Factors Affecting Hesitancy to mRNA and Viral Vector COVID-19 Vaccines among College Students in Italy.

Vaccine hesitancy (VH) may be significant in jeopardizing efforts to mass containment of COVID-19. A cross-sectional survey was carried out on a sample of 2667 Italian college students, before the COVID-19 vaccines became available for this age group (from 7 May to 31 May 2021). An online survey was created to obtain information about socio-demographic, health-related, and psychological factors linked to mRNA and viral vector COVID-19 vaccines. Statistically significant higher VH (30.4%) and vaccine resistance (12.2%) rates were found for viral vector than mRNA COVID-19 vaccines (7.2% and 1.0%, respectively; p < 0.001). Factors related to viral vector VH were partially different from those related to mRNA VH. Students with greater endorsement on conspiracy statements and negative attitudes toward the vaccine had higher odds of being vaccine-hesitant or -resistant. Students who had received a previous COVID-19 test and who scored higher on the agreeableness personality dimension had lower odds to be vaccine-hesitant or -resistant. The willingness to choose the vaccine was related to the viral vector but not to the mRNA VH. Taking into consideration the factors involved in vaccine hesitancy/resistance in college students could represent a key public health strategy to increase vaccine coverage and reduce viral spreading.

Who Should Get COVID-19 Vaccine First? A Survey to Evaluate Hospital Workers' Opinion.

Prospective planning of COVID-19 vaccines allocation will be essential to maximize public health and societal benefits while preserving equity. Decisions about how to allocate limited supplies of vaccines need to be clear about the criteria used in setting priorities, with a specific commitment to transparency and communication. The aim of our study was to think through these competing demands, focusing on the opinion of healthcare workers (HCWs). The primary endpoint of the study was to assess the opinion of all the HCWs in a University based Italian Hospital about the fairest priority order to COVID 19 vaccines and to understand on which criteria the prioritization preferences of HCWs are implicitly based. The secondary endpoints were to assess whether HCWs approach differs from national guidelines and to assess the attitude of HCWs towards mandatory vaccination. An online survey accounting with multiple choice single answer questions and ranking questions was administered to all the HCWs of the University Hospital P. Giaccone of Palermo (Italy) and completed by a total of 465 participants. Almost all respondents confirmed the need for prioritization in COVID-19 vaccination for HCWs (n = 444; 95.5%), essential services and law enforcement (both n = 428; 92%). Clinically vulnerable individuals, HCWs and population over 65 years have been considered the first three groups to be involved in getting vaccination, being indicated as first position group by 26.5%, 32.5% and 21.9% of respondents, respectively. A large majority of respondents (85%) asked for a consistent, transparent and detailed order of priority at a national level. After adjusting for potential confounding due to sex and age, physicians have been found to be statistically significantly associated with the choice of mandatory vaccination (odds ratio (OR): 10.2; 95% confidence interval (CI) = 2.7-39.1) or with other strategies different from voluntary (OR = 7.2; 95% CI = 1.9-27.3). The broad consensus expressed by respondents towards mandatory vaccination for HCWs is extremely relevant at a time when vaccination hesitation is one of the biggest obstacles to achieving herd immunity. Data show a mismatch in the position attributed to long-term care residents compared to the position of absolute priority assigned by most of national distribution plans, impelling us to reflect on the issue of maximizing benefit from limited healthcare resources. Our findings clearly indicate a preference for COVID-19 frontline health professionals as the first tier of recipients, since they better meet all the criteria (higher risk, immediate system stability). As the guidelines are likely to directly affect a considerable number of citizens, our results call for policy interventions to inform people on the ethical rationale behind vaccine distribution decisions, to avoid resentment and feelings of unfairness.

Rationing in a Pandemic: Lessons from Italy.

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds' availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent "first come, first served" principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy.