{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:06:09Z","timestamp":1785434769876,"version":"3.56.0"},"reference-count":14,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portuguese National Association of Pharmacies"},{"id":[{"id":"https:\/\/ror.org\/03vppr867","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background\/Objectives: Vaccine hesitancy is a complex and growing phenomenon worldwide, posing a serious threat to public health achievement in disease control and prevention. This study aimed to assess willingness to uptake and factors linked to shifts between different categories of willingness and uptake regarding the COVID-19 and influenza vaccines. Methods: Prospective cohort study with a representative sample of 1400 individuals aged \u226560 years residing in mainland Portugal, randomly selected. Two telephone surveys were conducted: one at the start of the 2023\/2024 vaccination campaign, assessing patients\u2019 characteristics and willingness for vaccination (using an 11-point Likert scale), and another at the end, assessing vaccination status and reasons for uptake\/non-uptake. Results: Shifts were observed among both acceptance and refusal groups\u201412.93% of the individuals within these categories shifted to an opposite decision. Hesitancy presents divergent attitudes: for the COVID-19 vaccine, 56.50% declined vaccination, while for the influenza vaccine, non-uptake was only 30.60%. Age, presence of chronic disease, level of education, household dimension, and previous uptake of booster doses are significantly associated with shifting attitudes, playing different roles for each category of willingness and uptake outcome. For the acceptance category, non-uptake relates to confidence factors. For hesitancy, non-uptake is mainly due to complacency. For refusal, the decision is influenced by all domains. Conclusions: Vaccine hesitancy remains an important public health concern in the Portuguese population and appears to differ between COVID-19 and influenza vaccination. Attitudes toward COVID-19 and influenza vaccines can vary in all directions over a short period. Acceptance does not guarantee uptake, and refusal can shift towards uptake. These findings highlight the importance of reinforcing public health strategies and interventions for uptake across a population, taking into consideration the specificities of each willingness group.<\/jats:p>","DOI":"10.3390\/vaccines14070555","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"555","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shifting Attitudes from Willingness to Uptake in COVID-19 and Influenza Vaccination\u2014Associated Factors and Reported Reasons"],"prefix":"10.3390","volume":"14","author":[{"given":"Sara","family":"Moura","sequence":"first","affiliation":[{"name":"Oeste Local Health Unit, Torres Vedras, Portugal"},{"name":"NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8161-9264","authenticated-orcid":false,"given":"Ant\u00f3nio Teixeira","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Cientis, Lisbon, Portugal"},{"name":"National Association of Pharmacies (ANF), Lisbon, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal"},{"name":"ICVS\/3B\u2019s-PT Government Associate Laboratory, Braga\/Guimar\u00e3es, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-0996","authenticated-orcid":false,"given":"S\u00f3nia","family":"Romano","sequence":"additional","affiliation":[{"name":"Cientis, Lisbon, Portugal"},{"name":"National Association of Pharmacies (ANF), Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Oeste Local Health Unit, Torres Vedras, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0690-4484","authenticated-orcid":false,"given":"Jos\u00e9","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Cientis, Lisbon, Portugal"},{"name":"National Association of Pharmacies (ANF), Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4087-375X","authenticated-orcid":false,"given":"Ema","family":"Paulino","sequence":"additional","affiliation":[{"name":"National Association of Pharmacies (ANF), Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1390-2076","authenticated-orcid":false,"given":"Andr\u00e9","family":"Peralta-Santos","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Dire\u00e7\u00e3o-Geral da Sa\u00fade, Alameda D. Afonso Henriques, 45, 1049-005 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","unstructured":"WHO (2023, December 11). Vaccines and Immunization. Available online: https:\/\/www.who.int\/health-topics\/vaccines-and-immunization#tab=tab_1."},{"key":"ref_2","unstructured":"World Health Organization (2014). SAGE Working Group on Vaccine Hesitancy. Report of the SAGE Working Group on Vaccine Hesitancy, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.4161\/hv.24657","article-title":"Vaccine hesitancy","volume":"9","author":"Laberge","year":"2013","journal-title":"Hum. Vaccin Immunother."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kumar, S., Shah, Z., and Garfield, S. (2022). Causes of Vaccine Hesitancy in Adults for the Influenza and COVID-19 Vaccines: A Systematic Literature Review. Vaccines, 10.","DOI":"10.3390\/vaccines10091518"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pinto de Carvalho, C., Ribeiro, M., Godinho Sim\u00f5es, D., Pita Ferreira, P., Azevedo, L., Gon\u00e7alves-S\u00e1, J., Mesquita, S., Gon\u00e7alves, L., Leite, P.P., and Peralta-Santos, A. (2024). Spatial Analysis of Determinants of COVID-19 Vaccine Hesitancy in Portugal. Vaccines, 12.","DOI":"10.3390\/vaccines12020119"},{"key":"ref_6","unstructured":"Santos, A., Kislaya, I., Machado, A., and Matias Dias, C. (2023). Reasons for non-adherence to taking the influenza vaccine in the 2020\/2021 season in the Portuguese population aged 65 and over. Obs.\u2014Bol. Epidemiol. 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Dire\u00e7\u00e3o-Geral da Sa\u00fade (2026, April 23). Relat\u00f3rio n.\u00ba 28 da Vacina\u00e7\u00e3o Sazonal 2025\/2026, 07\/04\/2026, Available online: https:\/\/www.dgs.pt\/em-destaque\/relatorio-n-28-da-vacinacao-sazonal-20252026-pdf.aspx."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/555\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:05:35Z","timestamp":1782371135000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["vaccines14070555"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14070555","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}