The Italian Society of Hygiene, Preventive Medicine and Public Health (Siti) has expressed a “contrary” opinion on the abolition of mandatory vaccinations for measles, rubella, mumps and chickenpox. “Italy has always been at the forefront and the introduction of the obligation has allowed us to obtain, in a relatively rapid time, a significant increase in coverage”.
“The recent epidemiological data on measles – says Giovanni Gabutti, coordinator of the Working Group ‘Vaccines and vaccination policies’ of the Siti – clearly demonstrate that we cannot lower our guard and that, indeed, a further effort is needed to increase vaccination coverage. The idea of abolishing mandatory vaccination therefore has no scientific rationale and would carry the risk of both nullifying the efforts made in recent years and encouraging the appearance of new epidemic episodes of diseases that absolutely cannot be considered either defeated or banal”.
Siti recalls that “vaccinations are a primary prevention tool of extraordinary importance and are used with the aim of conferring a state of protection to subjects who, due to age, epidemiological, health, occupational or behavioral conditions, are exposed to the risk of contracting infectious diseases preventable by immunization, as well as that of obtaining control or elimination, when possible eradication, of infectious pathologies that correlate with severe clinical conditions, complications or for which there is no therapy”.
‘In recent years, a new reduction in coverage has been observed which has nothing to do with the obligation’
A vaccination program “has two effects, a direct one, whereby the vaccinated population becomes immune (which results in a reduction in the number of infections), and an indirect one, whereby, once a certain coverage threshold is exceeded, a lower number of cases of infection is obtained and therefore a reduced strength of the infection itself (herd immunity) – continues Siti – The herd immunity mechanism is triggered, however, when high vaccination coverage rates are achieved and maintained, generally ≥95% as specified in the National Vaccination Prevention Plan 2023-2025 which clearly indicates the coverage objectives to be achieved”.
Italy has always been at the forefront in the vaccination field and has historically achieved excellent results, especially in the pediatric age group. “However, starting from 2013 and for some years, there has been a progressive decline in coverage for both mandatory and recommended vaccinations, which has led to an average coverage of <95% in our country and therefore the risk of losing herd immunity. For this reason - Siti points out - Legislative Decree no. 73 of 7 June 2017 was issued - 'Urgent provisions on vaccination prevention' - amended by the Conversion Law of 31 July 2017, no. 119, which determined the mandatory nature of the following vaccinations for minors aged between zero and sixteen and for unaccompanied foreign minors: anti-polio, anti-diphtheria, anti-tetanus, anti-hepatitis B, anti-pertussis, anti-Haemophilus influenzae type b (through the use of the hexavalent vaccine) and anti-measles, anti-rubella, anti-mumps and anti-chickenpox".
The introduction of the obligation has allowed a significant increase in coverage for mandatory vaccinations to be achieved in a relatively short time. However, in recent years, a new reduction in coverage has been observed that has nothing to do with the obligation but, rather, with a global reaction to events related to the pandemic since the reduction in coverage concerns all vaccinations and not just mandatory ones”, the hygienists highlight.
‘Rather than removing the obligation, it is necessary to strengthen the Prevention Departments’
In the period January-May 2024, in Italy, 556 cases of measles were reported (22.7 cases per million inhabitants), of which 125 cases in the month of May. Most cases (89.7%) involved unvaccinated subjects; a further 4.9% of cases were recorded in incompletely vaccinated subjects. The median age of reported cases is 30 years and cases among healthcare workers (37 in 2024) and transmission in nosocomial settings were reported. Approximately 30% of cases presented at least one complication.
“It is ridiculous to even imagine that parents who are convinced of the effectiveness of vaccinations do not vaccinate their children just because they are obliged to do so and, to annoy the State, put their children’s lives at risk,” concludes Roberta Siliquini, President of the Italian Society of Hygiene. “Rather than removing the obligation, it is necessary to strengthen the Prevention Departments, which are currently underfunded, so that they have the resources necessary to better communicate with families, ensuring widespread and correct information.”
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