The economic cost of anti-vaccination movements in Italy

conte 2019

Mr Giuseppe CONTE, Italian Prime Minister. Copyright: European Union Event: European Council – June 2018 (Day 1)

This article was exclusively written for the The European Sting by Mr. Francesco Rosiello, a doctor of medicine and surgery, graduated at “Sapienza-University of Rome”. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


In recent years, but also thanks to some political parties that defend no-vax theories, vaccination coverage is decreasing, increasing the costs of health care spending and the resistance of pathogens to antibiotics. On the other hand, even health professionals who declare themselves in favor of vaccines or who advise their patients to get vaccinated are not properly vaccinated. Some studies begin to show that vaccines, reducing the spread of pathogens (also by means of the so-called flock effect), reduce, in addition to mortality, morbidity and cost of health care, also the antibiotic-resistance, which it is increasingly a big problem in industrialized countries.

Methods: analysis of available literature and other valid government sources. The research was carried out by inserting on Pubmed: “vaccines”, “antimicrobial resistence”, “vaccines AND antimicrobial resistence”, “cost vaccination”, “cost antimicrobial resistence”. Later we added “AND Italy” to the previous queries.

Results: mistrust in the vaccines is spread in a variable way within and outside the borders of the European Union[1]: 41% in France, 21% in Italy, 13% in the USA and 10% in Germany; last, the UK with only 9%, compared to a world average of 12%.

In Italy the radiation procedures were opened against doctors (0.03%) who supported “free-vaccinist” theories; radiation from the register does not become immediately enforceable, because, in the absence of convictions by the ordinary judiciary, the National Federation of Medical Orders foresees that it will become enforceable only after the second degree of disciplinary judgment; so, before an actual radiation, at least 2 years pass from the first sentence.

In July 2017 a law makes the registration of children in nursery schools and preschools subject to the presentation of the vaccination certificate or its self-declaration. The coercive character, after eighteen years of recommendation-based vaccination policy, has given rise to many social and political debates.

Regarding costs, the proportion of infections on total acute hospitalizations under ordinary conditions is constantly increasing and in 2014 reached 36.5 per thousand. The infections lengthen the average stay of 3 days (DS: 0.4-10) and giving the value of 700 euros, on average, to the additional days of hospitalization attributable to infections, we understand how the annual expenditure varies between 369 and 492 millions of euros.

As for the total direct and indirect costs of influenza, which for Italy are estimated at 2.86 billion euros, vaccinating the whole adult population would fall to 1.56 billion (-€1.3 billion). All this leads to an increase in healthcare spending (in 2015 the National Health System spent € 317.9 million on vaccine purchases, or only 1.4% of total pharmaceutical expenditures), both in terms of resources diagnosis, treatment and treatment, both in terms of working days lost due to illness and post-infectious period.

Correct information (both in content and in communication strategies) towards citizens (with particular reference to women, who as mothers, in most cases, will take care of the vaccination of their children) is essential on the part of the institutions and doctors, who have the advantage of being able to meet their clients in person and provide personalized advice. Likewise, it is important to increase training for not only medical students, but for all health professions.

Bibliography

Signorelli C, Odone A, Cella P, Iannazzo S, D’Ancona F, Guerra R. Infant immunization coverage in Italy (2000-2016). Ann Ist Super Sanita. 2017 Jul-Sep;53(3):231-237.

Signorelli C, Odone A. Advocacy communication, vaccines and the role of scientific societies. Ann Ig. 2015 Sep-Oct;27(5):737-47.

Garattini L, Curto A, Freemantle N. Vaccination planning in Italy: increasing vaccines while reducing coverage? Expert Rev Pharmacoecon Outcomes Res. 2016 Oct;16(5):547-548.

Ciorba V, Odone A, Veronesi L, Pasquarella C, Signorelli C. Antibiotic resistance as a major public health concern: epidemiology and economic impact. Ann Ig. 2015 May-Jun;27(3):562-79.

Clift C, Salisbury DM. Enhancing the role of vaccines in combatting antimicrobial resistance. Vaccine. 2017 Dec 4;35(48 Pt B):6591-6593

Lipsitch M, Siber GR. How Can Vaccines Contribute to Solving the Antimicrobial Resistance Problem? MBio. 2016 Jun 7;7(3).

Mishra RP, Oviedo-Orta E, Prachi P, Rappuoli R, Bagnoli F. Vaccines and antibiotic resistance. Curr Opin Microbiol. 2012 Oct;15(5):596-602.

Ginsburg AS1, Klugman KP2. Vaccination to reduce antimicrobial resistance. Lancet Glob Health. 2017 Dec;5(12):e1176-e1177.

Smith KJ, Nowalk MP, Lin CJ, Zimmerman RK, Cost effectiveness of a practice-based intervention to improve vaccination rates in adults less than 65-years-old. Hum Vaccin Immunother. 2017 Oct 3;13(10):2207-2212.

Herdman M, Cole A, Hoyle CK, Coles V Carroll S3, Devlin N, Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review. Value Health. 2016 Mar-Apr;19(2):255-66.

Castiglia P, Pradelli L Castagna S3, Freguglia V, Palù G, Esposito S, Overall effectiveness of pneumococcal conjugate vaccines: An economic analysis of PHiD-CV and PCV-13 in the immunization of infants in Italy. Hum Vaccin Immunother. 2017 Oct 3;13(10):2307-2315.

[1] Vaccine Confidence Project in 2016

About the authors

Francesco Rosiello is a doctor of medicine and surgery, graduated at “Sapienza-University of Rome” on October 25, 2018 with a thesis in general and applied hygiene. He deals with CBRN emergencies, disaster medicine, healthy cities, medical intelligence, health simulations and Health Technology Assessment, International Humanitarian Law and Disasters one. During his studies, he has won 5 scholarships on disaster medicine and clinical trials and 5 university collaboration grants. He has presented work in all the International Workshops on CBRNe from 2013 to today, at the 1st international congress on CBRNe and in numerous conferences, some of which for medical students. He is a member of numerous Italian and international scientific societies.

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