Hesitancy and compulsory vaccination: are non-mandatory vaccines the victims? A study on Italian regions.

Vaccination campaigns are estimated to prevent up to 3 million deaths worldwide annually, with their success relying on sufficient immunization coverage and adherence to programs. Recent health crises and measures like the EU Digital Covid-19 Certificate have renewed interest in the effectiveness of strategies such as recommendations, mandates, and sanctions. We analyze data on vaccinations for children aged 0-2 from Italian regions during the pre-pandemic period, 2013 to 2019. This includes both recommended and mandatory vaccines, as well as the introduction of a 2017 law mandating certain vaccinations. Our analysis shows the law increased vaccination rates for newly mandatory vaccines by up to 6%. Regional differences emerged, particularly in high-hesitancy areas where citizens tended to prioritize mandatory vaccines over recommended ones. In these regions, while coverage for mandatory vaccines improved significantly, recommended vaccines saw relatively lower attention, highlighting the need for policies that support comprehensive vaccination efforts.