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.

Keywords: COVID-19 vaccine; Italy; policy tools; vaccine hesitancy; vaccine uptake.

Figure 1

COVID-19 vaccine uptake in the study sample between January 2021 and April/May 2022 (n = 10,000), overall and by NUTS statistical region. Percentages were post-stratified by using the distribution of Italy’s resident adult population by NUTS region, gender, and age group as of 1 January 2022. Notes: Northwestern Italy includes Piedmont, Aosta Valley, Lombardy, and Liguria; Northeastern Italy includes Trentino-South Tyrol, Veneto, Friuli-Venezia Giulia, and Emilia-Romagna; Central Italy includes Tuscany, Umbria, Marche, and Lazio; Southern Italy includes Abruzzo, Molise, Campania, Apulia, Basilicata, and Calabria; Insular Italy includes Sicily and Sardinia. Abbreviations: COVID-19, coronavirus disease 2019; NUTS, Nomenclature of Territorial Units for Statistics.

Figure 2

Trust in science scored on a scale from a minimum of 1 to a maximum of 10, by COVID-19 vaccine uptake status. Percentages were post-stratified by using the distribution of Italy’s resident adult population by NUTS region, gender, and age group as of 1 January 2022. Notes: Cumulative frequencies are displayed with the aid of area charts in the background. Trust among vaccine-exempt individuals is not displayed due to small numbers (n = 209). Abbreviations: COVID-19, coronavirus disease 2019; NUTS, Nomenclature of Territorial Units for Statistics.

Figure 3

Trust in the Italian government scored on a scale from a minimum of 1 to a maximum of 10, by COVID-19 vaccine uptake status. Percentages were post-stratified by using the distribution of Italy’s resident adult population by NUTS region, gender, and age group as of 1 January 2022. Notes: Cumulative frequencies are displayed with the aid of area charts in the background. Trust among vaccine-exempt individuals is not displayed due to small numbers (n = 209). Abbreviations: COVID-19, coronavirus disease 2019; NUTS, Nomenclature of Territorial Units for Statistics.

Figure 4

Voting intention as of April/May 2022 by COVID-19 vaccine uptake status. Percentages were post-stratified by using the distribution of Italy’s resident adult population by NUTS region, gender, and age group as of 1 January 2022. Notes: Voting intention among vaccine-exempt individuals is not displayed due to small numbers (n = 209); FdI, Fratelli d’Italia (Brothers of Italy); FI, Forza Italia (Forward Italy); PD, Partito Democratico (Democratic Party); +E, Più Europa (More Europe); Az, Azione (Action); M5S, Movimento 5 Stelle (Five Star Movement); IV, Italia Viva (Italy Alive). Abbreviations: COVID-19, coronavirus disease 2019; NUTS, Nomenclature of Territorial Units for Statistics.