These findings highlight that neuroticism significantly predicts variations in country vaccination rates in different continents. These findings remained significant even after controlling for gross domestic product or physical health/risk factors such as age or obesity known to impact vaccine distribution (Basak et al., 2022; Oshakbayev et al., 2022). These results can be related at a more local level to data showing that neuroticism predicted negative affect level and variability during the COVID-19 pandemic in Germany as well as with neuroticism’s associations with mean levels of attention to COVID-19 related information and worry (crisis preoccupation) (Kroencke et al., 2020). If people scoring high on neuroticism paid more attention to COVID-19 related information and worried more about one’s own health during the pandemic, it may explain neuroticism’s role in adhering to a vaccines’ national strategy. Our results also relate to UK findings showing that lower levels of neuroticism are associated with increased COVID-19 vaccination hesitancy (Halstead et al., 2022).

However, our data, in combination with the above-mentioned results, may seem to contradict other data from Russia showing that neuroticism is positively associated with vaccine hesitancy or resistance (Roshchina et al., 2022). It should be noted that most of the above-mentioned literature is related to vaccine intention (or attitude) when vaccination campaigns had not yet begun. This differs notably from the present data, which relates to actual vaccination rates rather than to anticipated behavior (intentions). The contradiction could, for example, be related to trust in vaccines or in the government, given that a recent study showed that a significant portion (around 30%) of those who had been vaccinated had nevertheless a low level of confidence in the Covid-19 vaccines (Gbenonsi et al., 2022).

From this perspective, it is interesting to note that in Roshchina et al. (2022), a high level of trust in institutions was associated with a stronger intention to be vaccined. Confidence in the solution (i.e., vaccines) together with fear of Covid-19 may appear as key factors to account for the apparent contradiction. The “appeal to fear” model (Witte, 1992) emphasizes that for a promoted behavior to be considered, one must feel at risk (susceptibility), and one must be confident that the solution (or response) is effective, easy to implement, and cost-effective. The appeal to fear model predicts that if risk susceptibility is high but confidence in the solution is low, there might be denial of the threat and rejection of the solution. In this sense, it is not surprising to observe in Roshchina et al. (2022) that vaccine resistance and hesitancy were greater in the regions with worse epidemiologic situations, where fear is potentially stronger because of threat proximity. This proposed explanation fits quite well with data showing that anxiety during covid Covid-19 is negatively related to confidence, controllability and physical distance to the nearest Covid-19 covid patients (Wu et al., 2021). In this way, it might be suggested that when there is a threat and confidence in the solution is high, neuroticism could increase acceptance, whereas if confidence is low, neuroticism could increase hesitancy.

Future research could aim to better understand how neuroticism not only influences vaccine intention but also the transformation of these intentions into actual behaviors. One way might be to use the photovoice method, which allows researchers to understand facilitators and barriers from the unique perspective of each participant, to understand the contextual conditions of participants, and to increase social justice by adequately informing mental health service providers and policy makers (Tanhan & Strack, 2020).