The situation is fraught: even within the same regional territory, very different protocols are in place regarding infection prevention policies, both in facilitating access to vaccines and in conducting screenings.
This is the picture emerging from a survey conducted in Italy by the civic participation NGO Cittadinanzattiva conducted in late April. The survey indicated that, in general, northern regions tended to limit access, by suspending or postponing some vaccinations, predominantly those aimed at teenagers, adults, and travel-related needs. However, some regions such as Marche, the Autonomous Region of Trento and Umbria are not even completing unfinished cycles of compulsory vaccinations.
Vaccination services in Piemonte have shut down completely and indefinitely; while Lombardia, despite the seriousness of the pandemic, reopened all vaccination programmes since 14 April.
The inexplicable decision to close vaccination clinics was adopted in Sicily, where the infection rates were significantly lower even at the peak of the outbreak; Messina closed entirely; and in Palermo only the first sets of inoculations are guaranteed.
Meanwhile vaccination services remain regularly active in Lazio, Valle d’Aosta, Calabria and Puglia. Veneto, Abruzzo, Sardegna and Toscana currently guarantee only the vaccinations which are compulsory for the 0-6 age group, thus closing the possibility of booster doses expected beyond that age group – although Sardegna also permits vaccinations for certain vulnerable populations.
Emilia Romagna also presents a very uneven situation: while in Ferrara patients can receive any vaccination, Bologna only suspended those for travel-related needs; Imola will only allow pediatric vaccinations; Parma has suspended all HPV vaccinations aside from those which were already scheduled. In the Marche and Trento, the only permitted vaccinations are those which are necessary for the 0-2 age group.
Uneven and erratic
In short, the Cittadinanzattiva’s survey on disease prevention services highlights an uneven situation both between regions and even between different areas of the same region; with many vaccination centres posting messages to the effect: ‘Come back later…I can’t tell you when’.
The level of uncertainty this implies is both confusing and potentially dangerous for citizens. Stopping vaccination programmes is an inherently flawed strategy – not only because doing so suggests that vaccination services are not essential, after all the years spent to make the public understand the importance of them; but also, and most urgently, because it heightens the risk of the return of serious pathologies such as measles or meningitis, or exposing young patients to a potential onset of tumours, by blocking vaccinations for HPV and Hepatitis B.
For Cittadinanzattiva, a civic organisation which promotes citizens’ activism for the protection of own rights, maintaining the common good, and offering the support for people in vulnerable conditions, it is not acceptable to respond to the immediate needs of citizens in the face of Covid19 simply by closing services. Alternative organisational solutions are therefore needed to guarantee continuity in the service; and in doing so to resume vaccination campaigns, which are extremely important even at this stage.
A fundamental component of healthcare
The World Health Organization (WHO), in particular, recently stressed that vaccinations are a fundamental component of health services; and that their interruption, even if for a short period, would lead to an accumulation of people susceptible to a greater risk of vaccine-preventable disease outbreaks. This in turn would render certain categories of people more vulnerable to disease or even death, as well as increasing the burden on healthcare resources in order to cope with them. According to the WHO, it is essential to keep vaccination appointments, especially for routine vaccinations.
Director-General of UNICEF, Henrietta Fore, has echoed the WHO. In her recent official statement, she expressed her concern on finding that: “As the pandemic progresses, essential lifesaving services, including vaccinations, will likely be interrupted, especially in Africa, Asia and the Middle East, where they are extremely necessary.”
Unfortunately, the coronavirus pandemic has already dealt a blow to measles control efforts. According to one study, “already 23 countries have suspended planned measles campaigns and 78 million children worldwide will not be vaccinated as it was previously planned.” The study goes on to warn of the negative impact that the cancellation of vaccination campaigns could have on rates of immunity to this dangerous and still widespread disease.
In Italy, continued adherence to vaccination guidelines as well as a return to full capacity for vaccination centres – obviously under conditions of maximum safety for both health professionals and patients – is also justified in view of a possible overload in the months to come, regardless of the potential discovery and commercialisation of a Covid-19 vaccine.
Recognising the value of immunisation, the Italian Federation of General Practitioners (FIMMG) and Cittadinanzattiva have recently written to the Italian Government and to all regional authorities to propose a flu and pneumococcal vaccination campaign, with a projected start in early October 2020, with the age at which patients can receive the vaccine for free lowered to 55 years.
While we are aware that the pandemic has forced Italy’s entire public health infrastructure and personnel to concentrate their efforts and activities on the management of the emergency, a planning effort with measures that can ensure the efficient performance of the next vaccination awareness campaign in the second half of the year is entirely appropriate.
The real risk is that we could find ourselves in October with insufficient stocks of vaccines, thus repeating the dramatic experience of personal protective equipment shortages during the most crucial days of the pandemic.
Mariano Votta, Director, Active Citizenship Network