The pandemic has slowed down pediatric vaccinations and the health service is struggling to make up for the delay, especially in some regions and for the most recently introduced vaccines. The data, in fact, speak for themselves: in 2021 no pediatric vaccination reached the optimal level, with a variability in coverage ranging from 70.4% for the anti-rotavirus vaccine to 94% for the anti-polio vaccine. An alarming situation, although an improvement compared to 2020 when the impact of the pandemic had caused the coverage of almost all vaccines to drop, revealed by the GIMBE Observatory report “Impact of the COVID-19 pandemic on vaccination coverage in children”. As always, there are strong differences from Region to Region: Lazio, for example, is the only Region to reach the target for vaccinations against polio, measles and chickenpox; Lombardy is the only one to exceed the target for the anti-meningococcus B vaccination. “Considering that no systematic analysis has ever been conducted on pediatric vaccinations – declares Nino Cartabellotta, President of the GIMBE Foundation – we have carried out a study with the primary objective of evaluate the impact of the COVID-19 pandemic on the 24-month coverage of mandatory and recommended vaccinations”.
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The analysis
The report is based on data published by the Ministry of Health and compared the vaccination coverage of 2020 against 2019 and 2021 against 2020 of all pediatric vaccines except anti-meningococcal C and anti-meningococcal ACWY a due to the heterogeneity of the way data relating to these vaccines is collected and reported. The targets considered optimal are, according to the recommendations of the National Vaccine Prevention Plan, 95% for all vaccinations, with the exception of the anti-rotavirus which in 2019 alone was expected to reach 75% and then also pass to 95%.
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The crash of 2020
The data analysis shows how vaccination coverage was already insufficient in 2019, when only 14 Regions reached the target for the hexavalent vaccine, 9 for the trivalent, 3 for the anti-pneumococcus and none for the anti-varicella and the ‘anti-meningococcus B. The 2020 data show that the pandemic has had a significant impact on hexavalent and trivalent vaccination, respectively with a reduction from 14 to 9 and from 9 to 3 Regions that have reached the targets. In particular, a general reduction in coverage was observed in 2020: anti-meningococcus B (-2.68 percentage points), anti-measles (-1.79 percentage points), anti-pneumococcus (-1.42 percentage points) , anti-polio (-0.99 percentage points), anti-chickenpox (-0.22 percentage points). In contrast, the only anti-rotavirus vaccine that recorded +36.65 percentage points.
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The recovery of 2021
In 2021, however, there was a partial recovery for the trivalent vaccine, with 6 Regions reaching the target compared to 3 in 2020. However, the report concludes, in 2021 the level of vaccination coverage remained below the recommended targets, in particularly for the most recently introduced vaccines (anti-rotavirus and anti-meningococcus B). The increase in coverage at national level recorded in 2021 does not always manage to make up for the losses recorded the previous year: anti-pneumococcus (+0.67 percentage points), anti-measles (+1.15 percentage points), anti – chickenpox (+1.8 percentage points), anti-rotavirus (+7.6 percentage points), anti-meningococcus B (+13.38 percentage points); anti-polio coverage (-0.02 percentage points) remained substantially stable. “If already in 2019 – explains Cartabellotta – public vaccination programs showed difficulties in reaching the recommended targets due to vaccination hesitancy, the COVID-19 pandemic, with the inevitable reorganization of services, limited access to health facilities and the fear of possible contagion, has had a significant impact on pediatric vaccination coverage. However, the extent of their reduction in 2020 and the rapid recovery in 2021 show that the vaccination services of the area have adequately handled the emergency, managing to guarantee continuity of service in most Regions “.
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2021, data from the Regions
In 2021 Lazio was the only Region to reach the targets for all three mandatory vaccinations. Tuscany, Emilia-Romagna, Lombardy, Umbria and Veneto have achieved the targets set for polio and measles vaccines, but not for the varicella vaccine. Finally, Campania, Friuli Venezia Giulia and Molise have reached the recommended targets only for the anti-polio vaccine, for which the Autonomous Province of Bolzano (75.62%) was placed in last position.
For anti-meningococcus B only Lombardy exceeded the target, reaching a coverage of 95.61%. The Regions that have not reached the target show values that vary from 49.95% in the Autonomous Province of Bolzano to 91.84% in Veneto. Coverage for the anti-pneumococcal vaccination varies from the minimum in the Autonomous Province of Bolzano (71.71%) to the maximum in Molise and Umbria (94.51%). The coverage for the anti-rotavirus, except in the Autonomous Province of Bolzano (39.68%) and in Valle d’Aosta (40.23%), is above 50% in all Regions, 11 of which exceed 75%: Basilicata, Calabria, Emilia-Romagna, Friuli Venezia Giulia, Lombardy, Molise, Piedmont, the Autonomous Province of Trento, Puglia, Sardinia and Veneto.