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OR I G I N A L P A P E R

Should vaccination be mandated? Individuals' perceptions on mandatory vaccination in Greece

Theodoros V. Giannouchos PhD, MS1,2 | Evaggelia Steletou MD3 |

Maria Saridi PhD4 | Kyriakos Souliotis PhD4,5

1Pharmacotherapy Outcomes Research

Center, College of Pharmacy, University of

Utah, Salt Lake City, Utah

2Laboratory of Health Economics &

Management, Economics Department,

University of Piraeus, Piraeus, Greece

3University Regional General Hospital of

Patras, University of Patras, Patras, Greece

4Department of Social and Education Policy,

University of Peloponnese, Corinth, Greece

5Health Policy Institute, Athens, Greece

Correspondence

Theodoros V. Giannouchos, PhD, MS,

Pharmacotherapy Outcomes Research Center,

College of Pharmacy, University of Utah, 30

South 2000 East, Salt Lake City, UT 84112,

USA.

Email: [email protected]

Abstract

Objectives: The aim of this study was to explore factors that influence individuals'

attitudes towards mandatory vaccination in Greece.

Methods: A nationally representative cross-sectional telephone survey was con-

ducted via a random multistage selection process in October 2019 in Greece. The

survey was designed to obtain information about whether vaccination should be

mandated or not among adults 18 years of age or older. A multivariable logistic

regression model was used to estimate the association between individuals'

sociodemographic, contextual and clinical characteristics, utilization, satisfaction, and

trust in the healthcare system and providers and their preference over mandatory

vaccination.

Results: A total of 901 participants fully completed the survey (response rate 90%-

901/1001). About 85% of the respondents supported mandatory vaccination. Indi-

viduals who used preventive services more often compared to those who never or

rarely used such, those who reported increased trust in official healthcare authorities'

guidelines and recommendations compared to those who reported no trust and those

who had underage children living in the household were significantly more likely to

support mandatory vaccination. No differences were observed for sociodemographic

factors and mandatory vaccination support.

Conclusion: This survey revealed that most Greek citizens support mandatory vacci-

nation, which was critically affected by the utilization of preventive services and trust

in healthcare authorities. Our results suggest that healthcare policy interventions

should promote mandatory vaccination through multi-level initiatives to improve

healthcare providers' and the general public's understanding of the value of

vaccination.

K E YWORD S

disease prevention, hesitancy, infectious diseases, patient preferences, public health, vaccination

1 | INTRODUCTION

Vaccination is widely recognized as one of the most cost-effective

medical interventions that has historically reduced and even

eradicated the incidence of many preventable infectious diseases

protecting millions of people.1-3 Despite the wide recognition of the

health, economic, and societal benefits of mass vaccination, large vari-

ation and gaps continue to exist in vaccination policies and uptake

Received: 22 December 2020 Revised: 8 March 2021 Accepted: 12 March 2021

DOI: 10.1111/jep.13568

1104 © 2021 John Wiley & Sons Ltd. J Eval Clin Pract. 2021;27:1104–1111.wileyonlinelibrary.com/journal/jep

