Background and Objectives:
COVID-19 vaccines represent a life-saving solution for the pandemic which has resulted in millions of deaths around the world, but vaccine uptake has remained low in Western Balkan countries. Vaccine hesitancy is the result of a plethora of factors which are usually addressed using general messaging in vaccination promotion strategies. The aim of this study was to identify gender differences in factors influencing vaccine behaviour in the Western Balkans.

Method:
This cross-sectional study was carried out from July to October 2021. Convenience sampling included 1605 individuals over the age of 18 from Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia. The questionnaire was shared online through social media.

Results:
Females were more commonly vaccinated in Serbia (73% vs 56%) and Bosnia and Herzegovina (40% vs 28%) while males were more often vaccinated in Albania (56% vs 37%), Montenegro (60% vs 53%), and North Macedonia (74% vs 57%). Statistically significant differences were seen between males and females in responses to questions on vaccine safety (p<0.01), vaccine efficacy (p<0.01), compulsory vaccination (p<0.01), disease comprehension (p<0.01), risk of disease and susceptibility (p<0.01) and trust in societal factors (p<0.01). Statistically significant differences between males and females were also seen in sources of information and health literacy, but these differences varied between Western Balkan countries.

Conclusions:
Strategies to combat vaccine hesitancy should take into account the specificities of target populations. General strategies which were applied in most Western Balkan countries were set to fail as they did not address specific factors influencing vaccine hesitancy.