The vaccine and vaccination against Covid-19: the propensity of the Italian population to join the vaccination campaign. A large scale survey by Agenas and Management and Healthcare Laboratory (MeS) of the Sant'Anna School
The Italian public administration is often used as an example of the so-called implementation gap: ambitious and technically advanced projects tend to betray the expectations during the implementation phase, producing lower impacts than potential ones. The provision of health services and, in particular, the successful implementation of a mass vaccination campaign against Covid-19 may well fall within this generalised trend.
The use of behavioural science theories and experimental research methodologies is increasingly widespread internationally to bridge the implementation gap in public policy across industries. In this respect, the Nudge theory elaborated by Richard Thaler, Nobel Prize in Economics in 2017, and Cass Sunstein (2008)1 and tested on the field by many, including Abhijit Banerjeez, Esther Duflo and Michael Kremer, Nobel Laureates for Economics in 2019, assumes a strategic relevance. Nudges are choice architecture interventions that alter people's behaviour predictably without preventing the choice of other options and without significantly changing economic incentives.
Based on this evidence, this project maps the attitudes of the Italian population towards the vaccine and vaccination against Covid-19 and the sources of information relating to the virus, studies some behavioural causes that can lead to a deficit of implementation regarding the acceptance of the vaccination campaign against Covid-19, and proposes some practical implications to policy makers and public managers at the national and regional health service.
To this end, AGENAS in collaboration with the Management and Healthcare Laboratory (MeS) of the Sant'Anna School conducted a large-scale survey involving 12,322 Italian residents, combining observational and experimental methodologies. Results allow the formulatation of some practical implications. More generally, the project presented in this document can serve as an example of a methodology to be adopt extensively to obtain timely assessments of citizens' attitudes and preferences. This is useful to inform at an early stage a wide range of public policies, which include the propensity to join a vaccination campaign in the face of an unprecedented pandemic.
In particular, the combination of observational and experimental survey methodologies makes it possible to estimate the relative importance that citizens attribute to the different characteristics of public interventions that are intrinsically multidimensional, especially when managing exceptional health emergencies.
Objectives
Based on the evidence summarised above, the project described in this document explored three relevant issues, which are current in the public debate and in the working agendas of decision makers dealing with health services at different government levels.
· First, the questionnaire measured the attitudes of the Italian population towards the vaccine and vaccination against Covid-19. This section also makes it possible to define the profile of those who are more or less inclined to get vaccinated.
· Second, the survey investigated issues related to information on vaccine and vaccination against Covid-19, on which the Italian population requires more information and what are the desired communication channels.
· Third, the questionnaire investigated the relative importance of several factors in influencing the propensity to get vaccinated against Covid-19. Overall, the project provides a tool and evidence useful for implementing the COVID-19 vaccination campaign and, more generally, health policies that are multidimensional in nature.
Methodology
This project envisaged the administration of an online questionnaire to a sample of the Italian adult population. The questionnaire combined the use of observational and experimental methodologies to provide solid evidence, propose practical implications, and suggest some priority lines of intervention. The use of a multi-method approach is in line with recent practices suggested by the international academic literature for the study of complex situations.
The sections of the observational questionnaire asked participants to express their degree of agreement regarding a series of statements, on a scale going from strong disagreement to strong agreement. In other observational questions, participants selected one or more options from a predefined list of answers. The sections of the experimental questionnaire included in the survey described in this document use two research designs. In the discrete-choice experiment, individuals choose between two alternative scenarios that vary in a systematic and controlled manner with respect to a series of levels for a set of predetermined attributes.
The second experimental design adopted in the questionnaire uses randomised experiments. In this case, survey respondents make a decision after reading a scenario in which the variables of interest are modified in a controlled manner. The subsequent sections of the document explain the details for each research method used.
In light of the research areas explained in the previous section, the survey involved 12,322 respondents residing in all Italian regions and recruited by Qualtrics Software Company. The data collection took place between 22 December 2020 and 28 January 2021. This time window provided a unique environment for answering our research questions. Indeed, on the one hand the historical contingencies made the questionnaire simultaneously realistic, tangible and relevant, on the other hand the survey offers a snapshot that can be used in a comparative way in the study of the same phenomena in relatively lower emergency situations, for example with reference to the uptake of vaccination coverage against the seasonal flu.
Results: Attitudes about the vaccine and vaccination against Covid-19.
This section shows the answers to the questions that investigate the attitudes of the Italian population towards the vaccine and vaccination against Covid-19; for each question, the detailed responses at regional level are also reported. In order to correctly represent the experience of the entire reference population (Italian population residing in the 21 regions and autonomous provinces) with the results collected, a sample weight was constructed for each stratum of the sample. Indeed, according to the principle on which the sample estimation method is based, the units belonging to the sample also represent the units of the population that are not included in the sample itself. For this to happen, it is necessary to attribute to the responding units a sample weight indicating the number of units of the population that the unit represents. The sample weight was calculated starting from the direct weight, which in turn was multiplied by a correction factor for non-response, necessary to ensure that the responding units also represent the non-responding units.
The results presented in this section therefore refer to the entire Italian population. The questions in this section were presented to respondents as statements about which the respondent had to express his or her level of agreement or disagreement on a five-point Likert scale. The following pages show the results relating to the perceptions of the population with respect to the following macro-themes, in order: risks of the disease and vaccination, vaccines and pharmaceutical companies, propensity to get vaccinated oneself and family members, knowledge of the vaccine and possible incentives to get vaccinated.
