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

Background Despite scientific breakthroughs in vaccine development, some people remain reluc-tant to accept the anti-SARS-CoV-2 vaccine. This study evaluates attitudes and behaviours to-wards 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 to-wards 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 51 years, 59.7% women, 63.6% highly ed-ucated), 2,449 (6.7%) were against or hesitant, 4,468 (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, 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, over-weight 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. The study highlights po-tential target groups for tailored communication and prevention campaigns.