rates across countries, thus raising the risk of exposure and transmis-

sion of preventable infections.4

Efficacious vaccination requires high-rates of acceptance and

adherence to guidelines and recommendations by healthcare profes-

sionals and by the general population in particular.5 Globally, only a

small share of individuals perceives vaccines as not safe.6 However,

trust in vaccines varies across different countries. In France, Switzer-

land, Belgium, Gabon, Togo, Russia, and Austria more than 20% of the

general population were sceptical about vaccination safety.6

Vaccination rates in Greece are among the highest globally and

only a small share of Greek citizens questioned the effectiveness of

vaccination.6-8 Most vaccines for preventable diseases are covered by

the national health insurance system at no cost, thus enhancing access

to such services by eliminating financial barriers. As of March 2020,

vaccination for transmittable diseases is legally mandated in Greece,

however, some vaccines such as those for meningitis-B are still in the

discretion of individuals and are not reimbursed.9 Despite the high

vaccination uptake, evidence in Greece has revealed differential atti-

tudes and suboptimal completed vaccination rates even among

healthcare professionals.10-13 In addition, a large share of Greek citi-

zens perceives that vaccination is necessary only for children, thus

increasing the susceptibility of adults.14

The existing variability in vaccination even within countries

implies that there is a complex interplay of systemic and individual

factors influencing uptake.15,16 In recent years, vaccine hesitancy, the

refusal, delay or uncertainty about vaccines, has emerged as a term

and has received significant attention, with arguments about the

safety of vaccines focusing on the perceived risks of vaccines instead

of their well-documented benefits.15,17,18 Several factors influence

and have been associated with vaccine-hesitant behaviours, ranging

from socioeconomic characteristics, perceived susceptibility, cultural,

behavioural and emotional factors, to trust to healthcare systems,

governments and information sources.16,19-23

The most common source of vaccine information are

healthcare providers, and health information credibility stemming

from trustworthy providers as well as frequent interaction with the

healthcare system was found to positively influence vaccination

uptake.16,20,21,24,25 In recent years the Internet has emerged as an

important source of information on vaccines as well. However,

most of the available online vaccine information contains anti-

vaccine content, and vaccine myths and harms are especially preva-

lent on the Internet and social networking sites.26-29 In fact, the

use of the Internet as the primary source of healthcare information

was associated with questioning the information accuracy and

credibility of healthcare providers, professional organizations, and

governmental health departments and in turn with decreased vacci-

nation acceptance.5

The purpose of this study was to explore factors associated with

individuals' perspectives on mandatory vaccination in Greece. To our

knowledge, this is the first study to estimate how individuals' attitudes

towards the healthcare system and authorities influence mandatory

vaccination preference using the most recent data available for the

Greek population, beyond their sociodemographic, contextual and

clinical characteristics. As such, our findings can contribute to public

health planning in Greece.

2 | MATERIALS AND METHODS

2.1 | Data collection and study population

This study was a cross-sectional telephone survey conducted in

October 2019 in Greece to obtain information on attitudes towards

mandatory vaccination among Greek citizens, as part of a larger-scale

project on preferences for healthcare policy reforms. Criteria for par-

ticipation included being 18 years of age or older, residing perma-

nently in Greece and fluency in the Greek language since the survey

was conducted in Greek. The sample was randomly selected from the

National Telephone Company Directory, categorized based on the

National Census by region, municipality, and urbanization level and

stratified proportionately according to the 13 administrative regions

in the country. The survey was carried out by a commercial company

working in the field of demographic surveys and the process was

supported by the specialized software computer-assisted telephone

interviewing (CATI). Calls were made during both weekdays and

weekends, during morning and evening hours. In cases where individ-

uals did not pick up, at least 6 callbacks were made.

2.2 | Study variables

The outcome of interest was whether individuals supported man-

datory vaccination or not, defined as a dichotomous indicator

(0 = No, 1 = Yes). The question was phrased as “Do you believe that

vaccination should be mandatory or in the discretion of each

individual?”. Multiple independent variables were obtained to explore their

association with the outcome variable of the study. These included:

(a) sociodemographic and contextual characteristics, namely age, gen-

der, education, occupation, income, area of residence, and insurance

status, (b) health-related characteristics, namely self-reported health

and whether the respondent had any chronic condition, (c) whether

underage children resided currently in the household, (d) information

regarding trust and satisfaction with the healthcare system and utiliza-

tion of preventive healthcare services, which were obtained by asking

participants to respond to the three Likert-scale questions. All vari-

ables were measured as categorical or dichotomous.

2.3 | Statistical analysis

Descriptive analysis was initially conducted to present characteristics

of all study participants and preferences over mandatory vaccination

using percentage points. We then conducted bivariate analyses on all

independent variables stratified on whether respondents supported

mandatory vaccination or not. We tested for statistical differences in

GIANNOUCHOS ET AL. 1105

the stratified mandatory vaccination preference using Pearson χ2 test.

Finally, to estimate the association between respondents' characteris-

tics, their healthcare system attitudes and utilization patterns and

their opinion on whether vaccination should be mandated or not, a

multivariable logistic regression was used. We controlled for

unobserved time-invariant regional characteristics using geographic-

level fixed effects. Standard errors were clustered at the geographical

region of residence. A P-value <.05 was considered as statistically sig-

nificant. All statistical analyses were conducted using Stata (version

16.1; StataCorp, College Station, TX). The study was approved by the

Ethics Committee of the University of Peloponnese.

3 | RESULTS

A total of 1001 individuals were approached and participated in the

survey. Of those, 44 participants (4.4%) did not respond to the

question regarding mandatory vaccination while 56 (5.6%) did not

fully complete the survey. This resulted in 901 respondents, who

TABLE 1 Descriptive characteristics and information of all participants overall and stratified by mandatory vaccination support

Should vaccination be

mandated?

