Gradient of vaccine hesitancy among French men having sex with men: An electronic cross-sectional survey in 2022

Figures & data

Table 1. Algorithms and threshold scores used to construct the VH variables.

		Perceived disease severity	Perceived fear of infection	Perceived vaccine effectiveness	Perceived vaccine risk
No VH (Disease perceived as serious OR worrisome) AND (vaccine perceived as effective AND safe)		Score >5/10	Score >5/10	Score >5/10	Score <5/10
Moderate VH	Complacency (Disease perceived as not serious AND not worrisome) AND vaccine perceived as safe – regardless of its effectiveness^a	Score ≤5/10	Score ≤5/10	–	Score <5/10
	Lack of confidence in vaccine (Disease perceived as serious OR worrisome) AND (vaccine perceived as ineffective OR unsafe)	Score >5/10	Score >5/10	Score ≤5/10	Score ≥5/10
High VH (Disease perceived as not serious AND not worrisome), AND vaccine perceived as unsafe – regardless of its effectiveness^b		Score ≤5/10	Score ≤5/10	–	Score ≥5/10

^aWe assumed that participants who consider the vaccine as safe, but the disease as neither serious nor worrisome will choose not to be vaccinated, regardless of the vaccine’s effectiveness.

^bWe assumed that participants who consider the vaccine dangerous will choose not to be vaccinated, regardless of the vaccine’s effectiveness.

VH = vaccine hesitancy.

Table 2. Sociodemographic characteristics of study participants (2022 French National MSM survey, N = 3 730).

	Finally included
	N	%
Age (quartiles)
18–29	953	25.6
30–38	873	23.4
39–49	992	26.6
50–84	912	24.5
What is your current gender?
Male	3652	97.9
Trans male (FtM/FT)	14	0.4
Genderqueer/nonbinary	55	1.5
Other	9	0.2
French area of residence (2 missing values)
Ile-de-France	1185	31.8
Northwest	515	13.8
Northeast	599	16.1
Southwest	606	16.3
Southeast and Corsica	788	21.1
Overseas	35	0.9
Educational level
Did not pass “baccalaureate”^a exam at end of high school or lower	403	10.8
Passed “baccalaureate” at end of high school	454	12.2
2 to 4 years of higher education	1512	40.5
Master’s degree or higher	1361	36.5
Employment status
Employed	2907	77.9
Unemployed	178	4.8
Not in the labor force^b	645	17.3
Currently, you are financially …
Comfortable or ok	2612	70.0
Barely managing or in difficulty or in debt	1118	30.0
Complementary health insurance^c
No or don’t know	235	6.3
Yes	3495	93.7
Self-reported vaccine uptake^d
Against hepatitis B virus (HBV)	2845	76.3
Against hepatitis A virus (HAV)	1849	49.6
Against human papillomaviruses (HPV)	832	22.3^e

^aExam at the end of high school.

^bMostly students and retired people.

^cComplementary health insurance: not-for-profit companies that reimburse their members’ healthcare costs not covered by the compulsory insurance fund.

^dFor each vaccine, participants who did not know their vaccination status were recoded with the unvaccinated participants HBV: 7.3% (n = 268), HAV: 17.6% (n = 585), HPV: 8.4% (n = 313).

^eAmong participants aged under 32 (this age corresponds to MSM who were already eligible for vaccination in 2017, when it was first recommended to them), vaccination coverage against human papillomaviruses was 46.4% (n = 527/1135).

Table 3. Specific VH grades for the HBV, HAV, and HPV vaccines separately (2022 French National MSM survey, N = 3 730).

	N	%	95% CI
HBV specific VH
High VH	199	5.3	[4.6;6.0]
Moderate VH
Complacency	923	24.8	[23.4;26.2]
Lack of confidence in vaccine	1060	28.4	[27.0;29.8]
No VH	1548	41.5	[39.9;43.1]
HAV specific VH
High VH	250	6.7	[5.9;7.5]
Moderate VH
Complacency	1467	39.3	[37.7;40.9]
Lack of confidence in vaccine	869	23.3	[21.9;24.7]
No VH	1144	30.7	[29.2;32.2]
HPV specific VH
High VH	181	4.9	[4.2;5.6]
Moderate VH
Complacency	1159	31.1	[29.6;32.6]
Lack of confidence in vaccine	1315	35.3	[33.8;36.8]
No VH	1075	28.8	[27.3;30.3]

VH = vaccine hesitancy; HBV = hepatitis B virus; HAV = hepatitis A virus; HPV = human papillomaviruses; 95% CI = 95% confidence interval.

Table 4. Sociodemographic correlates of the prevalence of grades of specific and general vaccine hesitancy (multiple multinomial logistic regressions, 2022 French National MSM survey, N = 3,730^a).

