Mistrust in Biomedical Research and Vaccine Hesitancy: The Forefront Challenge in the Battle against COVID-19 in Italy

"This evidence is worrying and deserves urgent consideration to plan dedicated initiatives to reassure the general population and to foster trust in biomedical research and in a potential future vaccination program against COVID19."

There is concern that the global effort to develop a safe and effective vaccine against the COVID-19 virus might be hampered by vaccine hesitancy, a phenomenon that has particularly impacted western countries. Italy is reportedly one of the countries with the highest rate of non-compliance to vaccination programmes in Europe. In a situation of great uncertainty (in daily life and in scientific advances), such as the one precipitated by the COVID-19 pandemic, the importance of citizens' trust in biomedical science as a factor affecting attitudes toward vaccination could be magnified. This study examined representative samples of the Italian population to understand citizens' willingness to accept a future vaccine against COVID-19.

During the early days of the initial spread of the SARS-COV-2 virus in Italy (phase 1 of the COVID-19 mitigation strategy), the researchers administered an online survey to a random, representative sample of 968 Italian citizens; a second random sample (n=1,004), still representative of the Italian population, was then recruited for a second wave of data collection during the early days of the Italian reopening after lockdown (phase 2).

The study showed that 59% of the respondents in phase 2 reported being likely to vaccinate for COVID-19 (namely, the percentage of respondents that answered 4, "likely", or 5, "very likely", on a Likert scale). Italian citizens' trust in scientific research decreased between the first and second phases of the Italian outbreak - from a mean value of 4.09 (standard deviation (SD)=0.87) to 3.89 (SD=0.91). Similarly, attitudes towards vaccines' efficacy decreased: from a mean value of 4.01 (SD=0.91) to 3.72 (SD=1.03). Willingness to vaccinate was positively correlated with both trust in scientific research and general attitude towards vaccines' efficacy.

These results indicate that the proportion of citizens that seem to have the intention to get the COVID-19 vaccine is probably too small to effectively stop the spread of the disease: Research indicates that between 55% and 82% of the population needs to be immune (through either exposure or vaccination) to gain herd immunity.

Considering that the results showed was no significant difference between smokers' and non-smokers' willingness to vaccinate against COVID19, the researchers indicate that at-risk populations require enhanced attention - not only because of their healthcare fragility but also because they may be psychologically less engaged in self-care and preventive behaviours and less aware of the importance of vaccination for their and their own community's safety.

More broadly, the researchers indicate that shifts in trust, such as that found in this study, need to be examined and addressed. This requires fostering a climate of mutual trust and cooperation between scientists and citizens, where scientific knowledge is not only disseminated but also cultivated and sustained through emphatic understanding of citizens' worries, needs for reassurance, and health expectations. "This implies creating a dialogue that is not aimed at top-down 'teaching' recommendations, but instead that is aimed to sensitize, educate, and engage the public towards scientific instances. Educational campaign[s] should not only explain the reasons behind some measures (hence increasing transparency), but also open a debate that allows concerns from the public - such as safety and urgency - to be expressed and, thus, properly addressed by the scientific community."

In conclusion, to help Italy foster uptake of a future COVID-19 vaccine, "public trust in scientific research should be considered as a multi-level phenomenon that is undoubtably affected by citizens' attitudes towards public health authorities and implementation forces. Therefore, citizens' engagement at those different levels should be pursued to actually realize a collaborative agenda between lay people and the scientific community."