All

(n = 901)

No

(n = 148)

Yes

(n = 753) P-value

% 14.8 85.2

Gender (%) .020

Male 50.7 59.5 49.0

Female 49.3 40.5 51.0

Age groups (%) <.001

18 to 24 11.8 3.4 13.4

25 to 39 26.5 29.7 25.9

40 to 54 25.8 37.2 23.5

55 to 64 15.4 10.1 16.5

≥65 20.5 19.6 20.7

Education (%) .685

Elementary 7.9 8.8 7.7

High School 42.3 39.2 42.9

University 41.7 41.9 41.7

MSc/PhD 8.1 10.1 7.7

Occupation (%) <.001

Full-time 50.6 65.5 47.8

Retired 26.9 23.6 27.5

Other (student,

housewife)

15.3 6.8 17.0

Unemployed 7.2 4.1 7.7

Underage children living in

the household (%)

.443

No 75.9 78.4 75.4

Yes 24.1 21.6 24.6

Chronic conditions (at least

one) (%)

.033

No 56.9 64.9 55.4

Yes 43.1 35.1 44.6

Rural residence (%) .126

No 76.9 81.8 76.0

Yes 23.1 18.2 24.0

Income (%) .950

Very low 27.9 27.0 28.0

Low to average 18.5 19.6 18.3

Average 41.7 42.6 41.6

Higher than average 11.9 10.8 12.1

Uninsured (%) .216

No 95.3 97.3 95.0

Yes 4.7 2.7 5.0

Do you have private

insurance coverage? (%)

.484

No 86.0 87.8 85.7

Yes 14.0 12.2 14.3

TABLE 1 (Continued)

Should vaccination be

mandated?

All

(n = 901)

No

(n = 148)

Yes

(n = 753) P-value

Self-reported health (%) .528

Average 21.2 25.0 20.5

Bad/very bad 5.2 5.4 5.2

Good 46.2 41.2 47.1

Very good 27.4 28.4 27.2

Trust in official healthcare

authorities' guidelines

and recommendations

on healthcare issues (ie,

vaccination) (%)

<.001

No trust 9.1 20.3 6.9

Somewhat 19.3 31.8 16.9

Quite 42.2 31.0 44.3

A lot 29.4 16.9 31.9

How often do you use

healthcare preventive

services (ie, checkup)?

(%)

.002

Never/Rarely 26.5 38.5 24.2

Few times 33.3 32.4 33.4

Often 33.4 24.3 35.2

Very often 6.8 4.7 7.2

How satisfied are you with

the healthcare system?

(%)

.011

Not at all 22.0 26.7 21.3

Somewhat 47.4 54.0 46.0

Quite/Very satisfied 30.6 20.3 32.7

1106 GIANNOUCHOS ET AL.

comprised the final analytic sample for this study (response

rate 90.0%).

3.1 | Sociodemographic, contextual and health- related characteristics of participants

About half of the respondents were 25 to 54 years of age (52.3%),

employed full-time (50.6%) and reported average incomes (41.7%),

while gender was balanced (Table 1). About 42% had high-school level

education, while a similar share had university-level education. Under-

age children resided in about one-quarter (24.1%) of the respondents'

households. The majority had compulsory health insurance coverage

(95.3%), while 14.0% had additional private insurance coverage. Most

participants reported having good health status (46.2%), while 5.2%

perceived their health status as bad or very bad. Overall, 43.1% had at

least one existing chronic condition.

3.2 | Healthcare system satisfaction, trust to authorities and utilization of preventive healthcare services

Among all respondents, 47.4% were somewhat satisfied with the

healthcare system, 30.6% were satisfied or very satisfied, while 22.0%

were not satisfied at all. In terms of trust in official healthcare authori-

ties' guidelines and recommendations on healthcare issues such as

vaccination, 42.2% quite trusted authorities, 29.4% placed a lot of

trust in them, while 9.1% did not trust healthcare authorities at all.

About one-third (33.3%) utilized preventive healthcare services

(ie, check-ups) a few times every year and a similar proportion (33.4%)

reported that they used such services often. In contrast, 26.5% indi-

cated that they rarely or never used preventive services.

