Prevalence of vaccine hesitancy in Italy: a cross-sectional study

Background Vaccine hesitancy (VH) remains a global threat, exacerbated by socio-political uncertainty. We aimed primarily to estimate VH prevalence in Italy, identifying the most susceptible subgroups, and secondarily to assess whether these patterns varied across VH dimensions. Methods Cross-sectional survey (web/telephone) among adults in Italy (September 2024–March 2025). The sample (n = 52,094) was nationally representative by age, gender, education, area, municipality size. The primary outcome was VH (score ≥25, adult Vaccine Hesitancy Scale, aVHS). The secondary outcomes were aVHS subscales “Lack of trust” and “Risk perception”. Post-stratification weighting for age, area, and municipality size was applied. Findings VH prevalence was 46.09% (95% CI: 45.65–46.53%). Multivariable models showed several associations with VH, e.g., gender, sexual orientation, ethnicity, health literacy, political and religious orientation, personal experiences, and vaccination support from community figures. Among many subgroups significant after multiplecomparison correction, the strongest differences in VH predicted probability (PP) were estimated among individuals using complementary/alternative medicine (PP = 58.5%), right-aligned (PP = 47.0%) or politically unaffiliated participants (PP = 48.4%), individuals with middle school education (PP = 48.3%), people aged 60–74 (PP = 49.0%), and participants uncertain about healthcare workers’ pro-vaccination support (PP = 52.8%). While some groups, e.g., individuals with chronic conditions, inadequate health literacy, or religious participants reported higher perceived risk, others, e.g., non-binary respondents, showed higher lack of trust. Interpretation This study highlighted the importance of granular data to inform inclusive strategies. Key figures and politics emerged as relevant, deserving further exploration. Future research should evaluate tailored interventions for identified at-risk groups.