ABSTRACT
In all Western countries, the vaccination campaign against COVID-19 encountered some resistance. To overcome vaccine inertia and hesitancy, governments have used a variety of strategies and policy instruments. These instruments can be placed on a 'ladder of intrusiveness', starting from voluntary tools based on simple information and persuasion, through material incentives and disincentives of varying nature and magnitude, to highly coercive tools, such as lockdown for the unvaccinated and the introduction of the vaccination mandate. Italy's experience during the vaccination campaign against Covid provides an ideal observational point for starting to investigate this issue: not only was Italy among the top countries with the highest percentage of people vaccinated at the beginning of 2022, but—at least compared to other European countries—it was also one of the countries that had gradually introduced the most intrusive measures to increase vaccination compliance. In the article the different steps of the ‘intrusiveness ladder' are presented, providing examples from various countries, and then tested on the Italian Covid-19 vaccination campaign between 2021 and the first months of 2022. For each phase of the campaign, the instrument mixes adopted by the Italian government are described, as well as the contextual conditions that led to their adoption. In the final section, an assessment of the composition and evolution of the Italian vaccination strategy is provided, based on the following criteria: legitimacy, feasibility, effectiveness, internal consistency and strategic coherence. Conclusions highlight the pragmatic approach adopted by the Italian government and underline the effects—both positive and negative—of scaling up the intrusiveness ladder.
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.