Keywords
COVID-19 vaccination
Green Pass Law
Mandatory vaccination
Green Pass Law
Mandatory vaccination
Abstract
Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population.
In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory “Green pass” (GP) to access workplaces for some categories considered at risk.
We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influenceof the introduction by law of the Green Pass (GP) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022.
Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the GP. The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom(Adj-OR= 2.45, 95%CIs= 1.51-3.97, p-value: <0.001)but a lower sense of safety (Adj-OR= 0.19, 95%CIs= 0.12-0.29, p-value: <0.001)after vaccine administration.
Our findings, in line with the available literature, suggest that the introduction of GP has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy.
References
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[15] Rzymski P, Borkowski L, Drąg M, Flisiak R, Jemielity J, Krajewski J, Mastalerz-Migas A, Matyja A, Pyrć K, Simon K, Sutkowski M, Wysocki J, Zajkowska J, Fal A. The Strategies to Support the COVID-19 Vaccination with Evidence-Based Communication and Tackling Misinformation. Vaccines (Basel). 2021 Feb 1;9(2):109. doi: 10.3390/vaccines9020109.
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[22] Costantino C, Rizzo C, Rosselli R, Battista T, Conforto A, Cimino L, Poscia A, Fiacchini D. Ten Actions to Counteract Vaccine Hesitancy Suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health. Vaccines. 2022; 10(7):1030. https://doi.org/10.3390/vaccines10071030.
[23] Islam MS, Sarkar T, Khan SH, Mostofa Kamal AH, Hasan SMM, Kabir A, Yeasmin D, Islam MA, Amin Chowdhury KI, Anwar KS, Chughtai AA, Seale H. COVID-19-Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020 Oct;103(4):1621-1629. doi: 10.4269/ajtmh.20-0812.
[24] Costantino C, Graziano G, Bonaccorso N, Conforto A, Cimino L, Sciortino M, Scarpitta F, Giuffrè C, Mannino S, Bilardo M, Ledda C, Vitale F, Restivo V, Mazzucco W. Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19. Vaccines (Basel). 2022 Mar 18;10(3). doi: 10.3390/vaccines10030475;
[25] Costantino C, Caracci F, Brandi M, Bono SE, Ferro A, Sannasardo CE, Scarpitta F, Siddu A, Vella C, Ventura G, Vitale F, Casuccio A, Restivo V. Determinants of vaccine hesitancy and effectiveness of vaccination counseling interventions among a sample of the general population in Palermo, Italy. Hum Vaccin Immunother. 2020 Oct 2;16(10):2415-2421. doi: 10.1080/21645515.2020.1728157
[26] Benin AL, Lockwood G, Creatore T, Donovan D, Predmore M, MacArthur S. Improving Mandatory Vaccination Against Influenza: Minimizing Anxiety of Employees to Maximize Health of Patients. Am J Med Qual. 2018 Jul;33(4):372-382. doi: 10.1177/1062860617748738
[27] Spitale G, Biller-Andorno N, Germani F. Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach. J Med Internet Res. 2022 Feb 16;24(2):e34385. doi: 10.2196/34385.
[28] Wilf-Miron R, Myers V, Saban M. Incentivizing Vaccination Uptake: The "Green Pass" Proposal in Israel. JAMA. 2021 Apr 20;325(15):1503-1504. doi: 10.1001/jama.2021.4300.
[29] BBC News. COVID passes set to stay as Europe heads for winter. Available at: https://www.bbc.com/news/world-europe-58973334. Accessed on 06/06/2022
[2] Li YD, Chi WY, Su JH, Ferrall L, Hung CF, Wu TC. Coronavirus vaccine development: from SARS and MERS to COVID-19. J Biomed Sci. 2020 Dec 20;27(1):104. doi: 10.1186/s12929-020-00695-2.
[3] NBER working paper series. Sequential lifting of COVID-19 interventions with population heterogeneity (No. w27063). Available at:
https://www.nber.org/system/files/working_papers/w27063/w27063.pdf
Accessed on 23/06/2022
[4] Santeramo FG, Tappi M, Lamonaca E. On the management of COVID-19 pandemic in Italy. Health Policy. 2021 Aug;125(8):995-1001. doi: 10.1016/j.healthpol.2021.05.014.
[5] Italian Ministry of health. Vaccine day on December 27 throughout Italy and Europe. Available at: https://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&id=5242. Accessed on 30/06/2022
[6] Italian Ministry of health. Interim recommendations on target groups for SARS-CoV-2/COVID-19 vaccination. Available at: https://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=24/03/2021&redaz=21A01802&artp=1&art=1&subart=1&subart1=10&vers=1&prog=002. Accessed on 30/06/2022
[7] Ministry of health. Report COVID vaccines. Available at: https://www.governo.it/it/cscovid19/report-vaccini/ . Accessed on 12/07/2022
[8] Ministry of health. Report COVID vaccines. Available at:
https://github.com/italia/covid19-opendata-vaccini . Accessed on 12/07/2022
[9] Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y, Jit M. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. 2021 Mar 13;397(10278):1023-1034. doi: 10.1016/S0140-6736(21)00306-8.
[10] Venegas-Vera AV, Colbert GB, Lerma EV. Positive and negative impact of social media in the COVID-19 era. Rev Cardiovasc Med. 2020 Dec 30;21(4):561-564. doi:10.31083/j.rcm.2020.04.195.
