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HEALTH

Why is Italy’s coronavirus vaccine plan missing its targets?

Italy's Covid-19 vaccination campaign remains a long way from meeting the government's targets, and slowed down further over Easter. What's causing the hold-up, and when might things improve?

Why is Italy's coronavirus vaccine plan missing its targets?
People line up outside a vaccination hub in Rome. Photo: Andreas Solaro/AFP

When Mario Draghi was sworn in as Italy’s new prime minister just under two months ago, one of his first stated priorities was to increase the pace of the country’s Covid-19 vaccination programme. 

Italy was at the time administering just over 100,000 doses per day. Draghi’s new head of the coronavirus response taskforce, General Francesco Paolo Figliuolo, soon announced a target of 300,000 jabs a day by the end of March, and 500,000 by the end of April.

There were high hopes that, after supply delays and a month-long political crisis early this year, the campaign was about to move up a gear. 

READ ALSO: Who is in Italy’s Covid-19 vaccine priority groups?

But over a month since the new targets were announced, and 100 days since the country’s vaccination campaign began, there’s no sign of it speeding up significantly amid ongoing setbacks and delays.

In total, some 11.5 million doses have been administered to date, and 3.5 million people in the country have received both doses (or 6.8 percent of the population over 16) according to the latest official figures.

While Italy’s vaccine campaign is progressing similarly to those in other EU member states, the slower-than-hoped pace of the vaccine rollout is causing high levels of frustration in the country, as the death toll remains notably high, and lockdown restrictions have been extended until at least the end of April.

There have been some 240,000 doses administered on average per day in Italy in recent weeks – more than double the number recorded a month ago.

But this is still some way from the stated goal of 300,000 a day, and the goal of half a million is looking increasingly unrealistic.

The vaccine campaign suffered an abrupt slowdown over the Easter weekend, with fewer than 500,000 doses administered nationwide over three days in total.

Italian media reports on Tuesday slammed the weekend slowdown as an “Easter vaccine flop”, while professor of virology Roberto Burioni commented: “we assumed everyone knew that the virus does not observe holidays. We were wrong”.

Some health experts said more staff were needed at vaccination centres, while others pointed to problems with organisation in some regions.

According to Italian newspaper La Repubblica, regional health authorities say the target isn’t being met due to an ongoing shortage of doses, as supply delays continue to affect vaccination campaigns around Europe.

However, the national government says regional health authorities currently have between 2.3 and 2.9 million doses in storage, ready to be administered.

READ ALSO: Italy’s vaccine supply short by nearly 30 percent, data shows

People waiting for the AstraZeneca jab on March 24th at a vaccination centre outside Rome’s Termini railway station. Photo: Andreas Solaro/AFP.

Delays across the country have reportedly been aggravated by the Italian medicine agencies’ decision to halt injections of the AstraZeneca vaccine for several days in March amid concerns about potential rare side effects. 

AstraZeneca jabs resumed after EU regulators re-confirmed they were “safe and effective”, but some health experts say the temporary block has dented public confidence in the vaccine in Italy – where vaccine scepticism was already relatively high.

In Naples alone, hundreds of people have asked their vaccination centre to delay their shot until Pfizer becomes available, the Ansa news agency reports

Meanwhile in Cagliari, Sicily, around 20-30% of those booked for an AstraZeneca shot are failing to show up for appointments.

This is “further slowing vaccinations in one of the worst performing regions, which vaccinated just 39 people over Easter”, Ansa writes.

IN CHARTS: Which regions of Italy are vaccinating people fastest?

As many of those who were scheduled to get the AstraZeneca jab were teachers, the cancellations and delays could also jeapordise Italy’s plan to reopen schools as a priority – and keep them open.

There are also fears that the slow pace of vaccinations for the elderly may be driving the death toll in Italy, which remains markedly higher in Italy than in neighbouring European countries, and is rising more sharply than in countries where vaccines are being distributed more quickly, like the US and UK.

