Exploring the effectiveness of the Green Pass Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area.


COVID-19 vaccination
Green Pass Law
Mandatory vaccination


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.



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