-h news channels. They were 56.8%
<table><caption>**Table 2** Opinions and attitudes of healthcare students towards COVID-19 vaccines and their history, exposures and experience of the COVID-19 outbreak. Unweighted numbers and weighted proportions in percent. COVID-19 vaccine hesitancy study among healthcare students, France, January–February 2021 (n = 1465)</caption><thead><tr><th>n (%)*</th><th>Total<br>N = 1465</th><th>Female<br>N = 1219</th><th>Male<br>N = 246</th></tr></thead><tbody><tr><td>Were you in internship during the epidemic<sup>†</sup>(y/n)<sup>‡</sup></td><td>1103 (97.8)</td><td>913 (97.2)</td><td>190 (99.7)</td></tr><tr><td>If yes, did you take care of COVID-19 patients? (y/n)</td><td>670 (58.5)</td><td>550 (59.6)</td><td>120 (54.6)</td></tr><tr><td colspan="4">Have you been infected with COVID-19?</td></tr><tr><td>Yes, with a positive test that proves it</td><td>199 (14.7)</td><td>165 (14.2)</td><td>34 (16.6)</td></tr><tr><td>Yes, I am convinced of it, but I did not perform a test</td><td>119 (8.4)</td><td>98 (8.3)</td><td>21 (8.7)</td></tr><tr><td>No/I do not know</td><td>1147 (76.9)</td><td>956 (77.5)</td><td>191 (74.7)</td></tr><tr><td>Have there been any cases among your relatives? (y/n)</td><td>1020 (68.1)</td><td>851 (68.6)</td><td>169 (66.3)</td></tr><tr><td>If yes, were they hospitalized for COVID-19? (y/n)</td><td>188 (12.9)</td><td>167 (14.4)</td><td>21 (7.8)</td></tr><tr><td colspan="4">Regarding your feelings since the beginning of the epidemic, which sentence(s) do you agree with?</td></tr><tr><td>I feel or have felt isolated</td><td>841 (57.2)</td><td>704 (57.0)</td><td>137 (57.9)</td></tr><tr><td>I am or was anxious</td><td>488 (34.4)</td><td>430 (36.8)</td><td>58 (25.4)</td></tr><tr><td>I am or was concerned about my health</td><td>218 (16.5)</td><td>197 (17.8)</td><td>21 (11.7)</td></tr><tr><td>I am or was concerned about my relatives' health</td><td>1051 (74.9)</td><td>901 (76.1)</td><td>150 (70.1)</td></tr><tr><td>Following the courses online was difficult</td><td>968 (71.0)</td><td>818 (71.2)</td><td>150 (70.1)</td></tr><tr><td>Have you been vaccinated against the flu this winter? (y/n)</td><td>353 (26.7)</td><td>272 (25.3)</td><td>81 (74.7)</td></tr><tr><td colspan="4">Do you intend to be vaccinated against COVID-19?</td></tr><tr><td>No hesitancy:</td><td></td><td></td><td></td></tr><tr><td>Yes, definitely</td><td>576 (36.7)</td><td>427 (31.6)</td><td>149 (54.9)</td></tr><tr><td>Yes, probably</td><td>286 (18.7)</td><td>231 (17.3)</td><td>55 (23.5)</td></tr><tr><td>Hesitancy:</td><td></td><td></td><td></td></tr><tr><td>Maybe</td><td>257 (17.6)</td><td>242 (20.2)</td><td>18 (8.5)</td></tr><tr><td>No, probably not</td><td>184 (13.5)</td><td>171 (15.4)</td><td>13 (6.7)</td></tr><tr><td>No, certainly not</td><td>159 (13.5)</td><td>148 (15.5)</td><td>11 (6.4)</td></tr><tr><td colspan="4">If "No hesitancy" was answered: what are the reasons for being vaccinated against COVID-19?