Italy is not administering fewer doses than other large European countries (not including the UK), but its low rate of vaccinations for over-70s is believed to be “a decisive factor in a nation with the highest average age of all”, Ansa writes.

There have also been major discrepancies across the country in terms of vaccinating the over-80s, in part due to the fact that each region manages its own health service and can set its own vaccination schedule.

The percentage of people over-80 who have been fully vaccinated ranges from almost 60 percent in South Tyrol to 14 percent in Sardinia, according to data analysis by the GIMBE independent evidence-based medicine foundation.

Meanwhile, some regions, including hard-hit Lombardy, have suffered setbacks due to problems with their booking systems.

Despite all this, Figliolo remains confident that Italy could still reach its targets soon.

“In two weeks we will be at 300,000 doses per day,” he told newspaper Corriere della Sera on Tuesday. “In April there will be a consistent arrival of vaccines, with the verification of the capabilities of vaccinators and vaccination points.”

“If the system holds up, and means we have 500,000 vaccinations a day at the end of the month, I will close the campaign at the end of September.”

The Italian campaign is expected to get a boost from April 19th, when the Johnson and Johnson one-shot vaccine should become available.

However, the number of doses expected to arrive in April will be around 8 million, according to Italy’s health undersecretary Pierpaolo Sileri – even less than the 8.2 million delivered in March. 

READ ALSO: Where to register for a Covid-19 vaccine in your region of Italy

On a more positive note, six million of those doses will reportedly be Pfizer, which should resolve the issue with delays caused by concern about AstraZeneca.

But clearly eight million doses will not be enough for the 500,000 doses a day expected under the national plan – even in addition to the 2.3 million or more doses currently in storage.

Silari added that the number of doses arriving will “double” in May.

So when will Italy’s vaccination campaign reach a point that allows the reopening of public life?

“Having 20 million people vaccinated as soon as possible will be a first important turning point in terms of reducing new cases,” according to Massimo Andreoni, scientific director of the Italian Society of Infectious and Tropical Diseases (Simit).

Davide Tosi, a researcher at Lombardy’s University of Insubria, told Sky Tg24 news on Tuesday: “To substantially reduce infections it would take 45-50% of the population vaccinated even with a single dose, plus the three million people recorded as being recovered,” 

“At this rate, however, we will only have a sufficient percentage of the population vaccinated at the beginning of next year.”

Member comments

  1. In Lombardy, the vaccine is still invisible. No news. No signs of changes. Our 94 year old mother has not received any news of a vaccine, nor has the 100 year old mother of the pharmacist. Corruption. We suspect underhanded dealings for profit…

    1. I know loads of people who have had the vaccine. It is inaccurate to say that it is ‘invisible’.

      1. I also know one. He is a policeman. I don’t know any reason why a young policeman should be vaccinated before over-80s, do you? In Germany the numbers are still going up: the new infections, occupied beds, everything – except for death toll. That’s because over-80s and even over-70s have been vaccinated already.

  2. No news here in Campania – Pozzuoli in particular. None of our friends over 60 have had their shots yet. I even wrote to my doctor asking him where the information would come from – his surgery, or the ASL. No reply. So we just wait.

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ITALIAN ELECTIONS

What will a right-wing election victory mean for abortion rights in Italy?

The right-wing parties poised to win Italy’s upcoming general elections have a history of denouncing abortion. Could a new conservative government threaten reproductive rights in Italy?

What will a right-wing election victory mean for abortion rights in Italy?

When Italians go to the polls on September 25th, a coalition of three right-wing parties – Giorgia Meloni’s Brothers of Italy, Matteo Salvini’s League and Forza Italia, led by former premier Silvio Berlusconi – are widely expected to win the vote and secure the opportunity to form Italy’s next government.