	Specific VH grade (ref. No VH)		General VH grade (ref. No VH)
	Moderate	High	Unsure acceptors	Delayers	Refusers
	aOR [95%CI]
Age (quartiles) (ref. 18–29)
30–38	1.67 [1.27;2.21]	1.71 [1.15;2.53]	0.72 [0.53;0.97]	0.93 [0.66;1.32]	1.11 [0.88;1.40]
39–49	2.15 [1.61;2.88]	2.97 [2.02;4.38]	0.62 [0.46;0.83]	0.85 [0.60;1.20]	1.11 [0.88;1.39]
50–84	2.29 [1.72;3.06]	3.10 [2.11;4.55]	0.46 [0.34;0.63]	0.44 [0.30;0.64]	0.85 [0.68;1.06]
Employment status (ref. Employed)
Unemployed	1.24 [0.72;2.11]	1.33 [0.70;2.55]	1.15 [0.73;1.82]	1.25 [0.71;2.20]	1.26 [0.86;1.83]
Not in labor force^b	0.88 [0.67;1.15]	0.72 [0.49;1.06]	0.48 [0.35;0.66]	0.86 [0.60;1.23]	0.86 [0.68;1.07]
Educational level (ref. Did not pass “baccalaureate^c or lower)
Passed “Bac” at end of high school	0.63 [0.38;1.06]	0.68 [0.38;1.23]	1.15 [0.77;1.71]	0.72 [0.44;1.19]	0.98 [0.71;1.35]
2 to 4 years of higher education	0.52 [0.34;0.81]	0.40 [0.24;0.67]	0.69 [0.49;0.97]	0.66 [0.44;0.97]	0.71 [0.55;0.93]
Master’s degree or higher	0.41 [0.26;0.64]	0.27 [0.16;0.46]	0.49 [0.34;0.70]	0.53 [0.35;0.81]	0.58 [0.44;0.77]
Feels financially ok/comfortable (ref. No)
Yes	0.79 [0.62;0.999]	0.65 [0.48;0.88]	0.55 [0.44;0.70]	0.72 [0.55;0.95]	0.73 [0.62;0.87]
Complementary health insurance
Yes	0.73 [0.47;1.15]	0.68 [0.39;1.19]	0.52 [0.36;0.75]	1.10 [0.66;1.85]	1.19 [0.85;1.67]

^aAll analyses were adjusted for French geographic area of residence; 2 missing values for this variable.

^bMostly students and retired people.

^cExam at end of high school.

VH = vaccine hesitancy; aOR [95% CI] = adjusted odds-ratio [95% confidence interval].

Table 5. Association between grades of specific vaccine hesitancy^a and general vaccine hesitancy^b (2022 French National MSM survey, N = 3 730).

			Specific VH grade
	All		No VH (13%)	Moderate (74%)	High (13%)
	N = 3730	%	row %
General VH grade					***
No VH	1697	45.5	18.4	73.6	8.0
Unsure acceptor	1204	32.3	10.1	77.3	12.5
Delayer	329	8.8	11.6	71.7	16.7
Refuser	500	13.4	4.0	70.2	25.8

^aSpecific vaccine hesitancy: variable combining the three vaccine hesitancy variables for each of HBV, HAV, and HPV vaccines.

^bGeneral vaccine hesitancy: variable constructed to operationalize the definition of the WHO SAGE group.¹²

VH = vaccine hesitancy.

***P ≤ .001.

Table 6. Associations between self-reported HBV, HVA, and HPV vaccination uptake and vaccine hesitancy variables (multiple modified Poisson regressions^a, 2022 French National MSM survey, N = 3,730).

Self-reported vaccination against ... (ref. No)	HBV	HAV	HPV
		RR [95% CI]
Specific VH grade for at least one of the three vaccines of interest (ref. no VH)
Moderate	0.88 [0.85;0.92]	0.71 [0.66;0.76]	0.63 [0.56;0.71]
High	0.80 [0.75;0.86]	0.57 [0.50;0.65]	0.55 [0.45;0.69]
HBV-specific VH grade (ref. no VH)
Moderate	0.83 [0.80;0.86]
High	0.71 [0.63;0.80]
HAV-specific VH grade (ref. no VH)
Moderate		0.61 [0.57;0.65]
High		0.52 [0.44;0.62]
HPV-specific VH grade (ref. no VH)
Moderate			0.51 [0.46;0.57]
High			0.45 [0.31;0.64]
General VH (ref. No VH)
Unsure acceptor	0.97 [0.94;1.01]	0.91 [0.85;0.98]	0.87 [0.77;0.98]
Delayer	0.95 [0.89;1.02]	0.84 [0.75;0.95]	0.83 [0.68;1.00]
Refuser	0.83 [0.78;0.89]	0.75 [0.66;0.84]	0.64 [0.52;0.78]

^aAll models were run separately and adjusted for sociodemographic characteristics (age, geographic area of residence, employment status, education level, perceived financial situation, and complementary health insurance). 2 missing values for area of residence.

HBV = hepatitis B virus; HAV = hepatitis A virus; HPV = human papillomaviruses; RR [95% CI] = relative risk [95% confidence interval]; VH = vaccine hesitancy.

