People with multiple sclerosis (MS) are vulnerable to severe outcomes from COVID-19 infection and were prioritised for COVID-19 vaccination in Australia from March 2021. Despite this, vaccine hesitancy may hinder optimal vaccination uptake. Aim(s) This study explored COVID-19 vaccine uptake, beliefs, and hesitancy in people with MS. Method(s) People with MS receiving MS healthcare management at two Australian health services were invited to participate in an online survey, between September and October 2021. The survey collected sociodemographic and disease-specific characteristics, as well as vaccine status, vaccine hesitancy and beliefs towards COVID-19 vaccination using validated scales the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Regression analyses were used. Result(s) Of the 281 people with MS (mean age 47.7 [SD 12.8] years;75.8% females) who participated, 82.9% had received >=1 COVID-19 vaccine dose. There were 17.1% who were unvaccinated, of which 51.2% reported they were likely to accept vaccination in future. Younger participants were less likely to be vaccinated (B[SE] 0.05[0.01]), as were those within 1-5 years disease duration (B[SE] -1.17[0.39]), all p<0.05. Compared to vaccinated participants, unvaccinated participants reported higher vaccine hesitancy (B[SE] 9.66 [0.72]), greater negative attitudes around vaccine complacency and confidence (B[SE] 13.36[1.40]), greater complacency toward COVID-19 in the context of MS (B[SE] 1.80[0.50]), and higher MS interaction concerns (B[SE] 3.38[0.52]), all p<0.001. Participants who reported no impact of MS on their daily life had lower concerns about the impact of COVID-19 vaccination on MS treatments or disease progression, compared with those reporting MS impacted their daily life all of the time (B[SE] -2.00[0.66], p=0.002). Conclusion(s) General and disease-specific COVID-19 vaccine concerns may influence uptake for people with MS. Understanding the reasons for hesitancy and how they correlate with MS disease and treatment interaction concerns may inform tailored education messages at individual and population levels that addresses these concerns, particularly for ongoing booster doses.