[11] European Community. Coronavirus-Commission proposes a digital green certificate. Available at: https://ec.europa.eu/commission/presscorner/detail/it/ip_21_1181. Accessed on 20/06/2022
[12] Official Gazzette of Italian Republic. D.L. 23 July 2021, n.105. Available at: https://www.gazzettaufficiale.it/eli/id/2021/07/23/21G00117/sg . Accessed on 13/06/2022
[13] Official Gazzette of Italian Republic. Decree of the president of the council of ministers 12 October 2021. Available at: https://www.gazzettaufficiale.it/eli/id/2021/10/14/21A06125/sg. Accessed on 15/06/2022
[14] Official Gazzette of Italian Republic. Decree of the president of the council of ministers 12 October 2021. Available at: https://www.gazzettaufficiale.it/eli/id/2021/10/14/21A06125/sg. Accessed on 15/06/2022
[15] Rzymski P, Borkowski L, Drąg M, Flisiak R, Jemielity J, Krajewski J, Mastalerz-Migas A, Matyja A, Pyrć K, Simon K, Sutkowski M, Wysocki J, Zajkowska J, Fal A. The Strategies to Support the COVID-19 Vaccination with Evidence-Based Communication and Tackling Misinformation. Vaccines (Basel). 2021 Feb 1;9(2):109. doi: 10.3390/vaccines9020109.
[16] Franco JVA. Should COVID-19 vaccination be mandatory? BMJ Evid Based Med. 2021 Dec;26(6):269-270. doi: 10.1136/bmjebm-2021-111813.
[17] The New York Times. CDC director warns of a ‘pandemic of the unvaccinated’. Available at: https://www.nytimes.com/2021/07/16/health/covid-delta-cdc-walensky.html. Accessed on 23/06/2022
[18] Ledda C, Costantino C, Liberti G, Rapisarda V. The Italian Version of the Adult Vaccine Hesitancy Scale (aVHS) for the Working-Age Population: Cross-Cultural Adaptation, Reliability, and Validity. Vaccines (Basel). 2022 Jan 31;10(2). doi: 10.3390/vaccines10020224.
[19] Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz MA, Hernán MA, Lipsitch M, Reis B, Balicer RD. BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N Engl J Med. 2021 Apr 15;384(15):1412-1423. doi: 10.1056/NEJMoa2101765.
[20] Tanveer S, Rowhani-Farid A, Hong K, Jefferson T, Doshi P. Transparency of COVID-19 vaccine trials: decisions without data. BMJ Evid Based Med. 2021 Aug 9:bmjebm-2021-111735. doi: 10.1136/bmjebm-2021-111735.
[21] Vaz OM, Ellingson MK, Weiss P, Jenness SM, Bardají A, Bednarczyk RA, Omer SB. Mandatory Vaccination in Europe. Pediatrics. 2020 Feb;145(2):e20190620. doi: 10.1542/peds.2019-0620.
[22] Costantino C, Rizzo C, Rosselli R, Battista T, Conforto A, Cimino L, Poscia A, Fiacchini D. Ten Actions to Counteract Vaccine Hesitancy Suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health. Vaccines. 2022; 10(7):1030. https://doi.org/10.3390/vaccines10071030.
[23] Islam MS, Sarkar T, Khan SH, Mostofa Kamal AH, Hasan SMM, Kabir A, Yeasmin D, Islam MA, Amin Chowdhury KI, Anwar KS, Chughtai AA, Seale H. COVID-19-Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020 Oct;103(4):1621-1629. doi: 10.4269/ajtmh.20-0812.
[24] Costantino C, Graziano G, Bonaccorso N, Conforto A, Cimino L, Sciortino M, Scarpitta F, Giuffrè C, Mannino S, Bilardo M, Ledda C, Vitale F, Restivo V, Mazzucco W. Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19. Vaccines (Basel). 2022 Mar 18;10(3). doi: 10.3390/vaccines10030475;
[25] Costantino C, Caracci F, Brandi M, Bono SE, Ferro A, Sannasardo CE, Scarpitta F, Siddu A, Vella C, Ventura G, Vitale F, Casuccio A, Restivo V. Determinants of vaccine hesitancy and effectiveness of vaccination counseling interventions among a sample of the general population in Palermo, Italy. Hum Vaccin Immunother. 2020 Oct 2;16(10):2415-2421. doi: 10.1080/21645515.2020.1728157
[26] Benin AL, Lockwood G, Creatore T, Donovan D, Predmore M, MacArthur S. Improving Mandatory Vaccination Against Influenza: Minimizing Anxiety of Employees to Maximize Health of Patients. Am J Med Qual. 2018 Jul;33(4):372-382. doi: 10.1177/1062860617748738
[27] Spitale G, Biller-Andorno N, Germani F. Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach. J Med Internet Res. 2022 Feb 16;24(2):e34385. doi: 10.2196/34385.
[28] Wilf-Miron R, Myers V, Saban M. Incentivizing Vaccination Uptake: The "Green Pass" Proposal in Israel. JAMA. 2021 Apr 20;325(15):1503-1504. doi: 10.1001/jama.2021.4300.
[29] BBC News. COVID passes set to stay as Europe heads for winter. Available at: https://www.bbc.com/news/world-europe-58973334. Accessed on 06/06/2022