BACKGROUND: COVID-19 vaccine hesitancy (CVH) has become a critical public health issue, with attitudes toward vaccines emerging as a broader social issue. Public debates surrounding vaccines have expanded beyond health considerations to include issues of trust, misinformation, and societal values, making CVH a complex challenge that requires multifaceted solutions. Analyzing the various determinants of CVH is crucial for developing targeted strategies to improve vaccine acceptance in specific countries and to better prepare for future public health crises. However, no study to date has evaluated the determinants of CVH in a representative sample of the Czech population. METHODS: A multiple hierarchical logistic regression was used to analyze the associations between various sociodemographic, trust and attitudinal factors with COVID-19 vaccine acceptance (CVA). The analysis utilized survey data from a representative longitudinal sample of the Czech population (N = 1,407). RESULTS: After controlling for all other factors, trust in official statements from the Ministry of Health was the strongest predictor of CVA, followed by prior positive attitudes toward COVID-19 vaccination (prior to vaccine availability) and older age. Lower trust in COVID-19 misinformation also predicted CVA, while lower interest in COVID-19 media content was associated with CVA. Higher income initially predicted CVA but lost statistical significance after controlling for other variables. Interestingly, education did not play a role in CVA. CONCLUSION: CVH was primarily driven by distrust in government-provided information. Notably, vaccine refusers demonstrated a higher motivation to seek information on the topic, offering a promising opportunity for health policy interventions. Our findings suggest that strategies to reduce CVH should prioritize building trust in state institutions and effectively combating misinformation.

• Keywords
• COVID-19, Misinformation, Trust in institutions, Vaccine acceptance, Vaccine hesitancy,
• MeSH
• COVID-19 * prevention & control   MeSH
• Adult MeSH
• Trust * psychology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Adolescent MeSH
• Young Adult MeSH
• Vaccination Hesitancy * psychology   statistics & numerical data   MeSH
• Patient Acceptance of Health Care * psychology   MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• COVID-19 Vaccines * administration & dosage   MeSH
• Health Knowledge, Attitudes, Practice MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH
• Names of Substances
• COVID-19 Vaccines * MeSH