Lessons from Italy’s policy shift on immunization

Italy’s experience of mandatory vaccination could complement the latest French case study you discuss (see Nature 553, 249–250; 2018). It provides insight into why such a law was enforced in Italy, whether there might have been better alternatives and whether the law is working.

In 2017, it became compulsory in Italy to vaccinate infants against ten diseases: Haemophilus influenzae type b, measles, mumps, rubella, varicella and whooping cough (pertussis), as well as those that were already mandated (diphtheria, tetanus, polio and hepatitis B).

Unlike in France, immunization coverage in Italy had decreased alarmingly over the previous 5 years: a fall of 5.3% in 2011–15 for the measles vaccine, for example. Italy was subsequently ranked sixth-highest worldwide for measles cases in 2017 (it had 1,620; see go.nature.com/2o7jnwc). Vaccination was swiftly made mandatory.

Pilot schemes in the Veneto region (5 million inhabitants) showed that alternative strategies were not feasible. The schemes suspended the formerly mandated vaccinations and invested in health education to promote voluntary vaccine uptake. This led to a decline in coverage for polio vaccine in 2006–16, for example: by 5.2% in Veneto compared with 3.3% nationwide (see C. Signorelli et al. Ann. Ist. Super. Sanità 53, 231–237; 2017).

The new law seems to be working. Preliminary data show that almost one-third of the previously unvaccinated children born in 2011–15 have now been immunized. Polio and measles vaccine uptake has increased by 1% and 2.9%, respectively, and by even more in selected regions (see C. Signorelli et al. Lancet Infect. Dis. 18, 26–27; 2018).

As public-health representatives, we acknowledge that government action was epidemiologically justified. However, proactive intervention is still needed to enhance vaccine uptake and promote public trust.

Nature 555, 30 (2018)

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