Perspectives of vaccination in Italy: adolescents and parental consent

Abstract

In July 2017, Italy introduced a national law extending the number of mandatory vaccines from four to ten for all residents aged between 0 and 16 years 1. The final list included mandatory vaccination against tetanus, hepatitis B, polio, diphtheria, Haemophilus influenzae type B, varicella, pertussis, and measles-mumps-rubella (MMR). This law was promulgated in response to a worrying decrease in vaccination coverage that occurred in Italy from 2012 to 2016 2. Between 2012 and 2014, vaccine coverage decreased dangerously in the country, reflecting an exponential increase in vaccine hesitancy 3 ; in 2015, Italy was one of the countries with the lowest levels of vaccine confidence in the world 4. Despite the efforts of European health authorities, Italy, as well as other European countries, witnessed a growing vaccine hesitancy between 2015 and 2016 5,6. None of the four vaccines that were mandatory in 2016 reached the 95% coverage that guarantees the "herd immunity" 7. For example, in the same year, vaccination coverage for the second dose of measles-containing vaccine was below 84% in Italy and other European countries 8. The new Italian law obliges all parents to vaccinate their children; if they do not comply with the imposed measures, children cannot be admitted to the school system from childcare to secondary school. From the beginning of 2018, an immediate increase in vaccine coverage testified the positive impact of the applied regulation 9. A few months after Law n. 119 came into force, the Italian National Institute of Health confirmed that the national immunization coverage of the hexavalent vaccine (against tetanus, diphtheria, pertussis, poliomyelitis, hepatitis B, and H. influenzae B) had reached 95% (goal for herd immunity) 10. Despite its excellent results, this law immediately sparked criticisms-from scientists-mainly based on the alleged lack of safety of vaccines 11. Many anti-vax conspiracy theories have spread throughout Italy, among which a major one is the lack of safety of vaccines, which could be related to certain mental illnesses. Studies on this subject, often cited by anti-vaccination organizations, present numerous limitations (underlined by the authors themselves) and fail in correlating vaccines and certain diseases; rather, they present solely a temporal association between vaccination and the development of some pathological conditions 12. They also often cite Wakefield et al. 13 , a retracted article that suggested a correlation between vaccines and autism. For campaigning, anti-vax movements apply studies that hypothesize an association between vaccines adjuvants and the occurrence of neuroinflammation or autoimmune diseases 14,15 .

From Human Papillomavirus to COVID-19: Adolescent Autonomy and Minor Consent for Vaccines

“…The World Health Organization (2014) noted that factors such as accessibility and cost for vaccines had more impact on vaccine uptake than consent. Making vaccines mandatory to participate in school and other activities have increased vaccine coverage in the United States and abroad ( Cioffi, 2020 ). Many countries use schools as a location for vaccinating children and adolescents, increasing the accessibility of vaccines, and in these countries, the time needed to obtain written parental consent is seen as a barrier to wider implementation ( Perman et al, 2017 ).…”

Can vaccine adherence against Sars-CoV-2 become a criterion for access to medical care?

“…Among those who choose not to vaccinate are those who are totally opposed to vaccination, “anti-vaxxers”, and those who have legitimate doubts about vaccination in terms of safety on their health (vaccine hesitancy). 2,3…”

“…Among those who choose not to vaccinate are those who are totally opposed to vaccination, "anti-vaxxers", and those who have legitimate doubts about vaccination in terms of safety on their health (vaccine hesitancy). 2,3 As useful as it is to understand the differences in this category of citizens and identify the reasons behind the decision not to vaccinate, we think it is necessary to pay considerable attention in trying to avoid the stigmatization of non-vaccinated subjects. In fact, this could favour a paradoxical effect that could generate an expansion and a further radicalization of antivax ideologies.…”

“…The reasons behind the decision not to vaccinate are varied and include distrust of science, misinformation and conspiracy theories. 2 However, anti-vax also includes people with diagnosed or undiagnosed mental disorders that make them particularly vulnerable to vaccine fear. 6 These subjects, different from those who consciously choose not to be vaccinated, are however difficult to identify and distinguish from other anti-vax subjects because mental disorders are often not diagnosed and are also triggered by stress situations (such as the pandemic Covid-19) and the spread of anti-vax theories.…”