Crossing the border: Adherence to the Vaccination Campaing in multicultural provinces of South-Tyrol during COVID-19 Pandemic, a cross-sectional study

Objectives and Background: “South-Tyrol” Alpine region in Italy is administered as an “autonomous statute region”, bordering Austria. This geographically heterogeneous environment is divided in 20 districts and is inhabited by a unique multicultural population. Poor evidence exists on factors influencing adherence to vaccination in peculiar contests, therefore The aim of this study was to investigate the role played by geographical, cultural and socio-demographical characteristics on COVID-19 vaccination adherence during the first year of the Italian vaccination campaign. Methods: We carried out an ecological study by analysing data collected from each district of South-Tyrol: altitude, population density, linguistic belonging, Austrian border proximity, cultural heritage, winter tourism, COVID-19 incidence, complete primary vaccination cycle and booster dose. Data refer to February 2022, one year after the beginning of the vaccination campaign. Spearman correlation, Kruskal-Wallis and Mann-Whitney-U tests were performed to assess relationships between variables. Results: On February 2022 district percentages of vaccination adherence varied widely ranging between 57.1% and 74.8%. Adherence to vaccination appears to be negatively correlated to altitude (Rho=-0.626, p=0.003; Rho=-0.693, p<0.001, respectively for primary vaccination and booster dose) and positively correlated to population density (Rho=0.585, p=0.007; Rho=0.600, p=0.005). Furthermore, primary vaccination appeared significantly lower in districts with a higher prevalence of German speaking population (69.2% vs 74.7%, p<0.05) and in those more isolated or with a prevalent German cultural heritage. Conclusion: In analysing vaccination adherence, diversity in geographic, demographic and cultural factors should be taken in great account, even when the target population appears homogeneous from a clinical standpoint and overall adherence to vaccination campaign is satisfying. To plan a more effective and homogeneous vaccination campaing, specific public health interventions more focused on cultural heritage and geomorphological peculiarities should be considered and implemented for specific subpopulations and areas