It is an appeal addressed above all to medical specialists what arrives today from the Ministry of Health, where the presentation of the document “Operational proposals for the vaccination of frail / immunocompromised adults” was held, so that they are the ones to intercept and direct vaccinations more can benefit from it. Because, despite the fact that the categories of fragile and pathological patients are already included in the preferential ones identified in the National Vaccine Prevention Plan, vaccinations are languishing. The covers against pneumococcus, herpes zoster or meningococcus are very low, exposing these patients to high risks both due to infectious diseases and their complications. Hence, a solution to try to fill the gap could be to offer vaccination where patients go most often to follow their diseases and receive treatments, such as specialist clinics.
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Creating the conditions for “opportunistic vaccinations”
The words that have resounded several times – in the presence of the Minister of Health Orazio Schillaci – were, in fact, “opportunistic vaccinations”, to precisely identify the opportunity offered by the visits by specialists of fragile and immunocompromised patients to receive counseling and initiation to vaccinations . “It would be a huge step forward, to recover the low coverage in this segment of the population, to ensure that the specialists who care for fragile patients can identify a phase in which to foresee the vaccination of their patients”, comments Massimo Andreoni, scientific director of the Simit (Italian Society of Infectious and Tropical Diseases). “Covid has taught us that we can vaccinate through a prioritization of risk, that we can create dedicated paths for fragile patients in hospitals.” And so that the lesson of the pandemic is not wasted, today we need to do everything possible to make the indications already contained in the operational vaccination plan. The document, promoted by Simit together with the Italian Society of Hygiene, Preventive Medicine and Public Health (SITI), and endorsed by various societies for the chronically ill and patients, gerontologists and general practitioners, aims exactly at this: provide guidelines to concretely increase vaccination coverage in fragile and immunocompromised patients.
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Operational proposals to increase vaccination coverage
Thus, for example, among the proposed initiatives is that of promoting vaccination among family doctors, especially for patients with chronic diseases, expanding the agreements so that they provide not only for the administration of the anti-flu vaccine, but a sort of vaccination package, as recalled by Roberto Messina, president of Federanziani. Or even at the clinics, or directly at the treatment centers, hospitals, both by ensuring the supply of vaccines and, perhaps, the presence of a reference center for vaccinations, which works alongside specialists, as Roberto hopes. Gerli, President of the Italian Society of Rheumatology (Sir), guaranteeing the necessary collaboration to manage complex patients. Because the problems, when talking about fragile patients, are different: in the case of rheumatology and others who undergo treatments with drugs that depress the immune system, for example, critical factors are both guaranteeing the availability of vaccines and coordinating their administration with that of treatments, as Gerli explained: “It is essential to identify the correct time window for the administration of vaccines in patients on immunosuppressive therapy, in order not to risk that the vaccination has no effect”. Beyond the desired solutions, the logic that must guide the various actions must be to ensure that vaccination can become simple, accessible, the experts repeated several times. “Vaccinating in the centers where the patient goes for the normal check-ups serves this very purpose, and would also allow a specialist and vaccinator, whoever he is, to interact, to discuss,” adds Andreoni. “The concept is to take every opportunity to increase coverage, because often it is not the citizen who does not want to get vaccinated, but he does not know that he must do it”.
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Make the national vaccination register operational
The proposals for vaccinations of frail and immunocompromised adults, however, will have to be organized and articulated by the different regions and by the individual Asl to become truly operational. Hopefully making efficient projects that have remained on paper for too long: “It is scandalous that even today there is no effective national vaccination register that works wherever the patient is, especially considering how easy it would be to implement it”, Andreoni continues, ” the citizen and the doctor can check whether all vaccinations have been carried out. It has been talked about for some time, it exists for children, but not for adults and frail patients. Doing everything possible to avoid an illness pays off abundantly for all the vaccinations we go to do: we are not talking about investments but savings ”.