</td></tr><tr><td>I want to protect myself against COVID-19</td><td>609 (70.8)</td><td>463 (71.2)</td><td>146 (69.7)</td></tr><tr><td>I want to protect my household members against COVID-19</td><td>802 (93.3)</td><td>614 (93.6)</td><td>188 (92.7)</td></tr><tr><td>I want to avoid COVID-19 transmission to patients</td><td>722 (84.6)</td><td>548 (83.9)</td><td>174 (86.2)</td></tr><tr><td>I want to be part of the epidemic control</td><td>694 (79.2)</td><td>527 (78.8)</td><td>167 (80.0)</td></tr><tr><td>I want to have my social, cultural, sporting interactions back</td><td>756 (88.4)</td><td>575 (88.3)</td><td>181 (88.7)</td></tr><tr><td>I believe that available vaccines are safe and efficient</td><td>466 (52.8)</td><td>330 (48.2)</td><td>136 (62.8)</td></tr><tr><td colspan="4">If "Hesitancy" was answered: what are the reasons for being vaccinated against COVID-19?</td></tr><tr><td>I prefer preventive measures or wearing mask to protect myself</td><td>196 (35.1)</td><td>185 (36.1)</td><td>11 (26.9)</td></tr><tr><td>I prefer to wait the safety of new vaccines demonstrated</td><td>456 (76.2)</td><td>428 (77.5)</td><td>28 (66.1)</td></tr><tr><td>I am afraid of side effects</td><td>319 (54.7)</td><td>298 (54.9)</td><td>21 (53.6)</td></tr><tr><td>I am against vaccination in general</td><td>20 (4.3)</td><td>19 (4.3)</td><td>1 (3.5)</td></tr><tr><td>I am not at risk-population of severe COVID-19 disease</td><td>192 (32.3)</td><td>173 (31.7)</td><td>19 (41.1)</td></tr><tr><td>I do not think new vaccines be efficient enough</td><td>208 (36.4)</td><td>196 (38.4)</td><td>12 (33.0)</td></tr><tr><td>I do not trust public authority about COVID-19 vaccination</td><td>196 (36.4)</td><td>177 (35.2)</td><td>19 (46.6)</td></tr><tr><td>I think vaccines serve the pharmaceutical industry</td><td>94 (18.1)</td><td>84 (16.1)</td><td>10 (34.9)</td></tr><tr><td>Have you downloaded the contact tracing mobile app ("TousAntiCovid")? (y/n)</td><td>503 (31.3)</td><td>412 (31.4)</td><td>91 (30.9)</td></tr><tr><td colspan="4">What are the sources you commonly use to inform yourself about COVID-19 vaccines?</td></tr><tr><td>Television news, radio, 24-h news channels ...</td><td>1232 (88.4)</td><td>1028 (89.5)</td><td>204 (84.3)</td></tr><tr><td>Written press (daily press, digital newspapers ...)</td><td>612 (44.0)</td><td>481 (41.6)</td><td>131 (52.5)</td></tr><tr><td>Social media (Facebook, Twitter, Instagram ...)</td><td>807 (56.8)</td><td>673 (58.0)</td><td>134 (52.7)</td></tr><tr><td>Searching keywords on internet</td><td>235 (17.1)</td><td>177 (15.0)</td><td>58 (24.6)</td></tr><tr><td>Institutional website (vaccination-info-service ...)</td><td>344 (25.5)</td><td>270 (23.5)</td><td>74 (32.5)</td></tr></tbody></table>
<table><caption>**Table 2** (continued)</caption><thead><tr><th>n (%)*</th><th>Total<br>N = 1465</th><th>Female<br>N = 1219</th><th>Male<br>N = 246</th></tr></thead><tbody><tr><td>Recommendations (HAS, specialties college)</td><td>467 (35.9)</td><td>370 (33.9)</td><td>97 (43.1)</td></tr><tr><td>Scientific journals</td><td>242 (17.9)</td><td>180 (15.4)</td><td>62 (26.4)</td></tr><tr><td>University courses</td><td>242 (19.0)</td><td>191 (17.4)</td><td>51 (24.7)</td></tr><tr><td>I don't look for information</td><td>57 (4.2)</td><td>49 (4.1)</td><td>8 (4.2)</td></tr><tr><td colspan="4"><strong>Some activities (trip, social events ...) must be determined by the individual COVID-19 vaccination status</strong></td></tr><tr><td>Agree</td><td>580 (38.1)</td><td>443 (34.0)</td><td>137 (52.7)</td></tr><tr><td>Neither agree or disagree</td><td>307 (20.5)</td><td>268 (21.8)</td><td>39 (15.8)</td></tr><tr><td>Disagree</td><td>558 (41.4)</td><td>489 (44.3)</td><td>69 (31.5)</td></tr></tbody></table>

