Vaccine hesitancy remains a significant public health challenge, particularly during pandemics when high immunization rates are crucial. While individual psychological antecedents of vaccine hesitancy have been extensively studied, limited empirical evidence exists on how contextual determinants, such as socioeconomic status, political trust, and digital literacy, collectively shape vaccine-related behaviors, particularly in Central European populations. This study explores the key determinants of COVID-19 vaccine hesitancy among Czech adults. A cross-sectional study was conducted using data from the 48th wave of the Czech national panel survey Život během pandemie [Life During Pandemic], carried out in March 2023. The data were obtained via an online questionnaire administered to a nationally representative sample of Czech adults (n = 1,708). Sociodemographic, socioeconomic, and anamnestic variables were examined alongside political attitudes. Psychological antecedents of vaccination were assessed using the 5C model (confidence, complacency, constraints, risk calculation, and collective responsibility), and digital vaccine literacy was measured using seven items covering trust in official sources, trust in social media, and the ability to evaluate and apply vaccine information. Statistical analyses included bivariate tests and multivariable regression models to identify vaccine uptake and intent determinants. Higher trust in constitutional institutions, including the president (OR = 1.55; 95/ CI: 1.38-1.74), government (1.60; 1.38-1.85), Chamber of Deputies (1.73; 1.48-2.02), and Senate (1.47; 1.29-1.69), was significantly associated with higher vaccine uptake. Similarly, positive attitudes toward the integration of Ukrainian refugees into Czech society - across domains such as work (1.63; 1.39-1.90), housing (1.59; 1.36-1.86), school (1.64; 1.41-1.92), language (1.57; 1.34-1.84), and culture (1.74; 1.50-2.03) - were positively associated with uptake. Greater confidence in vaccine safety and effectiveness was also a significant predictor (1.51; 1.44-1.58). In contrast, lower education (0.64; 0.56-0.73), lower income (0.91; 0.86-0.95), female sex (0.60; 0.47-0.76), and higher complacency (0.76; 0.73-0.80) were associated with reduced uptake. Respondents with better digital vaccine literacy, particularly those more adept at identifying misinformation, showed significantly greater vaccine confidence (mean score: 3.62 vs. 3.30, p < .001). Beyond psychological antecedents, institutional trust, political orientation, and digital vaccine literacy significantly shape COVID-19 vaccination behaviors. These findings underscore the importance of targeted interventions that address political and digital influences on vaccine hesitancy, and they highlight the need for future research to examine the causal pathways and longitudinal dynamics underlying these associations, particularly within Central and Eastern European contexts.

• Keywords
• COVID-19, Czech Republic, refugees, social determinants of health, vaccination hesitancy,
• MeSH
• COVID-19 * prevention & control   psychology   MeSH
• Adult MeSH
• Trust * psychology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Vaccination Hesitancy * psychology   statistics & numerical data   MeSH
• Politics MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Social Media MeSH
• Socioeconomic Factors MeSH
• Vaccination * psychology   MeSH
• COVID-19 Vaccines * administration & dosage   MeSH
• Health Literacy * 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 epidemiology   MeSH
• Names of Substances
• COVID-19 Vaccines * MeSH