Bulgarian general population attitude to mandatory COVID-19 vaccination: A nationwide cross-sectional study

Background: The issue of mandatory COVID-19 vaccination, entwined with citizens' rights and autonomy, impacts vaccine uptake and trust in health authorities. This study centers on Bulgaria, aiming to uncover attitudes towards obligatory COVID-19 vaccination. Methods: Employing an online questionnaire, we conducted a cross-sectional survey involving 1433 adults in Bulgaria between April and May 2022. Analysis of responses from 1200 participants illuminated perspectives on mandatory COVID-19 vaccination.Results: Among respondents, 38.6% supported or were uncertain about mandatory vaccination, while 61.4% opposed it. Binary logistic regression, utilizing demographic predictors, unveiled that younger age groups, particularly those aged 18-25, demonstrated diminished odds of supporting mandatory vaccination. Those with apprehensions about contracting the virus (OR 2.98, 95% CI 1.65-5.39), perceiving minimal vaccine risks (OR 3.86, 95% CI 1.80-8.26), acknowledging vaccine benefits for health protection (OR 3.86, 95% CI 1.80-8.26), and pandemic containment (OR 3.34, 95% CI 1.16-9.60) were more prone to endorse mandatory vaccination. Trust in general practitioners and pharmaceutical companies also emerged as influential factors.Conclusion: The study portrays a diverse sentiment within Bulgaria's population concerning compulsory COVID-19 vaccination. It underscores the importance of conveying accurate, evidence-based information while up -holding individual autonomy. National health authorities should harmonize methodical vaccination initiatives with health promotion interventions targeted at the general population and healthcare professionals. Such an approach can facilitate well-informed choices and contribute to public health objectives.