Influenza vaccine supply in Italy during the COVID-19 pandemic

Valeria Fava, Isabella Mori, Mariano Votta, and Maira Cardillo of Cittadinanzattiva have curated the results of a civic survey on the supply of influenza vaccine doses across Italy.

Some early vaccination campaigns began between 1 October and 15 October; and some of these will be extended until 31 January 2021. However, while there has been a percentage increase in the purchase of influenza vaccines up to three figures, there remains a serious lack of vaccines in pharmacies across Italy.

Cittadinanzattiva’s civic survey was conducted to better understand this situation. It collected information from the following 10 Italian regions: Abruzzo, Campania, Emilia Romagna, Lazio, Marche, Puglia, Sicilia, Toscana, Umbria, and Valle d’Aosta. Some of these regions have demonstrated a significant increase in available doses, such as Puglia (+320%), Lazio (+112%), Tuscany (+68%), and Sicily (+65%), while others show less marked increases, such as Campania and Emilia (+20%). More details are available on the Cittadinanzattiva website.

This year, even more than in previous years, the importance of flu and anti-pneumococcal vaccination cannot be overstated; these vaccines are crucial components of being able to cope with the COVID-19 emergency.

Italian Foia

Because of the importance of these vaccines, in September 2020 Cittadinanzattiva conducted the aforementioned civic survey on the supply of influenza vaccines by region in Italy. The information was obtained through the instrument of generalised civic access (known as ‘Italian Foia’) which came into force in 2016 and which allows individual citizens and civic associations to request data that is being held by the Public Administration, as this data must be made accessible. The Administration is required to respond to requests and has 30 days to do so.

The Italian regions had been sent a set of specific questions relating to the tender for the purchase of vaccines, as well as more general questions on the provisions they are adopting to anticipate this year’s vaccination campaign compared to previous years, and also on how they will be applying the guidelines that were provided by the Minister of Health on 4 June, 2020. The regions had the opportunity to respond by 3 October, 2020 while the data processing procedure was able to consider responses received by 7 October, 2020. Almost inevitably, there were differences in the answers provided.

Access to influenza vaccines

Regarding measures to facilitate access to vaccinations, the regions have made many provisions, from the involvement of general practitioners and family paediatricians to the choice of auditoriums and arenas to deliver the vaccinations while respecting social distancing measures.

Further provisions include:

• Sicily has extended the opening hours of vaccination centres, so that they are now open both in the morning and in the afternoon and on Saturdays, at least in the initial phase. Access to vaccination upon being discharged from health facilities is also being provided for here, while the co-administration of anti-pneumococcal and influenza vaccines is being delivered (a measure also provided for in Umbria);
• Campania is providing for the establishment of itinerant trucks to support GPs;
• Lazio is opening drive-in vaccination centres, as well as mobile stations, vaccinations in pharmacies, and the organisation of vaccination days in schools, hospitals, sporting events. Itinerant vaccination teams are also expected to be established;
• Marche is providing for the possibility of moving vaccination centres to the Palazzetti auditorium in order to enhance the delivery of a large number of vaccines in a few hours/days, in compliance with COVID-19 restrictions;
• Tuscany is providing healthcare company premises free of charge to general medicine;
• In Emilia Romagna there is the possibility to use large facilities such as gyms and sports facilities as vaccination centres; and
• In Valle D’Aosta, in addition to signing specific agreements with general practitioners and paediatricians in order to encourage vaccination through these doctors, the region has also made vaccination poles available via the local health authority (Azienda USL of Valle d’Aosta), which will be attended by doctors from the Hygiene and Public Health of the Department of Prevention.

It must, however, be noted that only 10 out of 20 Italian regions have responded to our request for data, which is a shame given the current COVID-19 landscape and the subsequent need for maximum transparency – which is crucial to dispel any doubts that might exist about which regions may be facing difficulties in procuring supplies of influenza vaccines in time and, indeed, to be able to intervene promptly to support the populations in regions where this procurement has either not yet happened, or has only happened partially.

In addition, with regard to measures to address a possible shortage of vaccines for those citizens deemed not to be at risk, the regions have committed to ensure a minimum quota of 1.5% of vaccines to be redistributed to pharmacies. This, however, is a totally inadequate amount when it is understood that in Italy in 2019, some 900,000 vaccines were purchased in pharmacies directly by citizens. This year, it was correctly predicted that this would be much higher due to the campaigns which have been running that invite everyone to get vaccinated against influenza because of COVID-19 in order to relieve flu-related stresses being placed on hospitals. The Italian regions’ response of making 250,000 doses available in pharmacies, which is about a quarter of what was available last year, is simply not enough.

Civic recommendations

According to Cittadinanzattiva, data from the survey suggests the following three priorities:

• Guarantee that all citizens deemed to be ‘at risk’, as well as those who are over 60 and ‘fragile’, have equal access to vaccines in every corner of the country. To this end, maximum transparency on the part of the regions is necessary. What is more, the regions must apply a principle of solidarity whereby those regions which, thanks to advanced planning and purchasing, have been able to guarantee that these groups will be able to access vaccines, can support those that are most in distress;
• After ensuring maximum coverage for at risk groups, it is necessary to make vaccines available to the entire population, including through pharmacies, so that even people not deemed to be at risk can purchase them; and
• In such a difficult year as this, it would have been desirable for the regions to move together in the purchase of vaccines, as well as for them to begin the vaccination campaign homogeneously.

Conclusion

We have been talking about the need to anticipate the vaccination campaign from as early as April 2020, and yet our survey has shown that the Italian regions have approached this in different ways; and this has not been for reasons of strategy, but because the influenza vaccine procurement procedures across Italy were started late. This is a serious issue not least because COVID-19 means that we simply cannot afford hospitals to become crowded because of influenza.

In short, we could have done better, even though – as has become clear from the data submitted by those regions that responded to our request, and whom we thank for their transparency – a significant part of the country has the capacity for adequate planning and organisation, even in such unprecedented times as these and as the coronavirus pandemic continues.

Through the civic survey, Cittadinanzattiva has again confirmed its commitment to the topic of vaccine accessibility, with activities being carried out not only at the national level but also at the EU level, thanks to its branch ‘Active Citizenship Network’, which is now particularly active in the promotion of a social media campaign across Europe that is focused on the value of the long-life immunisation culture.