COVID-19 vaccine uptake during the dark red risk zone restrictions: Insights from Italy

During the mass vaccination campaign against the Corona Virus Disease 19 (COVID-19), coloured risk zone restrictions were introduced in Italian regions to curb the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Of particular interest is the case of the Umbria region, which, due to an exponential increase in infections caused by two aggressive SARS-CoV-2 variants in early 2021, imposed ‘dark red risk zone’ restrictions. These were non-pharmacological measures that severely limited movement and personal freedoms in areas of Umbria during the rollout of mass vaccination. Combining severe risk zone interventions with the vaccination campaign may have impacted vaccine uptake decisions. This study analyses this issue by examining the case of the Umbria region using propensity score matching method combined with a panel event study design. The results show a significant decline in first doses towards the end of the restrictions. These findings may be relevant for policymakers who must balance the need to protect public health by controlling the evolution of a pandemic with the need to return to normal daily life through safe and effective vaccination.