Health fairness, meningococcal vaccinations declining among adolescents due to Covid

Health fairness, meningococcal vaccinations declining among adolescents due to Covid

Covid-19 has also penalized vaccination in adolescence: 16-year-old boys vaccinated in Italy against meningitis with the quadrivalent have increased from 74.94% in 2019 to 58.5% in 2021 (a figure up compared to 2020, when it was by 52.88%), with a negative difference of 16.44 percentage points. Virtually one in 6 teenagers less. This is what emerges from the 11th Report of Salutequità ‘Vaccinations and equity: focus on meningococcus in adolescence’, created with the unconditional contribution of Sanofi.

In 2021 – reads the document – for the vaccine on the four meningococcus strains, the national average coverage has improved compared to the previous year, but the figure is positively influenced by Valle d’Aosta, Pa di Trento, Veneto, Friuli Venezia Giulia , Emilia Romagna, Puglia and Basilicata, where 3 out of 4 adolescents have been vaccinated. Regional variability is in fact extremely marked, with values ​​between 11.82% in Umbria and 87.26% in Emilia Romagna. Not only. Young people aged 18 in 2019 were 58.31%, while in 2021 they were 62.22%, passing for 55.1% in 2020. The result is that the goal of protecting 95% of children from meningitis through vaccines still seems distant, despite the fact that invasive bacterial diseases, such as meningitis, are a public health priority, as indicated by the 2020-25 National Prevention Plan and the recovery of vaccinations among adolescents is a high priority in the circular of the Ministry of Health of 30 July 2020 (n° 0025631).

However – Salutequità notes – the ability of the Regions to guarantee access to vaccinations by adolescents is very different. Some have lost ground in vaccination compared to 2019: Piedmont (-13.72), Liguria (-11.97), Sicily (-11.6), with a peak in Tuscany (-48.12 percentage points going from 78. 53% in 2019 to 30.41% in 2021); still negative Calabria (-8.72), Emilia Romagna (-4.09) and Marche (-4.31). According to the report, differences between regions were recorded in the coverage achieved and the resilience of the number of vaccines between 2019 and 2021, but also in vaccination strategies and policies (e.g. type of vaccine, involvement of families and guys).

The theme of overcoming territorial inequalities inspires the implementation of the new National Vaccination Prevention Plan (Pnpv) 2023-2025: in the latest version – being examined by the Regions in view of the technical meeting in the State-Regions Conference – the criticalities of the vaccination system and regional heterogeneity and the issue of equity of access is placed at the centre, keeping the attention high also on groups that are difficult to reach or in conditions of marginality.

The new plan, according to Salutequità experts, presents several new features: it releases the update of the vaccination calendar from the plan to bring the offer more in line with scientific progress; speaks of maintaining free of charge over time for beneficiary cohorts (for example for HPV) who have lost or deferred vaccination, despite having acquired the right to it; involves pharmacies among the subjects who will be able to deliver the vaccination, underlines the inclusion of vaccination in the diagnostic diagnosis and treatment pathways (Pdta) and the more extensive involvement of health professionals, including specialists of reference for chronic / oncological pathologies, and exceeds the discretionary use by the Regions between anti-meningococcal C vaccine and tetravalent ACYW in the pediatric range (between the 13th and 15th month). To date, only 12 Regions have already approved the transition from MenC to Men ACWY: Pa di Trento, Fvg, Veneto, Emilia Romagna, Marche, Umbria, Lazio, Molise, Campania, Puglia, Basilicata and Calabria, but in 2021 vaccination with the quadrivalent at 24 months saw a national average of 54.16%, about one in two children.

“For a rapid, effective and fair offer of vaccinations – says Tonino Aceti, president of Salutequità – three actions are urgently needed: to address the issue of resources needed to effectively deal with regional disparities and implement the provisions of the plan; to promptly define qualitative and quantitative standards of staff of the prevention departments and act on the lever of Lea monitoring”. In particular, adds Aceti, “a plan without a specific allocation of resources alone will not be able to guarantee uniformity of the vaccination offer in the regions”. On updating the vaccination calendar “a streamlined methodology needs to be identified – suggests Aceti – The unpacking of the plan aims to make it an agile tool, but it is not clear how often it will be updated and which institutional mechanism will allow rapid alignment with each update of the calendar by the Regions”. Finally, on the subject of monitoring and evaluating the plan, “it is necessary – considers Aceti – to include indicators related to non-compulsory vaccinations in the new Lea guarantee system, including those for adolescents (for example meningococcus and HPV) and adults, thus pushing the Regions to achieve the coverage objective set by the Pnpv”.

But adherence to vaccination – Salutequità remarks – also passes through an increase in trust in vaccinations and correct information: according to a recent survey by The European House-Ambrosetti, about one in 4 people knows which vaccinations are recommended, and 4 out of 10 they remember only a few. Adolescents, therefore, should play an active role in taking care of their health: if listened to, they represent fertile ground for receiving information to then be translated into transparent and inclusive public communication of an evidence-based and data-driven type – as suggested by the OECD – that takes full advantage of digital tools, many of which are highly appreciated by teenagers.

Lastly, with regard to a fair offer of vaccination throughout the national territory, Salutequità defines vaccination at school as an “elective strategy”: all adolescents, in fact, are already present in schools; the distribution of the institutes is capillary throughout the territory, therefore a large target of students can be easily reached. The experience during the Covid-19 emergency in some regions (Apulia in particular for several years) has shown how this environment can have a dual function: a place of health where to provide information and create awareness and where to carry out the vaccination itself.


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