COVID-19 Vaccine Refusal and Delay among Adults in Italy: Evidence from the OBVIOUS Project, a National Survey in Italy

Abstract

Background: Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine. Methods: A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method. Results: In our sample, 83.2% stated that they were vaccinated as soon as possible (“vaccinators”), 8.0% delayed vaccination (“delayers”), and 6.7% refused to be vaccinated (“no-vaccinators”). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master’s degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of “delayers” or “no-vaccinators”. Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators). Conclusion: In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments.

Motivation and Hesitancies in Obtaining the COVID-19 Vaccine—A Cross-Sectional Study in Norway, USA, UK, and Australia

“…For example, a UK study found that women were more likely to be vaccinehesitant [24]. Higher rates of vaccination refusal among females have also been reported in other countries, including Italy and Japan [12,15]. A consistent finding across different settings and times was that distrust is still a leading contributor to vaccine hesitancy and that this issue needs to be addressed to increase vaccine uptake.…”

Vaccinating without complete willingness against COVID‐19: Personal and social aspects of Israeli nursing students and faculty members

“…Despite the apparent safety and efficacy of the vaccine (Bar-On et al, 2021;Dagan et al, 2021), a high percentage of people from all over the world did not get vaccinated until the present day, for various reasons (Frankenthal et al, 2022;Gori et al, 2023;Rego et al, 2023;Song & Lee, 2023;Takoudjou Dzomo et al, 2023;WHO, 2023). Many developed countries reported relatively low vaccination rates in their populations (WHO, 2023) despite offering free vaccines to all eligible subjects (there were almost no sub-groups of the adult population that were not allowed to get vaccinated for health reasons) (Barda et al, 2021;Hodgson et al, 2021;Polack et al, 2020;Zhu et al, 2020), and in spite of repetitive outbreaks of the pandemic.…”

“…Therefore, the reported low vaccination rates were perceived as a major threat to the general effort to combat the pandemic and a risk to public health (WHO, 2019). Vaccine refusal rates among the eligible adult population were relatively high all over the world (WHO, 2023) but varied greatly among different countries and regions (Frankenthal et al, 2022;Gori et al, 2023;Khubchandani et al, 2022;Rego et al, 2023;Song & Lee, 2023;Takoudjou Dzomo et al, 2023). For example, an Israeli study, which included nearly 3000 households (1827 Jews and 1171 Arabs) revealed that 16.3% of the sample population hesitated/refused to get vaccinated despite the availability of the vaccine to them (Frankenthal et al, 2022).…”

“…Factors that contributed to vaccine hesitancy/refusal were younger age, Arab ethnicity, higher level of religiosity, and lower education, among others (Frankenthal et al, 2022). A study from Italy, which included 10,000 adults, showed that 8% of the sampled population delayed vaccination, and approximately 7% refused to receive the vaccine while it was available to them (Gori et al, 2023). A large study from South Korea demonstrated that 3.9% of the eligible adult population refused to get the vaccine mainly due to concerns regarding its safety (Song & Lee, 2023).…”

“…Many reasons have been proposed to explain people's hesitation and/or refusal to get vaccinated (Jennings et al, 2021;Khubchandani et al, 2022;Leng et al, 2021;Schwarzinger et al, 2021;Wong et al, 2021). Among the most reported reasons for COVID-19 vaccine hesitation and refusal are: concerns regarding the safety of the vaccine (Khubchandani et al, 2022;Leng et al, 2021;Rego et al, 2023); skepticism regarding the efficacy of the vaccine (Leng et al, 2021;Wong et al, 2021); problems with the availability and accessibility of the vaccine to specific sub-groups of the population (Frankenthal et al, 2022;Gori et al, 2023;Leng et al, 2021); concerns regarding the duration of protection provided by the vaccine and the possible need to get multiple doses of the vaccine (Khubchandani et al, 2022;Wong et al, 2021); general negative opinions regarding the use of vaccines (not particularly the anti-COVID-19 vaccine) (Jennings et al, 2021;Leng et al, 2021;Schwarzinger et al, 2021); exposure to fake-news and unestablished data regarding the safety and efficacy of the vaccine (Jennings et al, 2021;Khubchandani et al, 2022;Leng et al, 2021); young age and/or normal health status (Frankenthal et al, 2022;Gori et al, 2023;Leng et al, 2021;Schwarzinger et al, 2021;Wong et al, 2021); female gender (not consistent in all studies) (Gori et al, 2023;Schwarzinger et al, 2021); education level (not consistent in all studies) (Gori et al, 2023;Leng et al, 2021;Rego et al, 2023;Schwarzinger et al, 2021;Wong et al, 2021); employment statusnonworki...…”