3.3 | Mandatory vaccination support

Table 1 also presents results of the stratified analysis by the differ-

ence in mandatory vaccination responses (Table 1). Overall, 85.2% of

participants supported mandatory vaccination. Individuals who

supported mandatory vaccination had higher shares of those who

trusted official healthcare authorities' guidelines and recommenda-

tions on healthcare issues such as vaccination (P < .001) (Figure 1A)

and those who used preventive healthcare services more often

(P = .002) (Figure 1B). Participants who were more satisfied with the

healthcare system were disproportionately higher represented in the

mandatory vaccination supporting group (P = .011) (Figure 1C). Simi-

larly, the mandatory vaccination supporters had higher percentages of

individuals with at least one chronic condition (P = .033), females

(P = .020), and those who were 18 to 24 years of age (P < .001), while

the opposite was observed for those employed full-time (P < .001).

3.4 | Determinants of mandatory vaccination support

The results of the multivariable logistic regression analysis are pres-

ented in Table 2. Compared to those who did not trust official

healthcare authorities' recommendation and guidelines on

healthcare issues, individuals who reported a lot or quite some trust

(A) (B) (C)

F IGURE 1 Percentages of participants by mandatory vaccination support (yes) or not (no) related to trust in official healthcare authorities' guidelines and recommendations on healthcare issues, frequency of preventive services utilization, and satisfaction with the healthcare system. A, Trust in official healthcare authorities guidelines and recommendations on healthcare issues (ie vaccination). B, How often do you use healthcare preventive services (ie checkup)? C, How satisfied are you with the healthcare system?

GIANNOUCHOS ET AL. 1107

in authorities were significantly more likely to support mandatory

vaccination (a lot: adjusted Odds Ratio - OR = 5.72, 95% Confi-

dence Intervals - CI = 2.82-11.62, P < .001; quite: OR = 4.57, 95%

CI = 2.40-8.67, P < .001). Participants who reported more frequent

use of preventive services were also more likely to support manda-

tory vaccination compared to those who never or rarely used such

services, particularly those who indicated that they utilize preven-

tive services often (OR = 2.24, 95% CI = 1.29-3.89, P = .004) or

very often (OR = 2.42, 95% CI = 1.02-5.78, P = .046). A similar

association was also observed for individuals who indicated that an

underage child resided in the household (OR = 1.84, 95% CI = 1.07-

3.16, P = .028) and for those who reported that their health status

was very good or good, although statistical significance was found

only for those with good self-reported health (OR = 1.89, 95%

CI = 1.14-3.14, P = .014). In contrast, participants who were

25 years of age or older were less likely to support mandatory vac-

cination, compared to those who 18 to 24 years old. We did not

observe any significant association between other independent

variables and mandatory vaccination in the multivariable analysis.

4 | DISCUSSION

The results of our study based on a random and nationally representa-

tive sample extend the current literature on preferences over manda-

tory vaccination in Greece and highlight the importance of

understanding the factors that influence individuals' attitudes towards

vaccination. These findings are critical to guide and tailor health-policy

interventions to address concerns, inform and support the rationale

for vaccination and improve uptake. However, it is imperative for

policymakers and authorities to first understand and identify popula-

tion subgroups that are more sceptical and hesitant towards vaccines.

TABLE 2 Multivariable logistic regression for mandatory vaccination support

Trust in official healthcare

authorities' guidelines and recommendations on healthcare issues (ie, vaccination) (Ref.: No trust) OR 95% CI P-value

Somewhat 1.65 0.88 - 3.12 .120

Quite 4.57 2.40 - 8.67 <.001

A lot 5.72 2.82 - 11.62 <.001

How often do you use

healthcare preventive

services (ie, checkup)?

(Ref.: Never/Rarely)

Few times 1.38 0.87 - 2.19 .170

Often 2.24 1.29 - 3.89 .004

Very often 2.42 1.02 - 5.78 .046

How satisfied are you with the

healthcare system? (Ref.:

Somewhat)

Not at all 1.13 0.70 - 1.83 .626

Quite/Very satisfied 1.61 0.95 - 2.75 .077

Underage children living in the

household (Ref.: No)

Yes 1.84 1.07 - 3.16 .028

Age groups (Ref.: 18 to 24)

25 to 39 0.23 0.08 - 0.67 .007

40 to 54 0.14 0.05 - 0.38 <.001

55 to 64 0.44 0.14 - 1.42 .169

≥65 0.22 0.06 - 0.73 .014

Self-reported health (Ref.:

Average)

Bad/very bad 1.17 0.43 - 3.19 .755

Good 1.89 1.14 - 3.14 .014

Very good 1.61 0.86 - 3.01 .136

Occupation (Ref.: Full-time)

