Six months of vaccines, the budget and the outlook

of Luca Salvioli
On 4 June, with almost 629 thousand doses, the daily record remains since the first anti-covid vaccines in Italy were inoculated six months ago at the Spallanzani in Rome.

From the following days the 7-day moving averages have fallen. We had reached 585 thousand doses on average per day, now we have dropped slightly to around 545 thousand.

The slowdown was affected by the new stop at Astrazeneca, which has been recommended only to over 60s since 11 June. The Anglo-Swedish vaccine had reached its maximum on 5 May, with 124 thousand doses administered. Now it travels around 40-50 thousand doses per day.

The collapse is seen above all on the first doses, as evident from the graph below. Astrazeneca after the new limitations of 11 June hardly reaches a thousand inoculations per day (it had exceeded 115 thousand).

It is used almost exclusively for decoy.

Johnson & Johnson also fell, but much less.

The Astrazeneca trouble has been a constant in recent months. It was the most anticipated vaccine in Europe. On the basis of the contracts stipulated in Europe, Italy should have received 40 million in the first two quarters of 2021. 10 have arrived. Less than 9 have been administered.

J&J was also much less used than expected. 7 million were to arrive in the second quarter. Just over 2 million have arrived, barely 60% (1.2 million) administered.

Both suffered the limitations that emerged as a possible correlation emerged, albeit very rare, between viral vector vaccines and some cases of cerebral venous thrombosis and venous thrombosis in an atypical location, especially in younger subjects.

Some contradictory indications arrived from the health authorities, which had a psychological impact on the population, were also affected.

• The Astrazeneca vaccine is approved on January 29 by the EMA aged 18 and over. However, the European authority points out the lack of reliable data on efficacy over 55 years of age, a vulnerability of clinical trials that had already had their problems.
• Italy, as well as Germany, indicates a preferential use for those under 55 without serious pathologies.
• On February 2, the CTS also gives the go-ahead for those over 55 in good health.
• On February 27, the use is extended up to 65 years.
• On 11 March the first batch is suspended by Aifa, from 15 to 19 March the administration of the vaccine is completely suspended.
• On April 7, a circular from the ministry of health recommends preferential use of Astrazeneca in people over the age of 60.
• A new circular on June 11 states that the vaccine “is only given to people aged 60 or over”. Recalls for under 60s must be made with another vaccine.
• On June 19, a new circular also allows under-60s to be called back with Astrazeneca in the event that they refuse the heterologous call.

In recent months, comparisons have often been made with other European countries that were going faster than Italy. In reality, if you read the data in relation to the population and with a 7-day moving average in order to purify some daily peaks, the situation is the one illustrated by the graph below, where it can be seen that the main European economies have kept a step similar with the exception of the UK, which vaccinated much faster.

As we have seen, Italy has slowed down the pace in the last 3 weeks, but the average remains well above 500 thousand daily doses. The trend of the main European countries is similar. They travel on a high and substantially stable level of administration.

According to the forecast model that we have integrated into the page with the daily data on vaccines in Italy, the government’s goal of immunizing 80% of the vaccinable population (those over 12) by September is achievable. The estimate is based on the dose delivery rate versus deliveries in the previous two weeks and expected arrivals.

It must be said that it is a rather vague target, because it does not have a precise date and from the latest statements it seems to refer to the percentage of the population that will have at least one dose, not to the fully vaccinated.

However, the spread of the Delta variant makes it necessary to reach vaccination with two doses for everyone as soon as possible. In particular, the age groups most exposed to the serious consequences of the virus.

In the 70-79 age group there is still 12% of people who have not even taken a dose. The percentage rises to 18% for 60-year-olds and 27% for 50-year-olds. Coronavirus deaths among the over 50s represent 98.8% of the total since the beginning of the pandemic, so there are still many people at risk.

There are two main unknowns on how the vaccination campaign will continue. The first concerns the timeliness of deliveries. The stop of Curevac, and the now marginal role of Astrazeneca and J&J, make Pfizer and Moderna’s respect for deadlines crucial.

Some regions said they were worried about deliveries in July, which would be less than expected, but Commissioner Figliuolo assured that the difference in July compared to June is only 5%.

The second concerns the willingness of people to get vaccinated. The spread of the Delta variant, more contagious than the Alpha, which in turn was already more contagious than the virus discovered in Wuhan, makes clear the need to reach a very high coverage of the population.

It may be useful to compare the trend of doses administered every day in Italy with the two large countries that have vaccinated faster than us. The United States, which today has 54% of the population who have had at least one dose and 46% fully vaccinated, and the United Kingdom (67% with at least one dose and 49% fully vaccinated).

In Italy 56.81% have had at least one dose, 30.75% are fully vaccinated.

As can be seen from the graph below, the United States has reached its peak on our levels, around 1,000 daily doses per 100,000 inhabitants. The UK peak was 877 doses. It touched it twice, so the pace was more constant, but it has been falling since the end of May. This does not mean that the immunization of the two countries is not proceeding, but that reaching the last mile is accompanied by a slowdown from the maximums.

We do not know if Italy will have a trend more similar to the United States or England. But we can say that if the first six months were those in which the selection between the vaccines available and the logistics in the country was made, in the next few the attention will be increasingly on the ability to intercept the portion of the population that is reluctant or does not intend to get vaccinated.