Exploring the Relationship between COVID-19 Vaccine Refusal and Belief in Fake News and Conspiracy Theories: A Nationwide Cross-Sectional Study in Italy.

The COVID-19 pandemic has been accompanied by an infodemic, which includes fake news (FNs) and conspiracy theories (CTs), and which may worsen vaccine refusal (VR), thus hindering the control of the transmission. This study primarily aimed to assess COVID-19 VR in Italy and its relationship with belief in FNs/CTs. Secondarily, it explored the conviction in FNs and CTs and associated variables. An online cross-sectional study was conducted in Italy (2021). The primary outcome was VR and secondary outcomes were FN misclassification score (0% to 100%: higher score means higher misclassification) and CT belief score (1 to 5: higher score means higher agreement). There were 1517 participants; 12.3% showed VR. The median FN and CT scores were: 46.7% (IQR = 40-56.7%) and 2.8 (IQR = 2.2-3.4). Age, education, FN, and CT scores had significant associations with VR. Education, economic situation, health and e-health literacy showed significant relationships with secondary outcomes. Study/work background had a significant association only with the FN score. FN and CT scores were associated. This work estimated a VR lower than before the first COVID-19 vaccine approval. The relationship between VR and FN/CT belief represents a new scenario, suggesting the need for planning effective strategies to tackle FNs and CTs to implement successful vaccination campaigns.