to inform themselves on social networks and 44.0% using the written press (daily press, digital newspapers). On the other hand, only 19.0% of them said they got information about COVID-19 vaccines from their university courses and 17.9% from scientific journals (Table 2).

## Vaccine hesitancy and its determinants among healthcare students

When asked whether healthcare students would be willing to be vaccinated against COVID-19, 36.7% answered “yes, definitely” while 13.5% were certain not to be vaccinated (Table 2). According to the SAGE definition of vaccine hesitancy, 44.5% (95%CI=[41.7–47.3]) of the students could be considered as hesitant (Fig. 2, weighted percentages). Women were more hesitant (50.9%; 95%CI=[48.0–53.9]) than men (21.6%; 95%CI=[15.2–28.0]). Depending on the training courses, students were more or less hesitant about the COVID-19 vaccines. Thus, medical students (from the 2nd year onwards) were the least hesitant with 16.0% (95%CI=[12.2–19.9]) hesitant. Students in the common and first year of several health studies were 28.2% (95%CI=[23.4–33.0]) to declare themselves hesitant and 67.1% (95%CI=[61.9–72.4]) of nursing students were hesitant.

The reasons for vaccine acceptance and hesitancy were specified by the students (Table 2). Protection of their relatives was reported by 93.3% of them as a reason to get the vaccine. Eighty-eight percent (88.4%) wanted to return to their previous social life without restriction through vaccination and 84.6% wanted to be vaccinated to protect patients they take care of. Only slightly more than half of the students who said they wanted to be vaccinated believed in the safety and efficacy of the COVID-19 vaccines (52.8%). Vaccine safety appeared to be the main reason for healthcare students’ hesitation to vaccinate: 76.2% of them said they prefer to wait until the safety of the vaccines had been demonstrated and 54.7%

feared side effects. Only 4.3% of students were against vaccines in general.

Vaccine hesitancy among healthcare students was significantly associated with gender: male were less likely to be hesitant than women (wOR=0.27, 95%CI=[0.18–0.39], p<0.001). Regarding training courses, medical students were less likely to be hesitant than students in the common and first year of several health studies (wOR=0.48, 95%CI=[0.33–0.70], p<0.001) while nursing students were more than 5 times more likely to be hesitant than the latter (wOR=5.20, 95%CI=[3.71–7.28], p<0.001). Students who did an internship during the epidemic (wOR=0.53, 95%CI=[0.41–0.69], p<0.001) and who downloaded the mobile contact-tracing mobile app (wOR=0.34, 95%CI=[0.26–0.44], p<0.001) were less likely to be hesitant.

In the adjusted model, vaccine hesitancy remained associated with gender (awOR=0.34, 95%CI=[0.19–0.60]) and training courses (Table 3). Nursing students were almost 3 times more likely to be hesitant about the COVID-19 vaccination than the students in the common and first year of several health studies (awOR=2.76; 95%CI=[1.70–4.48]). Downloading the contact-tracing mobile app (awOR=0.65; 95%CI=[0.44–0.95]) and being vaccinated against the 2020 seasonal influenza virus (awOR=0.42; 95%CI=[0.27–0.66]) were protective factors for vaccine hesitancy. Students who reported not having a good knowledge of vaccines were twice as likely to be hesitant (awOR=2.23; 95%CI=[1.35–3.70]). Students who considered that certain activities should be conditional on being vaccinated had a 30% lower risk of being hesitant (awOR=0.77; 95%CI=[0.49–1.20]) while those who said they were opposed to this statement had a 70% higher risk of being hesitant (awOR=1.73; 95%CI=[1.10–2.73]). Respondents stating that healthcare students should participate in the vaccine campaign were less likely to be hesitant (awOR=0.31; 95%CI=[0.21, 0.47])

<footnote>* %: proportions weighted on gender and training courses category</footnote>

<footnote>† Students in the “common and first year of several health studies” are exclude because they do not do an internship</footnote>