Unemployed 2.67 0.98 - 7.26 .055

Retired 1.42 0.65 - 3.10 .377

Other (student, housewife) 2.15 0.85 - 5.41 .104

Gender (Ref.: Male)

Female 1.35 0.90 - 2.00 .143

Income (Ref.: Very low)

Low to average 0.85 0.47 - 1.51 .570

Average 0.83 0.50 - 1.37 .464

Higher than average 0.74 0.36 - 1.53 .419

Chronic conditions (Ref.: No)

Yes 1.43 0.90 - 2.28 .135

Uninsured (Ref.: No)

Yes 1.69 0.53 - 5.36 .371

TABLE 2 (Continued)

Trust in official healthcare

authorities' guidelines and recommendations on healthcare issues (ie, vaccination) (Ref.: No trust) OR 95% CI P-value

Do you have private insurance

coverage? (Ref.: No)

Yes 1.20 0.65 - 2.25 .559

Rural residence (Ref.: No)

Yes 1.36 0.76 - 2.46 .301

Education (Ref.: University)

Elementary 0.58 0.26 - 1.28 .177

High School 1.30 0.80 - 2.12 .284

MSc/PhD 1.06 0.50 - 2.26 .874

Note: The regression model controls for geographic-level fixed effects.

Abbreviations: OR, Adjusted odds ratio; CI, confidence intervals; Ref.,

reference.

1108 GIANNOUCHOS ET AL.

Our study reveals that almost 85% of participants supported

mandatory vaccination. This finding is consistent and within the range

of previous studies in Greece about acceptance of mandatory vaccina-

tion (65% to 97%) and similar to the proportion of Greek citizens who

perceived vaccines as being effective and safe (87%).6,10,30 The stron-

gest predictors of mandatory vaccination support in our study were

increased trust in official healthcare authorities' guidelines and recom-

mendations (such as information on vaccines) and more frequent use

of preventive services. Our findings are supported by previous work

which found that interaction with healthcare providers and credible

health information by trustworthy and reliable sources were com-

monly associated with acceptance and uptake of recommended vacci-

nations.16,18,20,21,24,26,31,32 In fact, a review of the literature

highlighted that the credibility of institutions might influence vaccina-

tion attitudes more than information.32

Despite, there are still people who are uncertain and/or oppose a

mandate to vaccinate. Mandating vaccination or coercive actions

against such individuals restrict their liberty and autonomy and might

not be ethically justifiable. However, even when public health threats

are serious and the expected societal welfare and utility gains are

high, multifaceted, least restrictive to individuals' liberties, and ethi-

cally justifiable approaches and interventions should be adopted that

aim to balance between individuals' rights and the greater good.33,34

Given the current vaccine developments for the coronavirus dis-

ease 2019 (COVID-19) prevention, the importance of vaccination has

received particular attention in the public context and has raised

heated debates over mandating vaccines. Early evidence suggests that

messages emphasizing the personal and collective health risks and

consequences of not vaccinating increased individuals' intentions to

vaccinate in the United States, while another study in the United

Kingdom found that mistrust and concerns about vaccination benefits

and poor adherence to preventive recommendations were associated

with unwillingness to vaccinate against COVID-19.35,36 These findings

are in-line with the results of our study and shed light on the influen-

tial role of healthcare professionals and authorities to address and

mitigate both long-lasting and pandemic-induced vaccine-related pub-

lic concerns through effective community outreach efforts and infor-

mation dissemination.

Health professionals are the most influential and trusted source

of information on vaccination.20 Our findings highlight the need to

support and educate healthcare professionals through coordinated

efforts led by the national healthcare authorities, which have already

been proven to improve vaccination uptake.32,37,38 As vaccine scepti-

cism and hesitancy increase, efforts to improve vaccination rates

should focus on training health professionals not only on the benefits

of vaccination but also on the provision of consistent and homoge-

nous information in line with national guidelines.39,40

Evidence from previous studies among healthcare professionals

in Greece, and in other countries, has identified major knowledge defi-

cits, with only 12.9% of healthcare workers correctly naming rec-

ommended vaccines, while almost half were not concerned about

influenza infection and believed that they were not at risk of contract-

ing such diseases.10,11,13,30,41 Moreover, about one-fifth questioned

the effectiveness of vaccines.13 Further, time limitations to counsel

patients as well as some patients' overconfidence about their knowl-

edge may also hinder efforts to build a patient-provider relationship

that is based on trust.32,42 In particular, confidence about vaccines'

knowledge was found to be highest among patients with lower levels

of knowledge and was also associated with increased support for the

involvement of non-experts in policymaking processes.42 Recent

efforts by the Greek government to create a national vaccination reg-

istry will allow real-time monitoring of compliance with vaccination

schedule, which would, in turn, assist with targeted reminders and

information provision.

