The development of strategies to contrast vaccine hesitancy in Italy

Background. The extension of compulsory vaccination, introduced by law in 2017 in Italy, may not be sufficient to guarantee the compliance with immunization coverage in the long term. The aim of this research project is to assess knowledge and attitudes on vaccinations and on mandatory immunization in different populations (pregnant women, midwives, public health professionals), in order to support the development of tailored strategies to contrast vaccine hesitancy in the Country. Methods. We conducted a cross-sectional survey on a sample of pregnant women attending antenatal classes (CANs) in Rome through distribution of a self-administered questionnaire. Multiple logistic regression models were built to analyze the determinants of knowledge, attitudes and intention to vaccinate in this population. An online survey to identify level and determinants of knowledge and attitudes about vaccinations of midwives members of the professional register of Rome is currently ongoing, while a survey aimed at addressing the attitudes of Italian Public Health (PH) professionals on mandatory vaccinations is under development. Results. A total of 458 pregnant women attending CANs in 36 family health centers and two hospitals in Rome answered the survey. More than 26% of respondents showed a good level of knowledge of the safety and efficacy of vaccines, but there were high rates of uncertainty or agreement with some of the most common anti-vaccination thesis. Only 75% of women were sure about vaccinating their children with the hexavalent vaccine, and 64.3% with MMR. A good level of knowledge was the strongest predictor of positive attitudes towards vaccination (OR 11.61, 95% CI 6.43-20.96), which, in turn, influenced the intention to vaccinate for most vaccines, together with the perception of the benefit of immunization. Preliminary results on data collected from 87 midwives show a heterogeneous level of knowledge in this population: only 62% respondents were certain of the safety of multiple shots at the same time, while 24% agreed that three-month-old children are too young to begin the immunization schedule. Conclusions. Scepticism about the safety, efficacy and importance of vaccines is associated to pregnant women’s hesitancy on vaccinations, suggesting the need to develop strategies to increase vaccine acceptance in the antenatal period. Based on the results of the two surveys, we will focus on increasing the capacity of HCWs working in the antenatal setting, particularly midwives and nurses, to correctly deliver information to future parents. The results of the survey addressed at PH professionals will allow evaluating the impact of the mandatory vaccination policy on the PH services in the Country.