Vaccine Hesitancy during the Coronavirus Pandemic in South Tyrol, Italy: Linguistic Correlates in a Representative Cross-Sectional Survey

Abstract

Background: German is a minority language in Italy and is spoken by the majority of the inhabitants of the Autonomous Province of Bolzano, South Tyrol. Linguistic group membership in South Tyrol is an established determinant of health information-seeking behavior. Because the COVID-19 incidence and vaccination coverage in the second year of the pandemic in Italy was the worst in South Tyrol, we investigated whether linguistic group membership is related to COVID-19 vaccine hesitancy. Methods: A cross-sectional survey was conducted on a probability-based sample of 1425 citizens from South Tyrol in March 2021. The questionnaire collected information on socio-demographics, including linguistic group membership, comorbidities, COVID-19-related experiences, conspiracy thinking, well-being, altruism, and likelihood of accepting the national vaccination plan. Multiple logistic regression analyses were performed to identify the significant predictors of vaccine hesitancy. Results: Overall, 15.6 percent of the sample reported vaccine hesitancy, which was significantly higher among German speakers than among other linguistic groups. Increased hesitancy was mostly observed in young age, the absence of chronic disease, rural residence, a worsened economic situation, mistrust in institutions, and conspiracy thinking. In the multiple logistic regression analyses, linguistic group membership was not an independent predictor of vaccine hesitancy. Conclusion: Although German is a minority language in Italy and COVID-19 vaccine hesitancy was higher in the German native language group than in the Italian, linguistic group membership was not an independent predictor of hesitancy in the autonomous province. Known predictors of vaccine hesitancy are distributed unevenly across language groups. Whether language group-specific intervention strategies to promote vaccine hesitancy are useful requires further study.

Special roles of rural primary care and family medicine in improving vaccine hesitancy

“…Finally, national public health institutions placed less trust in pandemic management, as was their trust in local authorities, civil protection and local health services. Similarly to the effects of language group membership on vaccine hesitancy, 18 neither rural nor urban residence was an independent predictor in the regression analyses. The relatively higher vaccination hesitancy in rural areas of more than 1/3 can be adequately explained by known predictors.…”

“…The results showed vaccination hesitancy in 15.6% of participants. 18 Increased hesitancy was mostly observed in young patients with an absence of chronic disease, mistrust of institutions and conspiracy thinking. Also, worse economic situation was linked to vaccine hesitancy.…”

“…However, a linguistic group was not an independent predictor of vaccine hesitancy. 18 Since more members of the German-language group live in rural areas than in urban areas, and because rurality is a known risk factor for increased vaccination hesitancy, it was natural to look more closely at the question of the influence of residence type on vaccination hesitancy. A second analysis of the survey data showed that hesitant vaccination behaviors were significantly higher in rural than in urban areas (17.6% compared to 12.8%, p = 0.013).…”

Vaccine Hesitancy and Public Mistrust during Pandemic Decline: Findings from 2021 and 2023 Cross-Sectional Surveys in Northern Italy

“…The “COVID-19 Snapshot Monitoring” (COSMO) survey [ 9 ], a European instrument that has been repeated in several countries including Italy [ 10 ] since 2021, has played a key role in assessing public attitudes towards pandemic-related health measures. In response to the historically high level of vaccine hesitancy in South Tyrol, Italy [ 11 , 12 ], the 2021 application of the COSMO survey in this northern Italian province included additional questions to improve our understanding of public trust in information sources, perceptions of health institutions, the role of altruism, and attitudes towards vaccines [ 13 , 14 , 15 ].…”

“…The main objectives of the first and second surveys carried out in 2021 [ 13 , 14 , 15 ] and 2023 in South Tyrol were to explore the dynamics of vaccine acceptance in a region characterized by low vaccine uptake [ 16 ] against the background of linguistic and cultural diversity [ 17 ]. The 2023 survey added new elements to better understand the acceptance of vaccines.…”