| Summary: | <b>Background</b>: Vaccination is a crucial public health measure to control infectious diseases, including seasonal influenza. Yet, vaccine uptake varies globally due to sociodemographic factors, misinformation, and access disparities. <b>Objectives:</b> The objective of this study was to assess the prevalence and sociodemographic factors associated with vaccination and the main reasons for vaccine hesitancy in Albania. <b>Methods</b>: A cross-sectional study, conducted in Albania in November–December 2021, included a sample of 1302 individuals aged ≥18 years (≈57% females; mean age: 38.3 ± 15.0 years; response rate: ≈87%). A structured questionnaire was administered inquiring about co-vaccination status against seasonal influenza and COVID-19, reasons for not being vaccinated, and sociodemographic characteristics of participants. Binary logistic regression was used to assess the association of co-vaccination status with sociodemographic factors. <b>Results</b>: Overall, about 28% of individuals were co-vaccinated against seasonal influenza and COVID-19 at least with one dose (25% in males vs. 29% in females; 22% among 18–24-year-olds vs. 54% among those aged ≥65 years). Independent positive and significant correlates of being co-vaccinated included older age (OR = 7.0, 95%CI = 3.7–12.9) and a higher educational attainment (OR = 2.3, 95%CI = 1.4–3.6). The main reasons for vaccine hesitancy among non-vaccinated individuals included the belief that vaccines are: harmful (72%), not effective (66%), weaken the immune system (58%), are not safe (56%), and preference to recover naturally (52%). <b>Conclusions</b>: This study evidenced a relatively low co-vaccination rate in Albania with significant sociodemographic disparities, notwithstanding the availability of vaccines and their free-of-charge provision to the overall population. Older age and higher educational attainment were identified as independent positive predictors of co-vaccination uptake, suggesting the need for targeted public health strategies to address vaccine hesitancy, particularly among younger and less-educated population categories. Our findings emphasize the importance of tailored communication campaigns and community-based interventions to improve vaccine coverage and mitigate the impact of infectious diseases in Albania and elsewhere.
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