<footnote>‡ (y/n): yes/no questions. For these questions, only the statistics for the “yes” modality are mentioned in the table</footnote>
<table><caption>**Table 3** Identifying factors associated with vaccine hesitancy towards COVID-19 vaccines among healthcare students. Weighted logistic regression analysis. COVID-19 vaccine hesitancy study among healthcare students, France, January–February 2021 (n = 1465)</caption><thead><tr><th></th><th colspan="2">Vaccine hesitancy n (%)*</th><th>Univariate OR<sup>†</sup> (95% CI)</th><th>p</th><th>Adjusted OR<sup>‡</sup> (95% CI)</th></tr><tr><th></th><th>Hesitancy N = 600</th><th>No hesitancy N = 862</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>Gender</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>558 (89.3)</td><td>658 (68.8)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Male</td><td>42 (10.7)</td><td>204 (31.2)</td><td>0.27 (0.18, 0.39)</td><td>&lt;0.001</td><td>0.34 (0.19, 0.60)</td></tr><tr><td>Age</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>≤ 19 years old</td><td>201 (30.6)</td><td>290 (30.9)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>[20–22] years old</td><td>248 (43.3)</td><td>373 (43.1)</td><td>1.01 (0.78, 1.32)</td><td>0.92</td><td></td></tr><tr><td>≥ 23 years old</td><td>151 (26.0)</td><td>199 (26.0)</td><td>1.01 (0.74, 1.37)</td><td>0.95</td><td></td></tr><tr><td>Training courses</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Common first year<sup>§</sup></td><td>102 (10.5)</td><td>232 (21.4)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Medical (2nd year to 6th year)</td><td>56 (5.4)</td><td>292 (22.9)</td><td>0.48 (0.33, 0.70)</td><td>&lt;0.001</td><td>0.39 (0.23, 0.67)</td></tr><tr><td>Midwifery (2nd year to 5th year)</td><td>37 (5.1)</td><td>60 (6.8)</td><td>1.53 (0.95, 2.46)</td><td>0.08</td><td>0.79 (0.42, 1.50)</td></tr><tr><td>Physiotherapy (2nd year to 5th year)</td><td>237 (15.4)</td><td>104 (22.4)</td><td>1.41 (0.94, 2.10)</td><td>0.09</td><td>1.00 (0.57, 1.76)</td></tr><tr><td>Nursing (1st year to 3rd year)</td><td>64 (51.9)</td><td>109 (20.3)</td><td>5.20 (3.71, 7.28)</td><td>&lt;0.001</td><td>2.76 (1.70, 4.48)</td></tr><tr><td>Other</td><td>104 (11.7)</td><td>65 (6.3)</td><td>3.79 (2.56, 5.61)</td><td>&lt;0.001</td><td>1.70 (0.96, 3.03)</td></tr><tr><td>Internship during the epidemic<sup>**</sup></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>478 (86.6)</td><td>622 (77.5)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>No</td><td>122 (13.4)</td><td>240 (22.5)</td><td>0.53 (0.41, 0.69)</td><td>&lt;0.001</td><td></td></tr><tr><td>Have presented COVID-19</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>467 (75.5)</td><td>680 (78.3)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>133 (24.5)</td><td>182 (21.7)</td><td>1.17 (0.76, 1.21)</td><td>0.74</td><td></td></tr><tr><td>Being contact case of a confirmed case at least once</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>288 (46.4)</td><td>388 (45.4)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>312 (53.6)</td><td>474 (54.6)</td><td>0.96 (0.76, 1.21)</td><td>0.74</td><td></td></tr><tr><td>Have had relatives ill and/or hospitalized for COVID</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>None</td><td>205 (34.7)</td><td>239 (29.7)</td><td>Ref</td><td>0.72</td><td></td></tr><tr><td>Relatives hospitalized for COVID</td><td>84 (14.6)</td><td>104 (11.7)</td><td>1.07 (0.74, 1.55)</td><td>0.02</td><td></td></tr><tr><td>Relatives with COVID but not hospitalized</td><td>311 (50.8)</td><td>519 (58.7)</td><td>0.74 (0.57, 0.96)</td><td></td><td></td></tr><tr><td>Having relatives at risk of severe COVID</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>123 (21.1)</td><td>161 (18.0)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>477 (78.9)</td><td>701 (82.0)</td><td>0.82 (0.62, 1.10)</td><td>0.2</td><td></td></tr><tr><td>Have downloaded the contact tracing mobile app</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>474 (80.9)</td><td>486 (59.0)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>126 (19.1)</td><td>376 (41.0)</td><td>0.34 (0.26, 0.44)</td><td>&lt;0.001</td><td>0.65 (0.44, 0.95)</td></tr><tr><td>Have been vaccinated against the 2020 seasonal flu</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>520 (86.4)</td><td>545 (66.7)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>80 (13.6)</td><td>317 (33.3)</td><td>0.32 (0.23, 0.42)</td><td>&lt;0.001</td><td>0.42 (0.27, 0.66)</td></tr><tr><td>Feeling or having felt isolated</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>271 (48.7)</td><td>292 (38.1)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>304 (51.3)</td><td>535 (61.9)</td><td>0.65 (0.51, 0.82)</td><td>&lt;0.001</td><td></td></tr><tr><td>Fear for one's health</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>465 (79.8)</td><td>719 (86.3)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>110 (20.2)</td><td>108 (13.7)</td><td>1.60 (1.16, 2.20)</td><td>0.004</td><td></td></tr><tr><td>Fear for relatives' health</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>168 (28.1)</td><td>185 (22.7)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Yes</td><td>407 (71.9)</td><td>642 (77.3)</td><td>0.75 (0.57, 0.98)</td><td>0.03</td><td></td></tr></tbody></table>
<table><caption>**Table 3** (continued)</caption><thead><tr><th></th><th colspan="2">Vaccine hesitancy n (%)*</th><th>Univariate OR<sup>†</sup> (95% CI)</th><th>p</th><th>Adjusted OR<sup>‡</sup> (95% CI)</th></tr><tr><th></th><th>Hesitancy N = 600</th><th>No hesitancy N = 862</th><th></th><th></th><th></th></tr></thead><tbody><tr><td colspan="6"><strong>Sources of information used<sup>††</sup></strong></td></tr><tr><td>Do not look for information</td><td>31 (5.6)</td><td>26 (3.0)</td><td>Ref</td><td></td><td></td></tr><tr><td>Use reliable sources</td><td>274 (47.8)</td><td>466 (57.1)</td><td>0.46 (0.25, 0.83)</td><td>0.01</td><td></td></tr><tr><td>Use unreliable sources</td><td>281 (46.6)</td><td>365 (39.8)</td><td>0.64 (0.35, 1.16)</td><td>0.14</td><td></td></tr><tr><td colspan="6"><strong>Have personal good knowledge on COVID-19 vaccines</strong></td></tr><tr><td>Neither agree nor disagree</td><td>208 (35.4)</td><td>315 (36.5)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Agreed</td><td>88 (15.2)</td><td>270 (33.0)</td><td>0.47 (0.34, 0.66)</td><td>&lt;0.001</td><td>0.51 (0.30, 0.86)</td></tr><tr><td>Disagree</td><td>290 (49.4)</td><td>271 (30.5)</td><td>1.67 (1.29, 2.17)</td><td>&lt;0.001</td><td>1.14 (0.77, 1.69)</td></tr><tr><td colspan="6"><strong>Act as a referral for family or friends to provide information about COVID-19</strong></td></tr><tr><td>Neither agree nor disagree</td><td>158 (26.9)</td><td>171 (20.5)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Agreed</td><td>180 (31.0)</td><td>433 (50.6)</td><td>0.47 (0.35, 0.63)</td><td>&lt;0.001</td><td>0.61 (0.39, 0.97)</td></tr><tr><td>Disagree</td><td>248 (42.1)</td><td>252 (28.9)</td><td>1.11 (0.82, 1.51)</td><td>0.5</td><td>0.96 (0.60, 1.55)</td></tr><tr><td colspan="6"><strong>Consider that vaccination should be made mandatory for caregivers</strong></td></tr><tr><td>Neither agree nor disagree</td><td>159 (24.6)</td><td>212 (25.0)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Agreed</td><td>52 (8.2)</td><td>539 (62.5)</td><td>0.13 (0.09, 0.20)</td><td>&lt;0.001</td><td>0.33 (0.21, 0.53)</td></tr><tr><td>Disagree</td><td>375 (67.2)</td><td>105 (12.5)</td><td>5.46 (3.91, 7.63)</td><td>&lt;0.001</td><td>3.43 (2.17, 5.40)</td></tr><tr><td colspan="6"><strong>Consider that healthcare students should participate to the vaccination campaign</strong></td></tr><tr><td>Neither agree nor disagree</td><td>232 (37.5)</td><td>192 (21.8)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Agreed</td><td>92 (16.2)</td><td>593 (70.6)</td><td>0.13 (0.10, 0.18)</td><td>&lt;0.001</td><td>0.31 (0.21, 0.47)</td></tr><tr><td>Disagree</td><td>262 (46.3)</td><td>71 (7.6)</td><td>3.55 (2.47, 5.09)</td><td>&lt;0.001</td><td>2.45 (1.47, 4.08)</td></tr><tr><td colspan="6"><strong>Consider that certain activities should be conditioned by vaccine status</strong></td></tr><tr><td>Neither agree nor disagree</td><td>106 (17.1)</td><td>200 (23.1)</td><td>Ref</td><td></td><td>Ref</td></tr><tr><td>Agreed</td><td>89 (14.6)</td><td>491 (56.8)</td><td>0.35 (0.24, 0.49)</td><td>&lt;0.001</td><td>0.77 (0.49, 1.20)</td></tr><tr><td>Disagree</td><td>391 (68.3)</td><td>165 (20.1)</td><td>4.60 (3.32, 6.38)</td><td>&lt;0.001</td><td>1.73 (1.10, 2.73)</td></tr></tbody></table>

