# Role of Individual, Social and Health Factors as Determinants of COVID-19 Vaccine Hesitancy: Results from the Second Phase of the Italian EPICOVID19 Web-Based Survey

## TL;DR

This study explores why some Italians were hesitant about the COVID-19 vaccine, identifying factors like education, trust in institutions, and health perceptions.

## Contribution

The study identifies specific demographic and behavioral factors associated with vaccine hesitancy in Italy using a large-scale survey.

## Key findings

- Female sex, middle age, and low education were positively associated with vaccine hesitancy.
- High hesitancy was linked to low trust in science and institutions, while low hesitancy was associated with environmental concerns and retired status.
- Tailored communication strategies are needed for groups showing high vaccine hesitancy.

## Abstract

Background: Despite scientific breakthroughs in vaccine development, some people remain reluctant to accept the anti-SARS-CoV-2 vaccine. This study evaluates attitudes and behaviours towards the vaccine and factors associated with refusal/hesitancy at the start of Italy’s vaccination campaign. Methods: EPICOVID19 is a two-phase observational web-based study where adult volunteers completed questionnaires in April–June 2020 and January–February 2021. Refusal/hesitancy towards the vaccine was assessed among those not yet vaccinated. We analysed factors associated with refusal/hesitancy by applying multivariate multinomial logistic regression models. Results: Among 36,820 survey participants (mean age of 51 years, 59.7% women, 63.6% highly educated), 2449 (6.7%) were against or hesitant, 4468 (12.1%) were inclined but unsure, and 29,903 (81.2%) were willing to be vaccinated. Factors positively associated with refusal/hesitancy included female sex, middle age, at-risk occupations, medium and low education, deprived status, being underweight, previous SARS-CoV-2 positivity, poor perceived health, no fear of contracting SARS-CoV-2, the fear of contaminated food and natural disasters, and low trust in science, media, government, or institutions. Low hesitancy was associated with student and retired status, overweight and obesity, moderate and high alcohol consumption, no concern about economic and working conditions, and sensitivity to climate change/environmental pollution and epidemics. Conclusions: This survey showed that, during the first month of Italy’s vaccination campaign, some individuals were reluctant to receive the anti-SARS-CoV-2 vaccine. This study highlights potential target groups for tailored communication and prevention campaigns.