Abstract

Global COVID-19 booster vaccination uptake has been low, particularly in low-middle-income countries (LMICs). However, studies on the determinants of COVID-19 booster vaccination remain limited, especially in LMIC settings. This study aims to describe the determinants of COVID-19 booster vaccination uptake in an LMIC context. We analyzed data from a crosssectional survey that was conducted in September 2022 in four provinces in Indonesia. Participants (n=2,223) were recruited using multiple-stage cluster sampling. Multivariable logistic regression analysis was used to identify factors associated with booster vaccination status. The proportion of COVID-19 booster vaccination among fully vaccinated adults was 29.5%, while fear of transmission (12.4%) and perceived risk of getting a COVID-19 infection (33.5%) were low. Multivariable analysis showed that people living on Java Island (aOR: 2.45, 95% CI: 1.87-3.24), living in the urban area (aOR: 2.04, 95% CI: 1.60-2.61), being an employee in the formal sector (aOR: 3.99, 95% CI: 1.93 – 8.58), experiencing a side effect from previous vaccination (aOR: 1.71, 95% CI: 1.40-2.09), having a history of SARS-COV2 infection (aOR: 2.10, 95%CI: 1.27-3.50), having perception on the upcoming new wave of COVID-19 (aOR: 1.37, 95% CI: 1.07 -1.76), and believing the pandemic has not ended (aOR: 1.29, 95% CI: 1.01, 1.64) were associated with booster shot uptake. Low educational level (aOR: 0.6, 95% CI: 0.39-0.93) inhibited booster vaccination uptake. Current booster dose coverage was considerably lower than the primary vaccination dosage. The low booster vaccination uptake in four provinces was associated with a belief the pandemic has no longer, which might hinder the catch up of wide-population target coverage and COVID-19 control for reduced disease severity and hospitalization. Thus, efforts need to be prioritized in reaching the COVID-19 vulnerable population, which includes elderly and those with comorbidities.