than those who disagreed with this proposal (awOR=2.45; 95%CI=[1.47, 4.08]).

## Discussion

In this study, vaccine hesitancy of healthcare students to the COVID-19 vaccination at the beginning of the year 2021 was estimated at 44.5, 95%CI=[41.7–47.3]. Vaccine hesitancy was significantly associated with gender, training courses and having downloaded the contact-tracing mobile app. It was also significantly associated with not being vaccinated against influenza, feeling or having felt isolated during the epidemic, and being afraid for their

own health. Healthcare students who considered having a good knowledge of COVID-19 vaccines and that vaccination should be made mandatory for caregivers were significantly less likely to be reluctant to be vaccinated. Vaccine acceptance was finally associated with considering that healthcare students should participate in the vaccination campaign and, considering that certain activities should be conditional on being vaccinated.

Among the motivations for being vaccinated, healthcare students give priority to reasons related to protecting the health of their relatives or patients they might take care of. For a large majority of them, the

<footnote>* Weighted proportions. Amounts may be discreetly less than or greater than 100% due to rounding</footnote>

<footnote>† Univariate odds-ratio (OR) are calculated using a weighted logistic regression</footnote>

<footnote>‡ Adjusted odds-ratio (aOR) are calculated using a weighted logistic regression</footnote>

<footnote>§ Common and first year of several health studies</footnote>

<footnote>** This variable was not used in the multivariate model because the students of the common first year of medial, midwifery and physiotherapy studies do not carry out an internship during their training year</footnote>

<footnote>†† The variable was defined based on several responses about the nature of the sources of information used by the respondents. Thus, if the respondent mentioned looking for information on institutional sites (Ministry of health, recommendations from experts or medical associations ...), in scientific journals, university lectures, it was indicated that he/she was using "reliable sources". On the contrary, the respondent looking for information via mass media, general press, social networks, or the Internet was considered as using "unreliable sources". Responses indicating that the respondent did not look for information at all were kept as such</footnote>
<figure><img src="image_5.png" /></figure>

perspective of a return to cultural, social, or sport-
ing life and activity is an important motivation. Most
healthcare students who are reluctant to be vaccinated
say they have little confidence in the safety of the new
vaccines and more than half of them fear side effects.

The use of the SAGE group definition of vaccine
hesitancy allows comparisons between vaccine hesi-
tancy of healthcare students in this study with those of
other national and international studies [2]. Like that
of the general population, vaccine hesitancy among
healthcare students varies greatly from one country
to another and from one continent to another [5]. A
recent study among medical students in India, con-
ducted between February and March 2021, showed that
only 10.6% of the students were hesitant [14]. A sur-
vey of 2133 Egyptian medical students in January 2021
found that 46% were reluctant to be vaccinated against
COVID-19 and nearly 20% refused outright [15]. In the
French context, the COVIREIVAC survey conducted
between May 10 and May 23, 2021, showed that 70%
of French 18–24-year-olds surveyed were already vac-
cinated or said they wanted to be [16]. Nevertheless,
these global estimates do not account for the great het-
erogeneity, according to the gender of the students and
their training courses.

For example, it appears that women healthcare stu-
dents are more hesitant than men healthcare students.
This finding has been reported in studies conducted in
the general population [7, 17] as well as in studies con-
ducted among healthcare professionals [18]. We hypoth-
esize that women are more cautious about new vaccines
and typically about pregnancy concerns and fertility
despite no proven relationship [19]. Indeed, they may be
more concerned than men about potential side effects
and vaccine safety. Our results show that among hesitant
women and men, a higher proportion of women said they
wanted to wait for new vaccines to be proven safe.

