The introduction of the vaccination obligation often reflects a compromise between the protection of public health and the socio-cultural context of reference, and represents a defeat for those who deal, in various capacities, of public health. An open and informed discussion is essential to reason on measures that are capable of leading to an increase in the vaccinated population without recourse to coercion
The opinions expressed by the author in this article are personal and do not necessarily reflect those of the institution to which they belong.
The Italian vaccination calendar provides for the prevention of infectious diseases in children the administration of 15 vaccines, to which is added the vaccine Antipapillomavirus recommended for girls and boys after the age of 11 years of age.
Some of these vaccines are mandatory, others recommended. Why is this difference exist? It is a question to which it is not easy to provide an answer, but above all it is difficult to clarify that the choice to impose a mandatory vaccine It is not oriented by objective data obtained in the course of scientific studies, but by reasons of health policy.
Mandatory vaccines in Italy
We make a short excursus to understand from where the obligation of vaccinations is born in our country.
In Italy, until 2017 there were 14 vaccines available for children (basically the same as today, with the exception of the influence that was not yet recommended). The vaccination obligation concerned only antidifteritis, antipolio, antitano and anti -epatitis B. except the latter, introduced in 1991, the other vaccines had been introduced between the 1930s and 1960s, in a social and health context very different from the current one, in which it was frequent that the public health interventions were accompanied by coercive measures, for the purpose, even, in short, With possible very serious consequences.
Before mass vaccinations, around 10,000 cases of diphtheria and 3,000 of Polisi del Poliomielite viruses were recorded every year in Italy. These were, therefore, diseases with an impact on the population such as to justify a mandatory vaccine for these diseases. After the start of the vaccination campaigns, the incidence of these diseases has drastically reduced: as regards polomielite, the last case of wild virus infection was reported in 1982.
In light of the change in the epidemiological situation, which had seen a clear decrease in infectious diseases thanks to vaccines, and a new socio-cultural context, it had begun to warn the need to overcome the concept of Obligation of vaccinationsto privilege theconscious adhesion and informed to vaccination by parents; This approach has been experienced concretely, starting from 2007, in the Veneto Region, which for ten years has suspended the vaccination obligation.
During 2017, however, there was a new change in vaccination policies: with a decree law of the Minister of Health Beatrice Lorenzin, then converted into law (119 of 31 July 2017), i Mandatory vaccines They go from 4 vaccines to 10 and are combined in two vaccinations:
- hexavalent (against diphtheria, tetanian poliomelitis, hepatitis B, pertussis, Haemophilus influenceand type B), administered in three doses during the first year of life (with subsequent references for diphtheria-tetano-tapecosse-pilio)
- Tetravalent (also known as Mprv vaccine, against measles, parotitis, rosolia, chickenpox), administered between 12 and 15 months of age and subsequently with a second dose between 5 and 6 years.
Non -vaccinated children cannot attend nursery schools and schools for children, while enrollment in primary and secondary school is allowed. Administrative penalties are planned for parents.
The extension concerning compulsory vaccination was introduced for the concern due to the drop in the percentage of vaccinated children, in particular against measles, a highly contagious disease and with possible serious consequences (pneumonia, encephalitis), potential long -term damage and risk of death, especially in subjects who have a weakened immune system.
To avoid that the Morbillo Virus Circles within a community it is necessary that 95% of people be immune (for vaccination or for having already contracted the infection): in 2016 children under the age of 2 vaccinated against measles were 87%, a share well below the threshold that guarantees immunity to the whole community.
Recommended vaccines
The compulsory antimorbillo vaccine therefore protects fragile subjects (for example those who are under treatment for a tumor) who cannot get vaccinated and that would run serious risks if they get sick.
However, it must be clarified that in other cases the extension of the vaccination obligation did not have as a predominant motivation to protect the community, but it was a pragmatic intervention, due to the fact that in Italy (and the same applies to many other European countries) Single vaccines are not availablebut only combined. For example, even before 2017, the hexavalent, in practice, was a mandatory vaccination, despite two of the vaccines that contains it were not, because it was extremely difficult to vaccinate only against polio, tetanus, diphtheria and hepatitis B.
If then some vaccines, today, are recommended and not mandatory, it does not mean that they are less importantbut simply that benefit the health of the individual rather than the community as a whole, so coercion is not justified.
Specifically, in addition to mandatory vaccines, among the Recommended vaccines We find those against:
- Rotavirus;
- pneumococcus;
- some types of meningococcus (B and ACWY);
- influenza;
- Antipapillomavirus (recommended between 11 and 12 years of age).
Vaccinal obligation: what is the situation at European level?
Most European countries believe that the negative repercussions of the compulsory are greater than the potential benefits: 18 of the 30 States that are part of the European Union and the European Economic Space (EEA) do not provide for mandatory vaccines. With the exception of France, Italy and Malta, the most extensive vaccination obligation are the Eastern European countries who were part of the USSR.
Even among the countries that have decided to adopt the vaccination obligation, however, the number and type of vaccines varied. That Against Poliomielite It is the only mandatory in all 12 states, while the one with measles is mandatory in 11. The anti-artivaricella, on the other hand, is mandatory only in Italy, Latvia and Hungary, while France, in order to avoid confusion, has decided to make all the childhood vaccines required on its vaccination plan (hexavalent, measles-parotitis-rosolia, antipneumococcus and antiminguococcus c), becoming so the only one. European nation to have provided the obligation for the vaccine against meningococcus C.
In general, there is no correlation between the presence of vaccination obligation and the percentage of vaccinated children: High covers are also observed in countries that do not have mandatory vaccines and, vice versa, countries that provide for the obligation may have insufficient covers.
Is the vaccination obligation effective?
Five years after the introduction of thevaccination obligation in Italy The roofs have increased, especially for the measles vaccine: from 87% in 2016 to 94% in 2022. It could therefore be concluded that the obligation is useful and necessary, but it would be a hasty interpretation: the situation is a little more complex than that. Although useful, in fact, the measure of the obligation, alone, is not sufficient to guarantee the achievement of immunity by the population. 94.4% of vaccinated recorded in Italy does not return the extreme regional variability, which has an interval between 76% and 98%; Only in 6 regions the 95% threshold needed to prevent the circulation of the virus has been reached or exceeded.
Beyond the obligation, therefore, it is necessary to intervene with other measures that favor vaccination: for example, improve information And communication because you acquire greater awareness of the benefits obtainable with vaccines, improve access to the latter (with adequate diffusion in the area and times compatible with daily commitments) and also improve the welcome of healthcare professionals and places where vaccination takes place.
THE’Vaccinal hesitationin fact, it is a complex phenomenon, and it is wrong to believe that all parents who do not vaccinate it because they are ideologically contrary to vaccinations: the data that emerges from the sample investigations conducted in Italy is that the share of parents strongly contrary to any vaccine is between 1 and 3%, while 15% nourish doubts or fears towards some vaccinations.
The vaccination obligation, therefore, risks representing a simplistic answer, while the question requires one plurality of interventions. Experts that deal with vaccination policies underline the potential risks of coercive measures: the latter risk, for example, to reduce a trust already compromised towards doctors and institutions, further polar the positions, increase confusion, and pushing the parents hesitant towards a more clear opposition.
These are problems that emerged forcefully during the Covid pandemic: the adoption of the Green pass And the introduction of the obligation of the vaccine for the over 50s has increased the resentment towards the health institutions of a part of the population, numerically small but also constituted by people who, not contrary to the vaccines, nourished concerns towards that specific type. It is therefore necessary to carefully evaluate both positive and negative impacts of the measures of vaccination obligation, also to be able to plan effective strategies in the event of future public health emergencies.
Mandatory vaccination is not a dogma
That vaccinations must be mandatory is not a dogma. In some contexts (historical, territorial, cultural), inserting the vaccination obligation can be a useful measure to protect the health of the community, but it would be necessary to plan and implement other interventions with the perspective, in the future, to eliminate coercive measures.
There is a consensus between those who deal with vaccinations in believing that coercive measures should represent one Extrema Ratio To resort to when other interventions were not sufficiently effective or when there is no time necessary to put them into practice, and they should still be adopted for a limited period of time. It is good to always keep in mind that the recourse to compulsory vaccination represents a defeat For those who deal with public health at different levels (politicians, administrators, health workers) and for the whole community. Finally, it should be reiterated that it is completely legitimate to discuss the vaccination obligation, but when it is done only for political interests or on the basis of prejudices, the debate is sterile and counterproductive.
