This master thesis is focused on decreasing levels of vaccination as a new health risk. In recent years it has become a new trend that we can observe in European countries. Low vaccination levels amongst population are one of the reasons for new epidemics or pandemics happening. When immunization rises above 95 % then a collective immunization comes into effect. Collective immunization lowers the chances of diseases spreading. For this reason, World health organization supports immunization and tries to make immunization affordable reachable for everyone everywhere. This these analyses measles which can be stopped by vaccinating the population. Therefore, the World health organization prepares strategic plans aimed at eradication of this disease. Each member state has a task to apply these plans in their specific environment. This thesis focuses on the Czech Republic and its implementation of strategic plans happening 2005-2010 and 2011-2020. This thesis is structured into 5 chapters focused on theory of international relations, hesitancy to vaccinate, strategic plans of World health organization and the Czech Republic.

Background: In the second year of the COVID-19 pandemic, highly effective and safe vaccines became available. Since patients with rheumatic diseases show increased susceptibility to infections and typical medications raise the risk of severe COVID-19, high vaccination coverage is of significant importance to these patients. Methods: Consecutive patients with different rheumatic diseases were asked for their vaccination status regarding COVID-19, influenza and Streptococcus pneumoniae during their routine consultations. Any reported vaccination was validated with their personal vaccination card and/or by reviewing the CovPass smartphone app. Reasons for not having a COVID-19 vaccination were documented. Results: A total of 201 patients (mean age 62.3 ± 14.1 years) were included, the majority of them (44.3%) with rheumatoid arthritis, followed by spondyloarthritis (27.4%) and connective tissue diseases (21.4%). Vaccination coverage for SARS-CoV-2 was 80.1%; 85.6% got at least the first vaccination shot. Both valid influenza and pneumococcus coverage were associated with a higher probability of SARS-CoV-2 vaccination (odds ratio (OR) 6.243, 95% confidence interval (CI) 2.637–14.783, p < 0.0001 and OR 6.372, 95% CI 2.105–19.282, p = 0.0003, respectively). The main reason for a missing SARS-CoV-2 vaccination (70%) was being sceptical about the vaccine itself (i.e., the subjective impression that the vaccine was not properly tested and fear of unwanted side effects). Conclusions: Vaccination coverage against SARS-CoV-2 is high in patients with rheumatic diseases. Nevertheless, there are unmet needs regarding vaccination education to further increase vaccination rates.

I början av 2020 drabbar covid-19-pandemin världens befolkning. Den livsfarliga smittan sprids snabbt världen över och forskare och läkemedelsbolag börjar arbeta intensivt för att utveckla ett vaccin som kan stoppa sjukdomens framfart. Knappt ett år senare godkänns världens första vaccin mot covid-19 och massvaccinering inleds. Världens politiker, forskare, epidemiologer och läkare påtalar otaliga gånger att vaccinet är lösningen på pandemin och vikten av att alla som kan ska tacka ja till erbjudandet om att vaccinera sig. Vaccinationsviljan världen över är generellt sett god, men det är också många människor som väljer att inte ta vaccinet och vaccinationsgraden varierar på internationell-, nationell- och lokal nivå. Syftet med den här uppsatsen är att undersöka om det finns lokala förhållanden som påverkar vacci­nat­ions­graden mot covid-19 i Sveriges kommuner under pandemin och om kommunernas verkliga vacci­nationsgrad avviker från vad som kan förväntas utifrån de lokala förhållandena. Baserat på tidigare studier och teori skapas och testas hypoteser genom att använda linjär regression för att skapa modeller som beskriver förväntad vaccinationsgrad. Studien undersöker sambandet mellan vaccinat­ions­grad och variabler som beskriver könsfördelningen i kommunerna, andel utrikesfödda, befolk­ningens ålder, utbildnings-, inkomst-, och hälsonivå, andel arbetslöshet, valdeltagande och befolk­ningens partisym­pa­tier.  De viktigaste resultaten är att faktorerna andel kvinnor, utrikesfödda, arbetslöshet och hälsonivå korre­lerar negativt med vaccinationsgrad, och faktorerna ålder, utbildningsnivå och valdeltagande korrelerar positivt. I univariat analys förklarar variabeln utrikesfödda 78 procent av skillnaden i vaccinationsgrad mellan kommunerna och valdeltagande förklarar 57 procent av skillnaden. Resultatet i riksdagsvalet 2018 på kommunnivå kan delvis förklara skillnaden i vaccinationsgrad mellan Sveriges kommuner. Utmärkande vid undersökningen av befolkningens partisympatier är att univariat analys med Center­partiet som oberoende variabel enskilt förklarar över 20 procent av skillnaden i vaccinationsgrad.  Baserat på regressionsmodeller beräknas varje kommuns förväntade vaccinationsgrad, vilken jämförs med den verkliga vaccinationsgraden. Haparanda och Ljungby kommun avviker mest positivt respek­tive negativt från sitt förväntade värde (+10,42 procent och -6,10 procent). En möjlig förklaring till kommunernas stora avvikelser är deras geografiska läge och dess påverkan på befolkningens behov av att resa till utlandet. Alla kommuner i Uppsala län har en högre vaccinationsgrad än förväntat, medan alla kommuner i Blekinge län har en lägre vaccinationsgrad än förväntat. En möjlig förklaring är att det beror på länens olika vaccinationsstrategier. / In early 2020, the covid-19 pandemic hit the world. The deadly infection spread rapidly, and researchers and pharmaceutical companies worked intensively to develop a vaccine which could stop the progres­sion of the disease. Barely a year later, the world’s first vaccine against covid-19 is approved and mass vaccination begins. The world’s politicians, researchers, epidemiologists, and medical personnel point out countless times that the vaccine is the solution to the pandemic and the importance of getting vac­cinated. In general, the willingness to get vaccinated is high, but there are also many people who choose not to take the vaccine and the degree of vaccination varies at international, national, and local level. This study aims to investigate whether local conditions affect the vaccination rate against covid-19 in Swedish municipalities during the pandemic, and whether municipalities’ actual vaccination rate devi­ates from what can be expected based on these local conditions. Based on previous studies and theory, hypotheses are created and tested by using linear regression to create models that describe the expected degree of vaccination. The study examines the relationship between vaccination rate and variables that describe gender distribution in the municipalities, proportion of foreign-born, age of population, level of education, income and health, proportion of unemployment, turnout, and the population’s party sym­pathies. The main findings are that the factors proportion of women, foreign-born, unemployment and health level negatively correlate with vaccination rate, and the factors age, level of education and turnout cor­relate positively. In univariate analysis, the variable foreign-born explains 78 percent of the differ­ence in vaccination rate among the municipalities, and turnout explains 57 percent of the difference. The result of the 2018 parliamentary elections at municipal level can partly explain the difference in vac­cination rate between Sweden’s municipalities. Notable when examining the population’s party sym­pathies is that univariate analysis with Centerpartiet as an independent variable individually explains over 20 percent of the difference in vaccination rate. Each municipality’s expected vaccination rate is calculated and compared to the actual vaccination rate based on regression models. The municipalities of Haparanda and Ljungby deviate most from their expected value (+10.42 percent and -6.10 percent). A possible explanation for the municipalities’ large deviations is their geographical location and its impact on the population’s need to travel abroad. All municipalities of Uppsala County have a higher vaccination rate than expected, while all municipalities of Blekinge County have a lower vaccination rate than expected. One possible explanation is that it depends on the counties’ different vaccination strategies.