In our study, nursing students were 4 times more hes-
itant than medical students. This difference has already
been demonstrated among healthcare workers [17, 20,
21], especially for vaccination against COVID-19, for
which vaccination coverage varies according to the car-
egiver's profession. At the end of July 2021, vaccination
coverage for full vaccination was 70.6% among medical
doctors, 56.7% among physiotherapists, 54.9% among
nurses and 54.3% among midwives in France [22]. Simi-
larly, our results show that midwifery students and
physiotherapy students are approximately twice more
hesitant than medical students. These observations are
consistent with the differences in vaccine intention and
coverage by healthcare profession for seasonal influ-
enza [23]. The students would be more prone to fol-
low the attitudes of their elders with whom they work
during their internships. Indeed, the evolution of the
vaccine hesitation rates between the common and first
year of several health studies and the upper years of
these studies suggests that the youngest students, who
are not yet doing an internship in a professional envi-
ronment, are relatively less hesitant than students who
are further along in their training courses. Another
hypothesis is that vaccine hesitancy among healthcare
students could be partly explained by preconceived
representations regarding vaccines in general. These
representations could be addressed using interdisci-
plinary approaches for lectures on vaccine preventable
diseases [24]. Prior to designing such educational pro-
grams on vaccination, exploring these representations
with qualitative studies is needed, particularly among
nursing students, whose reluctance to be vaccinated
is significant. Such research could be conducted on a
European scale to identify possible disparities between
countries. It is also important to ask whether, within
each of the European countries, differences in terms of
vaccine hesitancy exist in the same proportions or not.
Recent European studies have shown that vaccine hesi-
tancy is not different between healthcare students and
other students [25]. The specificity of healthcare stu-
dents could thus be questioned in a broader perspec-
tive by considering the role and place occupied by the
healthcare professions in the different European health
systems.

Our results also show that healthcare students are
widely solicited by their entourage, probably because
of the nature of their studies, which places them as a
reliable source of information on health issues. They
are also able to convey prevention messages for their
relatives, as it has already been shown in other studies
[26, 27]. In this context, it is particularly reassuring to
see healthcare students being proactive about the epi-
demic: downloading the contact-tracing mobile app
“TousAntiCovid” [28] or seeking information from reli-
able sources as other studies have already shown [29].
In this way, healthcare students could help limit the
spread of misinformation within their age group and in
their families.

Our study also asked healthcare students about the
impact of COVID-19 and vaccination on their personal
lives. As with many students, they reported feeling par-
ticularly isolated during the various epidemic waves,
and in particular during the first two waves that marked
the year 2020 [30]. In this study, they expressed a desire
to return to a more fulfilling social life, with a major-
ity of them saying they were in favor of a covid-health

pass. Similarly, at the beginning of 2021, the majority of
healthcare students were in favor of the mandatory vac-
cination of healthcare professionals, which will ultimately
be effective since 15 September 2021.

As this study cover the beginning of 2021, it could be
repeated in order to monitor the evolution of healthcare
students’ perceptions and attitudes towards COVID-19
vaccination, especially since regulatory measures (covid-
health pass, vaccination mandatory for healthcare pro-
fessionals) have been taken to accelerate vaccination
campaign in France. Indeed, vaccination has been offi-
cially extended to younger people without comorbid-
ties since May 31, 2021. At this time, vaccine coverage
was estimated at 19.9% (one or two doses) and reached
48.5% July 10, 2021 prior to the announcement of the
implementation of the covid-health pass for those over
18 starting from August 9, 2021. Thereafter, vaccine cov-
erage for 18–24-year-olds (one or two doses) increased
to 60% at the end of July 2021 to achieve 84% at the end
of August [31]. The significant increase in vaccination
coverage of young people before the introduction of the
covid-health pass would highlight the variety of factors
that may explain vaccine hesitancy in this age group and
reinforces the need to study vaccine hesitancy through
its determinants, especially since the covid-health pass is
intended to be used only in a transitory manner. Consid-
ering COVID-19 vaccine hesitancy through its determi-
nants should allow to implement vaccination promotion
strategies based on health education approaches, espe-
cially that some factors associated with COVID-19 vac-
cine hesitancy are also found for other vaccines as well.
This is all the more important as these challenges also
concerned other European countries [5, 25] and thus
need effort at the European level.

Although our study sample represented only 30% of
the study population, all the estimates, including vaccine
hesitancy and measures of association, were a posteriori
weighted on gender and training courses category. As the
study was carried out at the very beginning of the imple-
mentation of the vaccination campaign in France and
over a very short period of time (only 18 days), we con-
sider that the responses of the participants in the survey
could not have been influenced by the information and
vaccination promotion campaigns which remained the
same during the survey period. In addition, young peo-
ple were not primarily concerned by vaccination because
they were not among the priority people.

It is important to remain cautious about the generaliz-
ability of our results to the entire population of health-
care students in France, as this study was not conducted
in all the universities. However, it allowed us to question
students from different training courses and to consider
comparisons between these training courses. The choice
of a non-probabilistic sampling exposes us to a selection bias which we have nevertheless tried to avoid by proceeding with a weighting to produce adjusted proportions on our population. In addition, because of the social desirability bias, the estimate of vaccine hesitancy among healthcare students may have been underestimated. This bias may also have influenced the estimates of the measures of association. However, we believe we reduced the magnitude of this bias by conducting an Internet questionnaire rather than a face-to-face one. Despite these potential limitations, we think that this study provides reliable estimates about vaccine hesitancy and its determinants among healthcare students.

