LAUSR

Background COVID-19 vaccination for general population started on April 12, 2021, in Osaka, Japan. We investigated public attitudes toward vaccination and associated factors of vaccine hesitancy during the third state of emergency. Methods An internet-based, self-reported, cross-sectional survey was conducted in June 2021, using the smartphone health app for residents of Osaka aged ≥18 years. Respondents were asked about their attitudes toward COVID-19 vaccine. Responses “Don’t want to receive vaccines” or “Don’t know” were defined as vaccine hesitancy (vs. “Received [1st dose]”, “Received [2nd dose]”, or “Want to receive vaccines”). Multivariable Poisson regression analysis was conducted to examine the associations between hesitancy and population characteristics. Results 23,214 individuals (8,482 men & 14,732 women) were included in the analysis. Proportions that answered “Received (1st dose)”, “Received (2nd dose)”, “Want to receive vaccines”, “Don’t want to receive vaccines”, “Don’t know”, and “Don’t want to answer” were 14.6%, 3.8%, 70.6%, 4.3%, 6.1%, and 0.5% among men; and 11.3%, 6.0%, 64.9%, 6.2%, 11.0%, and 0.6% among women. Factors associated with vaccine hesitancy included being a woman (aPR = 1.33; 95%CI = 1.23–1.44), age 18–39 (aPR = 7.00; 95%CI = 6.01–8.17) and 40–64 years (aPR = 4.25; 95%CI = 3.71–4.88 vs. 65+ years), living alone (aPR = 1.19; 95%CI = 1.08–1.30 vs. living with 3+ members), non-full-time employment and unemployment (aPRs ranged 1.12 to 1.49 vs. full-time employment), cardiovascular diseases/hypertension (aPR = 0.72; 95%CI = 0.65–0.81), and pregnancy (women of reproductive age only) (aPR = 1.35; 95%CI = 1.03–1.76). Conclusions Most respondents expressed favorable attitudes toward COVID-19 vaccination while hesitancy was disproportionately high in certain populations. Efforts are needed to ensure accessible vaccine information resources and healthcare services.