Vaccination services suffer from the lack of coordinated management between the various organizational levels, also the result of an incomplete implementation of the indications already provided for by the 2017-2019 National Vaccine Prevention Plan. This is also highlighted by the monitoring carried out by Cittadinanzattiva in the period September / November 2021.
An initiative which is accompanied by the presentation of a Charter of the quality of vaccination services, elaborated in the working table composed of: AIL Association, COPD Association, UNIAMO-FIMR Association, Assofarm, CARD Italy, Dr. Andrea Siddu (Dir. Gen Prevention of the Ministry of Health), Dr. Roberto Ieraci (Lazio Region Vaccination Strategies Group), Federfarma, FIMMG, FIMP, FOFI, SIFO, SIMG, SIMIT, SIP, SITI, Catholic University of the Sacred Heart.
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First phase: monitoring
Cittadinanzattiva launched in April 2021, on the occasion of the annual European Immunization Week, a program that is divided into three phases. The first concerned the development and implementation of a civic monitoring of the Vaccinal Services, with the aim of photographing the state of the art at the regional councils, the vaccination centers, general medicine clinics and free choice pediatricians.
The monitoring (which can be downloaded at this link) involved regional health departments, vaccination centers, family doctors and free choice pediatricians, and involved the different targets (children, adolescents, adults and elderly) for all non-vaccinations. Covid: Diphtheria-tetanus-pertussis, Poliomyelitis, Hepatitis B, Haemophilus Influenzae type B, Measles-mumps-rubella, Varicella, Meningococcus B, Meningococcus ACWY, Rotavirus, Papillomavirus, Pneumococcus, Herpes Zoster, Antinfluenza.
The context
The data on vaccination coverage reported by the latest Report on the Coordination of Public Finance and taken up by Cittadinanzattiva in the Civic Observatory on Federalism in Healthcare 2019 highlight the persistence of important critical issues in terms of mandatory vaccines in Italy: coverage of 95% per hexavalent, for example, it is not reached in all regions of our country, not to mention the levels of coverage of measles, mumps and rubella, which are unsatisfactory everywhere.
Furthermore, with regard to coverage for the flu vaccine in the 2019-2020 season, the data still show substantial insufficiency, with all regions recording coverage levels below 75%. Finally, the situation in terms of territorial adhesion is heterogeneous as regards the HPV vaccine, which is fundamental for the control of related HPV tumors. Against this backdrop, the pandemic has only exacerbated past inefficiencies.
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The results of the monitoring
The survey reveals, among other data, that the Vaccine Registers established in each Region do not reach the optimal level of computerization; the same are available for consultation and / or update to all operators involved only in some regions (it does not happen in Abruzzo, Marche, Molise, Veneto, Umbria).
Discrepancies are also noted as regards the subjects appointed to carry out the administrations: in Tuscany, for example, free choice pediatricians take care of all vaccinations for children, while in other Regions (Marche, Umbria, Veneto) they only carry out the flu shot. Regional agreements, aimed at involving general practitioners and pediatricians of free choice in vaccinations, are not present in all regions; where signed, doctors do not always agree on which vaccinations are included.
Second phase: the Charter of the Quality of vaccination services
Cittadinanzattiva, together with a multistakeholder table and with the unconditional support of GSK, MSD and Sanofi, presented the Charter of the quality of vaccination services, a document that consists of six fundamental principles to guarantee: uniform access to the territory; information, communication and transparency; training and updating; digitization and simplification; achievement of the objectives of prevention and vaccination coverage; continuous improvement of services and evaluation of the quality offered.
The principles indicated identify the aspects of the vaccination process that primarily require organizational and technological interventions, to respond optimally to the needs of citizens and operators.
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Ten things to do now
The recommendations of the Charter, addressed to the various interlocutors at national, regional and company level, as well as to the citizens themselves, include:
- production and dissemination of information and awareness campaigns that motivate citizens to make informed choices based on validated scientific knowledge, also to combat the phenomenon of fake news;
- simple and quick access to all vaccination information (indication of the vaccination offer provided by the region, location of the proximity vaccination centers, methods of access, execution of a truly informed consent procedure, etc.) also thanks to digital technologies;
- promotion of homogeneous and coherent training throughout the national territory, for all subjects with whom there are agreements – general practitioners, pediatricians of free choice, pharmacists, nursing homes;
- implementation of the Ministerial Decree of 17 September 2018 which provides for the establishment of the national vaccination register and regulates the regional ones, and which to date cannot ignore the integration with the Electronic Health Record and the platforms relating to screening;
- creation or adaptation / enhancement of the Electronic Health Record;
- publication, also for recommended vaccinations (Rotavirus and Meningitis for childhood, Herpes Zoster, Pneumococcus and Diphtheria-Tetanus-Pertussis recall for adults), of annual coverage data, as already happens for the flu;
- inclusion, in the definition of new PDTAs or in the updating of those already present, of the vaccinations recommended for the specific disease targets;
- in the definition of Individual Care Plans, inclusion of vaccination as a prevention activity;
- planning the supplies of influenza vaccines at the beginning of the year to ensure adequate quantities, defining the delivery times useful for the seasonal vaccination campaign;
- collaboration with Local Health Authorities, Vaccination Centers, GPs, PLS and Pharmacists for: active call for the identified targets, sending information to the citizen on his vaccination status, managing recall, recovery of non-vaccinated people, recovery of missed appointments.
“We hope that the recommendations included in the Charter for the quality of vaccination services, shared with the scientific community, prevention service operators, patient associations and institutions, will be accepted and implemented at the various levels of the system, as well as in the next National Plan vaccination prevention, for the drafting of which we have not been involved to date – reads the note from Cittadinanzattiva -. Vaccination prevention must be a priority for our country, to be achieved through effective and homogeneous strategies throughout the country, greater digitalization and simplification of access and timely monitoring, starting with the extension of the LEA monitoring grid indicators to all scheduled vaccinations “.
“In order to ensure the delivery, homogeneity and full usability of the vaccinations included in the vaccination calendar, it will also be necessary to actively participate in general practitioners and pediatricians of free choice in vaccinations, providing for specific commitments in the context of regional supplementary agreements “- he said Valeria Favaresponsible for coordinating the health policies of Cittadinanzattiva.
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