Trends in COVID 19 vaccine hesitancy in Italy: a comparison between 2021 and 2024
Abstract
Abstract Monitoring vaccination hesitancy is a key component of immunization programmes, as recommended by the WHO. COVID-19 vaccines are estimated to have saved at least 14.4 million lives in 2021 alone, highlighting their major public health value. However, lessons from the pandemic underscored the need to understand changes in public perceptions in order to inform future immunization policies and sustain vaccine confidence. This study used a longitudinal design with two waves of data collection to examine changes in COVID-19-related attitudes and behaviors in the general population in Italy. Data were collected through an online survey administered by a professional panel agency in May 2021 and March 2024. Differences between the two time points were assessed with paired-samples t-test or the Wilcoxon signed-rank test, as appropriate. The final sample consisted of 1,821 adults (mean age = 54 years), of whom 54% female. All attitudes examined showed statistically significant changes over time, particularly for to the following items (all p < 0.001): “Support for mandatory COVID-19 vaccination for everyone” (6.7 vs 5.7); “Preference for natural immunity over vaccination” (2.3 vs 3.8); “Belief that vaccine effects are worse than those of COVID-19” (2.8 vs 4.1); “Belief that vaccination helped the community to control the pandemic” (7.7 vs 6.9). The most marked change between 2021-2024 was observed for willingness to receive an annual COVID-19 booster dose: mean intention declined from 71.3 in 2021 to 36.2 in 2024 (p < 0.001). Overall, the findings indicate a potential decline in the perceived vaccine benefits and in the impact of SARS-CoV-2 infection. The study is relevant for public health policy, as it points to a shift toward greater vaccine hesitancy rather than sustained adherence. Strengthening and rethinking institutional strategies is crucial, not only to support vaccination programmes, but also to address evolving public perceptions in the post-pandemic context.