Table A1. Prevalence of grades of specific and general vaccine hesitancy and associations with sociodemographic characteristics (2022 National French MSM survey, N = 3 730).

			Specific VH grade			General VH grade
	All		No VH (13%)	Moderate (74%)	High (13%)	No VH (46%)	Unsure acceptor (32%)	Delayer (9%)	Refuser (13%)
	N = 3730	%	row %
Age (quartiles)					***				***
18–29	953	25.6	20.2	70.1	9.8	43.0	29.6	10.3	17.1
30–38	873	23.4	13.3	75.7	11.0	43.3	33.3	9.9	13.5
39–49	992	26.6	9.9	75.1	15.0	43.5	34.7	9.3	12.6
50–84	912	24.5	9.5	76.0	14.5	52.4	31.5	5.8	10.3
Geographic area of residence					-				***
Ile-de-France	1185	31.8	13.9	74.0	12.1	51.5	29.3	9.0	10.2
Northwestern France	515	13.8	12.6	76.5	11.0	45.1	33.0	7.2	14.8
Northeastern France	599	16.1	12.7	73.0	14.4	41.4	36.2	8.2	14.2
Southwest France	606	16.3	12.1	73.6	14.4	40.1	34.2	10.4	15.4
Southeastern France	788	21.1	13.8	74.1	12.1	44.7	32.0	8.5	14.9
Overseas	35	0.9	14.3	77.1	8.6	31.4	31.4	17.1	20.0
Employment status					**				**
Employed	2907	77.9	12.5	74.5	13.0	45.4	32.4	8.6	13.6
Unemployed	178	4.8	9.6	74.7	15.7	33.7	36.0	10.1	20.2
Not in labor force	645	17.3	17.4	72.6	10.1	49.0	30.9	9.3	10.9
Educational level					***				***
Did not pass “Baccalaureate”^a exam at the end of high school or lower	403	10.8	6.2	76.4	17.4	34.7	37.5	10.7	17.1
Passed “Bac” at the end of high school	454	12.2	10.1	72.9	17.0	35.5	36.6	7.9	20.0
2 to 4 years of post-secondary education	1512	40.5	13.0	74.8	12.2	45.1	32.4	9.0	13.5
Master’s degree or higher	1361	36.5	16.6	73.3	10.1	52.5	29.2	8.4	10.0
Currently, you are financially …					**				***
Comfortable/OK	2612	70.0	14.2	74.1	11.7	49.2	31.1	8.4	11.3
Barely managing/in difficulty/in debt	1118	30.0	10.9	74.3	14.8	36.8	35.0	9.8	18.4
Complementary health insurance					-				***
Yes	3495	93.7	13.4	74.1	12.5	45.9	32.7	8.8	12.6
No or don’t know	235	6.3	10.2	75.7	14.0	39.6	26.4	8.5	25.5

^aExam at the end of high school.

VH = Vaccine hesitancy; HBV = hepatitis B virus; HAV = hepatitis A virus; HPV = human papillomaviruses.

- not significant *P ≤ .05 **P ≤ .01 ***P ≤ .001.

Table B1. Perceptions of HBV, HAV and HPV diseases and their vaccines, according to year and survey.

	2022 Vaccigay (n = 3,730)%	2016 Health Barometer (n = 15,216^a)%
Fear of being infected with HBV
No	68.3	–^b
Yes	31.7	–
HBV severe
No	32.6	7.8
Yes	67.5	92.2
HBV vaccine effective
No	25.0	24.8
Yes	75.0	75.2
HBV vaccine unsafe
No	79.9	41.6
Yes	20.1	58.4
Fear of being infected with HAV
No	75.9	–
Yes	24.1	–
HAV severe
No	48.9	–
Yes	51.1	–
HAV vaccine effective
No	35.9
Yes	64.1
HAV vaccine unsafe
No	84.1
Yes	15.9
Fear of being infected with HPV
No	53.4	–
Yes	46.6	–
HPV severe
No	43.5	6.2
Yes	56.5	93.8
HPV vaccine effective
No	46.3	27.7
Yes	53.8	72.3
HPV vaccine unsafe
No	82.3	46.0
Yes	17.7	54.0

^aQuestions relative to HPV were only asked of women aged 15–25 or parents of girls aged 11–19, who had heard about the vaccine (n = 2168). Data are weighted to be representative of the French population in the Health Barometer. Items were dichotomized at the middle of the scale (>5 on the Vaccigay 0–10 scale, >2.5 on the Health Barometer 1–4 scale). “Don’t know” answers were recoded at 2.5 on the 1–4 scale in the Health Barometer survey, while they were recoded according to their correlations with other answers on the 0–10 scale in the Vaccigay survey.

^bItems not present in the 2016 Health Barometer.

HBV = hepatitis B virus; HAV = hepatitis A virus; HPV = human papillomaviruses.

MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015 Aug;33(34):4161–4. doi:10.1016/j.vaccine.2015.04.036.

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