Influenza vaccine refusal among healthcare workers: A cross-sectional study

Seasonal influenza poses a persistent public health burden, and vaccination of healthcare workers is a key preventive measure. Despite availability, influenza vaccination coverage among healthcare workers remains suboptimal, often influenced by vaccine hesitancy and risk perception. This study aimed to investigate the motivations underlying influenza vaccine refusal among healthcare workers in a large tertiary university hospital in Italy during the 2025/2026 vaccination campaign.

A cross-sectional design was employed. During the 2025/2026 influenza vaccination campaign, 6079 healthcare workers were invited to receive on-site vaccination. Returned refusal slips were analysed for nine predefined reported reasons for non-acceptance of the on-site vaccination invitation, which were grouped into composite indicators: hesitancy, perceived invulnerability or low risk perception, and pragmatic/contextual or other reasons. Associations with professional category and age were assessed using Fisher-Freeman-Halton exact tests. The study received acknowledgement from the Territorial Ethics Committee CET-ACEV: 0021766 23.02.2026.

Of 5935 eligible healthcare workers, 1370 received on-site influenza vaccination through the hospital campaign, corresponding to an on-site uptake of 23.1%. Among 4565 healthcare workers without recorded on-site vaccination, 839 returned a refusal slip with at least one reported reason (18.4%). The most frequent individual motivation was low perceived need for vaccination (36.8%), followed by previous negative experiences (18.0%). Hesitancy-related motivations were reported in 33.3% of refusals, while invulnerability-related motivations accounted for 46.1%. Age-stratified analyses among healthcare professionals who returned a refusal slip showed a strong association between younger age and invulnerability-related reasons. Only 5.5% of refusal slips reported multiple motivations, frequently spanning different domains.

Among refusal-slip respondents, reported reasons for non-acceptance of the on-site vaccination invitation were more frequently related to low perceived personal risk than to classic vaccine hesitancy. Age-stratified findings, restricted to healthcare professionals, suggested that younger respondents more often reported invulnerability-related reasons. Given the voluntary return of refusal slips and the limited proportion of respondents among healthcare workers without recorded on-site vaccination, these findings should not be generalized to all healthcare workers who did not receive vaccination through the hospital campaign.