Lessons learned from vaccines roll out — It’s Necessary to Stablish a Transparent Process for Priority Setting and Monitoring
By: Health Journal
Tags: Requirement, Vaccines Roll Out, Transparency

Lessons learned from vaccines roll out — It’s Necessary to Stablish a Transparent Process for Priority Setting and Monitoring health journal Apr 9·5 min read

Italy’s botched vaccine rollout highlights Draghi challenge

PM seeks to repair previous government’s errors that led to elderly missing out on jabs

Financial Times, APRIL 9 2021

Miles Johnson in Rome

After the authorities in Italy’s Puglia region asked Antonio La Scala to conduct an audit of everyone who had been given a coronavirus vaccine, the findings left him in shock.

Of the 140,000 people in the region who had received a jab having been classed as priority medical workers, thousands appeared to have no links with the healthcare industry.

“We could immediately see the numbers didn’t add up . . . Puglia doesn’t have this many healthcare workers,” La Scala, head of the region’s medical inspection unit, said of his research carried out in mid-February.

“We cross referenced the data with social security information and found there were many people getting doses with no right to them: friends of friends, associates, parents,” said the 52-year-old dubbed the “007 of vaccines” by the local press for his investigative skills.

Puglia is perhaps the most vivid example of the dysfunctional vaccination rollout that has plagued the EU’s third-largest economy since Covid-19 jabs became available early in the year. As of the end of last week, 98 per cent of people in Puglia aged 70–79 were still waiting for a first dose, along with almost half of over 80s.

The stark numbers underline the challenge facing prime minister Mario Draghi as his government seeks to repair the mistakes made by Italy’s previous government to ensure the country’s limited vaccine supplies go to the elderly and most vulnerable as quickly as possible.

“We’re working around the clock,” said La Scala, a former inspector in the Italian financial police. “We’ve found people who wrote nothing on their self-certification forms about their reason for getting a priority vaccine . . . It’s absurd.”

His unit has handed its preliminary findings to Italian law enforcement and he hopes that those who illegally jumped the queue will be prosecuted.

Italy’s predicament can be traced back to decisions made by the previous government of Giuseppe Conte to prioritise healthcare workers, as well as those working in education. The logic was this would limit transmission in hospitals and protect front-line workers.

Yet with the detail of how to achieve this devolved to the country’s 20 regional governments, disparities quickly emerged as to what counted as a priority. The uncertainly left the system open to abuse and prompted jostling for position among privileged guilds of workers, including lawyers, judges and journalists claiming essential-worker status.

Antonio La Scala, head of the medical inspection unit for the Puglia region, has been dubbed the “007 of vaccines” by the press for his investigative skills

The lobbying has not been confined to the southern Puglia region.

Nicola Zingaretti, head of the Lazio region that includes Rome, acknowledged in a newspaper interview on Thursday that “we too have received pressure” to divert vaccines to different interest groups.

By the time Draghi, a former European Central Bank chief, had relaunched the vaccine strategy in February with a call to Italians to “wait their turn”, just two in every ten doses administered in the country were being given to people aged over 70, according to government data.

By February 20, Italy had administered a single vaccine dose to just 6 per cent of people aged over 80.

In Germany and France, more than a fifth of people in that category had received a first shot by the same date, according to data from the European Centre for Disease Prevention and Control and Robert Koch Institute.

“There’s been a focus on [the limited] vaccine supply but we had the same amount of doses as France and Germany,” said Matteo Villa, a research fellow at the ISPI think-tank. “Italy was the only large country in Europe to follow this strategy.”

Significant progress has been made since Draghi refocused the rollout. The number of doses going to the over 70s had risen to above six out of every ten administered by the start of April.

However, 43 per cent of Italians aged above 80 are still waiting for a first vaccine dose, as of data up to the end of last week, and 88.9 per cent of those aged 70–79.

Almost as many Italians aged 30–39 have received a jab as those in their 70s.

There are also large regional disparities, with 60 per cent of over 80s in Sicily not having been jabbed, while just 30 per cent in the northern region of Veneto remain without a single dose.

More than 1m doses out of a total of 11.7m administered as of Wednesday have also gone to educational workers even though most schools and universities remain closed.

Academic researchers, many aged below 40 and working from home, have also been given vaccines.

Draghi on Thursday acknowledged the problem. “Enough vaccination of this expanding group of healthcare workers,” he told a press conference. “We need to vaccinate as a priority all people aged over 70.”

But with Italy recording 627 coronavirus deaths on Wednesday, the largest daily increase since early January, experts say it continues to pay a heavy price for its previous strategy.

Villa estimated that the decision to prioritise younger workers over the elderly cost as many as 7,000 avoidable deaths, based on the mortality rates for each age cohort since the vaccine rollout began. While impossible to know with precision, this would make up 6 per cent of the 111,000 people who have died from the virus in Italy.

La Scala said he hoped the queue jumping had come to an end. “These are not intelligent people, they are disloyal people who’ve taken vaccines while the elderly and vulnerable were left behind,” he said.