"Cultivating" acceptance of a COVID-19 vaccination program: Lessons from Italy.

Dear Editor,

in their article, García and Cerda [1] found a relatively high vaccine acceptance rate (90.6%) and stated that the COVID-19 pandemic has not only had a negative impact on people’s health and life behavior, but also on economies around the world. We agree with the authors and we think that a robust vaccination program against SARS-COV-2 would mitigate its huge effects on social, clinical, and economic levels for the global population. However, vaccine hesitancy risks to hamper such effort. In Italy, which is among the countries most severely impacted by COVID-19 outbreaks early on, experts have been primarily involved in social and traditional media to disseminate scientific knowledge against COVID-19 vaccine-related fake news [2]. However, improving health literacy is probably not enough to improve vaccine acceptancy [3]. Citizens need to be engaged in a deep process of psychological acceptance, in order to adopt a socially responsible approach to COVID-19 preventive behaviors [4], [5].

A sample of 1004 individuals representative of the Italian adult population was involved in a cross-sectional survey study in May 2020. Participants were asked whether they would vaccinate against COVID-19, along with questions regarding their attitude towards preventive behaviours. A series of 2x2 contingency tables with Pearson’s chi-squared tests was performed to test variables association. Percentage distribution of people willing and unwilling to vaccinate were compared across groups with a z-score test.

Results of our study showed that 41% of the participants reported to be unwilling or hesitant towards COVID-19 vaccine. Chi-squared and z-tests showed that the percentage of willing people is significantly higher amongst those who agree with the statement “I have the primary responsibility for preventing the infection by COVID-19” (63%) when compared with those who disagree (42.6%). Moreover, our data showed that the percentage is higher amongst those people who agree that preventive behaviours are an act of social responsibility (64.1%), when compared to those who don’t agree (24.9%). Conversely, when comparing the percentage of willing and unwilling people between groups of persons that relied on social media to search for COVID-19 information and people who didn’t, no significant difference was found, as no difference was found between people who reported being exposed to fake news and those who didn’t.

Our data suggest the opportunity for a shift from “preaching the pros” of the future COVID-19 vaccine to “cultivating citizens’ engagement” and their partnership with the institutions in the battle against COVID-19. Citizens need to be sustained in growing more confident in their own ability to individually contribute to slow down the pandemic. Involving citizens in a more accountable dialogue with public health experts is a priority; this requires a climate of mutual trust [6]. Engaging citizens towards the acceptance of the COVID-19 vaccination is a urgent challenge that the public health community needs to face. In our opinion, developing a COVID-19 public vaccination program should start from considering people’s attitudes to engage them in an educational campaign focused on fostering the citizens-science alliance.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.