We also found that healthier and younger individuals were more

likely to support mandatory vaccination. Health status is a critical fac-

tor that affects the demand for health and medical care. Our finding is

consistent with the human capital framework and implies that, in

Greece, healthier individuals might be future-oriented and acknowl-

edge the benefits of vaccination and thus invest in preventive care to

maintain their health status.43 The presence of underage children in

the household was also associated with increased mandatory vaccina-

tion preference. This could be related to the parental perception of

their children's increased susceptibility to infectious diseases and,

coupled with the existing pre-school mandate for vaccination in

Greece, might shape vaccination supporting attitudes.44

We note that we did not observe any significant association

between other socioeconomic factors such as gender, income, educa-

tion and health insurance coverage and mandatory vaccination sup-

port. Similar results were also found by Coniglio and colleagues in

Italy.25 This finding might be related to the fact that the sample popu-

lation in our study was random and representative of the overall

Greek population, hence yielding different results compared to previ-

ous work among parents with young children in Greece.19 Finally, the

free-of-charge access to most vaccines in the country might also elim-

inate disparities and barriers to receive vaccinations among heteroge-

neous sociodemographic population subgroups.

This study is not without limitations. First, participants were rec-

ruited from the telephone household bank and recruitment was based

on landline phones rather than mobile phones which might lead to

sampling bias. However, more than 80% of Greek households have

fixed telephone lines and our study sample was similar to national

estimates, and thus representative of the Greek population.45 Second,

due to the study design, we cannot rule out some other sources of

bias inherent in surveys, such as social desirability bias, and response

bias. In addition, since the data used in this study were part of a

larger-scale project on public attitudes for healthcare policy reforms,

we were not able to include other information and variables that

might influence vaccinating decisions, such as receiving physician

advice and past experiences with vaccines (ie, side effects), due to the

absence of those in our data. We also highlight that the findings are

relevant only to the Greek population and thus cannot be extrapo-

lated to other countries. Finally, we highlight that our results are

based on data collected in 2019 and thus might not fully generalizable

to the current situation given the ongoing pandemic. Despite these

limitations, our study results are supported by previous literature on

GIANNOUCHOS ET AL. 1109

mandatory vaccination preferences and thus present timely and criti-

cal evidence for healthcare authorities.

In conclusion, our study provides novel evidence on factors that

critically affect the support of mandatory vaccination in Greece. The

results indicate that despite the high support for mandatory vaccina-

tion, trust in official healthcare authorities and utilization of preven-

tive services in general primarily shape the general public's decisions

on vaccination. Provision of univocal and accurate evidence-based

information on the risks and benefits of vaccination by healthcare pro-

viders, which have to be consistent with national guidelines and rec-

ommendations, is crucial to maintain and improve vaccination uptake

and rates. It is, therefore, increasingly important for national public

health authorities to integrate holistic approaches and strategies

targeting both health professionals and the general population and to

ensure that community outreach efforts and information dissemina-

tion are consistent, scientifically driven, and tailored to the needs of

different populations with respect to individuals' autonomy.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

AUTHOR CONTRIBUTIONS

Theodoros V. Giannouchos: Conceived and designed the study, con-

ducted data and statistical analyses and wrote the first draft of the

manuscript. Kyriakos Souliotis: Collected the data and contributed to

the study design. Evaggelia Steletou, Maria Saridi, Kyriakos Souliotis:

Critically reviewed the manuscript for important intellectual content

and contributed to the editing and writing of the final manuscript. All

authors read and approved the final manuscript.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on

request from the corresponding author. The data are not publicly

available due to privacy or ethical restrictions.

ORCID

Theodoros V. Giannouchos https://orcid.org/0000-0002-1574-

6767

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How to cite this article: Giannouchos TV, Steletou E, Saridi M,

Souliotis K. Should vaccination be mandated? Individuals'

perceptions on mandatory vaccination in Greece. J Eval Clin

Pract. 2021;27:1104–1111. https://doi.org/10.1111/jep.

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