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Background Vaccine hesitancy among general population can be even greater regarding flu than other vaccine preventable diseases, as complacency towards influenza is quite high and confidence can be reduced by the confounding effect of influenza-like-illnesses. Health professionals face hesitant people alleging many different motivations against flu vaccination, some of them being susceptible to tailored one-to-one health promotion. Methods During 2019/20 flu vaccination campaign, 44 trained pharmacists of Carnia District in Friuli Venezia Giulia Region (Italy) surveyed at-risk people accessing 25 pharmacies regarding beliefs on flu vaccination and offered one-to-one advice. As stated in the Italian national vaccination plan, subjects with comorbidities or older than 65 were considered at risk. Adherence to influenza vaccination during past flu season and reasons for that choice, as well as intention to be administered flu shots after counseling were registered. Results A total of 2,748 at-risk subjects adhered to the project with a mean age of 70±12 years, 57% of them being females; 1,702 (38%) did not adhere to flu vaccination campaign last year. Most of them confirmed a low complacency level, reporting to have refused flu vaccination because of “not getting ill” (43%) believing that vaccines are dangerous (12%) or not effective (5%); some did not know they could access flu vaccination (8%). After counseling, 2196 (80%) decided to adhere to flu vaccination, in particular 83% (1284/1555) of over 65 and 84% (684/816) of at-risk subjects. Conclusions More than one third of over 65 or at-risk surveyed subjects did not receive influenza vaccination during 2018/19 flu season. One-to-one tailored counseling conducted by pharmacists resulted to be effective in tackling vaccine hesitancy among 2019/20 flu shot target population. Key messages Motivations underlying vaccine hesitancy toward flu vaccination continue to impair health outcomes of target population. A one-to-one counseling intervention conducted by pharmacists with specific targets should be useful to improve seasonal flu vaccine coverage.

Pharmacists’ one-to-one counseling succeeds in promoting flu shots among target population