## Conclusions

Overall vaccine hesitancy among healthcare students was high. To get insight into determinants of vaccine hesitancy in healthcare students could be essential in the perspective of a long-term COVID-19 epidemic and the possible need for subsequent vaccination campaigns including a possible third dose or seasonal vaccine. In addition, substantial differences in vaccine hesitancy were found between training courses. To reduce these disparities, dedicated interdisciplinary lectures on vaccines for all healthcare students at the University may be implemented and evaluated.

### Abbreviations

awOR: Adjusted weighted odds ratio; CHERRIES: Checklist for Reporting Results of Internet E-Surveys; CNIL: Commission Nationale de l'informatique et des Libertés; COVID-19: Coronavirus disease-2019; SAGE: Strategic Advisory Group of Experts on Immunization; USA: United States of America; WHO: World Health Organization; wOR: Weighted odds ratio.

## Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-022-03343-5.

### Additional file 1.

### Acknowledgments

We would like to thank Christophe Tzourio (MD, PhD - Inserm U1219 and iShare Cohort, Universities of Bordeaux and Versailles Saint-Quentin-en-Yvelines) for his help in carrying out this study. We would also like to thank all the healthcare students who responded to this survey as well as the student associations and the faculty administration who helped us distribute the questionnaire. Finally, we would like to thank the departments of maieutic, general medicine and nursing for their help.

### Authors' contributions

SG, DL, TC, LJ, MH and EDA designed the study. SG, DL and TC have carried out the technical and regulatory procedures. All authors contributed to the elaboration of the questionnaire (content and formulation of questions). SG, DL and TC contributed to the database preparation. SG, DL, TC and EDA analysed data. SG, DL, BD and EDA wrote the manuscript. MH, TC, AR, DA and LJ revised the manuscript. All authors commented on and approved the draft and final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The author(s) read and approved the final manuscript.

### Funding

None.

### Availability of data and materials

The European Data Protection Regulation (GDPR) provides a clear framework for international data transfers. Data transfers, especially outside the EU, must be assessed on a case-by-case basis in accordance with Article 45 of the GDPR. In accordance with this regulation, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

## Declarations

### Ethics approval and consent to participate

All the study and methods used were performed in accordance with relevant guidelines and regulations. The study was approved by the Research Ethics Committee of Paris Saclay University, Paris, France (Polethis) (CER-Paris-Saclay-2021-014) and the French data protection authority (Commission Nationale de l'informatique et des Libertés [CNIL]) (registration number: 2220726). Participation in this study was voluntary. An information note was placed on the platform at the beginning of the questionnaire. It mentioned that the response to the questionnaire was voluntary and anonymous and that the collected data would be statistically processed to study vaccine hesitancy and its determinants, in accordance with the French regulations. All participants had to read the information note before answering the questionnaire. By clicking to participate to the questionnaire, they gave us their individual informed consent. Informed consent was obtained from all the participants.

### Consent for publication

Not applicable.

### Competing interests

The authors declare that they have no competing interests.

### Author details

¹Faculty of Health Sciences Simone Veil, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France. ²Hospital Department of Epidemiology and Public Health, Raymond Poincaré Hospital, GHU University of Paris Saclay, Assistance Publique – Hôpitaux de Paris, Garches, France. ³Inserm U1018, CESP, Primary Care and Prevention team, University of Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France. ⁴Infectious diseases Department, Raymond Poincaré Hospital, GHU University of Paris Saclay, Assistance Publique – Hôpitaux de Paris, Garches, France. ⁵Inserm U1018, CESP, Anti-Infective Evasion and Pharmaceutical Epidemiology team, University of Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France. ⁶Midwifery Department, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France. ⁷Department of Obstetrics and Gynecology, Poissy-Saint-Germain en Laye Hospital, Poissy, France. ⁸Inserm U1018, CESP, Clinical Epidemiology team, University of Paris Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France. ⁹FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), RHU RECORDS (Rapid rRecognition of CORticosteroID resistant or sensitive Sepsis), Department of Intensive Care, Hôpital Raymond Poincaré (AP-HP), Laboratory of Infection & Inflammation - U1173, University Versailles Saint Quentin - University Paris Saclay, INSERM, 92380 Garches, France.

Received: 23 November 2021 Accepted: 29 March 2022

Published online: 20 April 2022

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