Abstract

This study explores the evolving dynamics of vaccine hesitancy and refusal (VHR) during the COVID-19 pandemic, highlighting the shift from a simple dichotomy to a nuanced continuum including cautious acceptance, a «wait and see» approach, and firm refusal. Based on 42 in-depth interviews conducted between August 2021 and March 2023 with 22 vaccine refusers and 20 vaccine- hesitant individuals from central-northern Italy, the research spans ages 21 to 69 across diverse demographics. The findings reveal significant differences in trust towards health authorities and vaccine information. Hesitant individuals maintain some trust and seek assurances, while refusers exhibit deep-rooted skepticism, especially regarding pharmaceutical influences and government mandates. Misinformation impacts both groups differently; hesitants seek credible clarifications, while refusers view misinformation as validation of their doubts. Personal health beliefs are crucial, with hesitants concerned about vaccine safety and efficacy, and refusers opposing vaccines on ideological grounds. The study underscores the importance of autonomy in health decisions and the need for informed choices. Both groups struggle with conflicting information, highlighting the need for clear, accessible, and respectful communication that addresses diverse concerns within the VHR spectrum.