Vaccine hesitancy is anything but homogeneous: The social representations of COVID-19 vaccines among not hesitant and slightly hesitant vaccinated adults

Vaccine hesitancy (VH) among vaccinated individuals remains a relatively under investigated topic. This study contributes to fill this research gap by examining the social representations of COVID-19 vaccines among vaccinated Italian adults. Using a mixed-method approach, we analyzed data from 664 vaccinated Italian adults through hierarchical cluster analysis and similarity analysis. Results revealed distinct representational patterns between non-hesitant and slightly hesitant adopters despite their shared vaccination status. While safety emerged as a core element in both groups' representations, non-hesitant participants expressed a more positive affective-cognitive orientation anchored in scientific trust whilst slightly hesitant adopters exhibited persistent ambivalence, with emotional elements (particularly fear and anxiety) playing a prominent role. The findings challenged the assumption that VH reflects complete vaccine refusal and suggests the need for tailored public health communication strategies. The results indicate that interventions should consider VH levels and variability beyond the mere dichotomy hesitant-not hesitant. Recommendations are discussed.