The last 2019/20 northern hemisphere influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. Italy was the first western country where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to a significant extent. In this representative cross-sectional survey, we aimed to describe some opinions and attitudes of the Italian general population towards both influenza vaccination and the COVID-19 pandemic, and to identify potential modifiers of the decision-making process regarding the uptake of the 2020/21 influenza vaccine. A total of 2543 responses were analyzed. Although most (74.8%) participants valued influenza vaccination positively and declared that it should be mandatory, some misconceptions around influenza persist. The general practitioner was the main source of trusted information on influenza vaccines, while social networks were judged to be the least reliable. Younger and less affluent individuals, subjects not vaccinated in the previous season, and those living in smaller communities showed lower odds of receiving the 2020/21 season influenza vaccination. However, the COVID-19 pandemic may have positively influenced the propensity of being vaccinated against 2020/21 seasonal influenza. In order to increase influenza vaccination coverage rates multidisciplinary targeted interventions are needed. The role of general practitioners remains crucial in increasing influenza vaccine awareness and acceptance by effective counselling.

Perceptions of the risks of vaccine-preventable diseases and preventive behaviors change over time. The ongoing COVID-19 pandemic may have modified laypeople’s attitudes towards routine vaccinations. In this longitudinal study, we aimed to assess changes in attitudes and beliefs concerning (influenza) vaccines between the first and second COVID-19 pandemic waves. A total of 1979 participants completed both 2020 and 2021 surveys. After one year, more interviewees agreed that vaccines were fundamental and should be mandatory (77.3% vs. 75.0%). Analogously, willingness to undergo influenza vaccination increased (p < 0.001) from 44.1% to 48.6%. This increase was seen in subjects aged ≥35 years. Previous influenza vaccinations, receipt of a COVID-19 vaccine, positive attitudes towards (influenza) vaccination, male sex, and older age were the main correlates of willingness to receive the 2021/22 influenza vaccine. Totals of 12.6% and 11.8% had no intention to receive the next seasonal influenza and COVID-19 vaccines, respectively. Most respondents favored a hypothetical combined influenza/COVID-19 vaccine (73.7%) or influenza and COVID-19 vaccine co-administration (67.5%). In Italy, influenza and COVID-19 vaccination hesitancy and refusal are common. Effective public health strategies to pursue higher uptake of both vaccines are urgently needed.

Co-administration of coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines has several advantages, has been advocated by various public health authorities and should be seen as an opportunity to increase the uptake of both vaccines. The objective of this survey was to quantify the acceptance of concomitant COVID-19/influenza vaccination and to identify its correlates in a representative sample of Italian adults. Of 2463 participants, a total of 22.9% were favorable to vaccine co-administration, while 16.6% declared their firm unwillingness to receive both vaccines simultaneously. The remaining 60.5% of subjects could be dubbed hesitant to some degree. Compliance with the primary COVID-19 vaccination schedule (adjusted proportional odds ratio (aOR) = 7.78), previous influenza vaccination (aOR = 1.89) and trust in public health institutions (aOR = 1.22) were the main determinants of positive attitudes toward vaccine co-administration. Other significant correlates included age, sex, perceived disease severity and vaccination risk–benefit, being offered a more personalized influenza vaccine and recent seeking for influenza-related information. In Italy, hesitancy toward COVID-19/influenza vaccine co-administration is common and appears to be higher than hesitancy toward either vaccine administered alone. This pattern is multifaceted and requires specific and tailored strategies, with public health institutions playing the central role.

BACKGROUND Seasonal influenza vaccination (SIV) is a well-recognized and cost-effective means to reduce the burden of influenza. However, SIV uptake is insufficient in most jurisdictions, including Italy. Evidence from countries that achieved high SIV coverage suggests that active invitation to get vaccinated may increase SIV uptake. OBJECTIVE The goal of this study was to explore experience and attitudes of Italian adults towards active invitation to receive SIV, triggered by different sources and delivered by different communication channels, and to assess projected benefits of this strategy. METHODS A cross-sectional survey on a large sample of Italian adults aged ≥18 years was conducted by using computer-assisted web interviewing. Representativeness of the adult Italian population in terms of principal socio-demographic characteristics was achieved through applying a two-stage probabilistic quota sampling. RESULTS Responses from 2513 subjects were analyzed. A total of 52.16% (95% CI 50.63%-54.57%) of individuals previously received invitations to undergo SIV and, compared with people who did not receive any reminder, were 3 times more likely (68.15% versus 22.17%) to be vaccinated in the last season with an adjusted odds ratio (aOR) of 6.47 (95% CI 5.35-7.83). Among other sources investigated, reminders sent by general practitioners (GPs) were perceived as more attractive and associated with the largest effect size. Analogously, more positive attitude towards SIV reminders sent by GPs were significantly (P<.001) associated with higher intentions to get the next season vaccination. As for communication channels, most participants preferred text/instant messaging (27.19%, 95% CI 25.45%-28.96%) or email (24.59%, 95% CI 22.92%-26.32%), suggesting an acceleration in the Italian digital transformation triggered by the COVID-19 pandemic. Notably, there was no statistically significant differences in terms of sex, age groups, education level and previous season vaccination between subjects preferring text messages or email, suggesting that both digital channels may have equal reachability of the principal target populations. Conversely, traditional postal letters or phone calls were preferred by only 16.99% (95% CI 15.54%-18.52%) and 8.60% (95% CI: 7.53%-9.76%) of respondents, respectively. The remaining 22.64% (95% CI: 21.02%-24.33%) did not want to receive any reminder. CONCLUSIONS Reminders sent by GPs via text/instant messages or email is a valuable option for increasing SIV uptake among Italian adults. Public health implications were discussed.