READ ALSO: Your ultimate guide to Italy’s crucial elections on Sunday

With all three parties to the right of centre – by quite some way, in the case of Brothers of Italy and the League – activists are concerned about what Italy’s most socially conservative government in years could mean for women seeking to access abortions, as they have had the legal right to do here for over four decades.

Here’s what Italian law says about abortion, what the right-wing alliance has promised it will – or won’t – change, and what all this could mean for people in need of abortion care in Italy.

What is Italy’s law on abortion now?

Abortion – formally referred to in Italian as interruzione volontaria di gravidanza or IVG, ‘voluntary termination of pregnancy’ – has been legal in Italy since 1978.

Passed after years of protests and several other failed bills, Legge 194 (‘Law 194’) decriminalized the procedure and entitled women to request it for any reasons of physical or mental health within the first 90 days after conception.

Women can continue to seek an abortion after 90 days if a significant foetal abnormality is present, or if continuing the pregnancy would endanger the woman’s life.

READ ALSO: The long road to legal abortion in Italy

The procedure is offered free of charge to those who qualify for public healthcare in Italy.

To access it, women first must consult a doctor and discuss options “to help her to overcome the factors which would lead her to have her pregnancy terminated”.

If the patient continues to affirm her original choice, she will be issued a certificate either stating that the termination is urgent and can be carried out immediately, or, if it is not deemed urgent, that she can seek the procedure after a obligatory seven-day wait.

Campaigners in front of a banner reading ‘Don’t touch law 194’. Photo by FABRIZIO VILLA / AFP

In reality, the wait for an appointment is likely to be far longer. Law 194 also affirms the right of health workers to refuse to carry out abortions on the grounds of “conscientious objection”. 

This has translated into serious gaps in coverage across Italy, with some facilities staffed mostly or even entirely by personnel who decline to deliver abortion services.  

READ ALSO: Why abortions in Italy are still hard to access – despite being legal

In fact, a majority of gynaecologists in Italy – 64.6 percent, according to 2020 figures from the Ministry of Health – are registered objectors, as well as 44.6 percent of anaesthesiologists and 36.2 percent of non-medical staff at health facilities. 

In several parts of the country, including the regions of Sicily, Basilicata, Abruzzo, Molise and the province of Bolzano, the percentage of gynaecologists refusing to perform abortions is over 80 percent.

These doctors are probably out of step with public opinion in Italy. A 1981 referendum gave voters the opportunity to reject the new abortion law; 68 percent of them voted to keep it. 

More recently, an Ipsos poll conducted earlier this year found that 73 percent of people surveyed in Italy said abortion should be legal in all or most cases.

What election promises has Italy’s right-wing alliance made about abortion?

No doubt sensing the lack of appetite for a full-scale repeal of Italy’s abortion law, the right-wing coalition has made clear that that’s not on its agenda. 

Abortion doesn’t get a single mention in the joint platform put forward by the Brothers of Italy, League and Forza Italia. 

Law 194 does appear in the Brothers of Italy programme, which promises “full application” of the legislation, “starting with prevention” of abortion.

To this end, it pledges the allocation of funds to support single and economically disadvantaged women to carry pregnancies to term, a proposal echoed by the League and presented by both parties as part of a broader drive to reverse Italy’s plummeting birth rate.

The League’s platform also calls for implementation of Law 194’s provisions on the “effective promotion of life”, including by involving non-profit groups – presumably Catholic and other pro-life ones – in pre-abortion counselling.

Forza Italia, historically the most centrist of the three, hasn’t broached the subject at all. 

READ ALSO: Salvini vs Meloni: Can Italy’s far-right rivals put differences aside?

Both Meloni and Salvini have faced questions on the campaign trail about their position on abortion, given previous comments calling abortion “a defeat for society” (Meloni), loudly professed Catholicism (Salvini) and support for European allies who have restricted access to abortion, such as Hungarian Prime Minister Viktor Orban (both). 

“Law 194 isn’t to be touched,” Salvini told reporters this week. “The last thing Italy needs is a country divided and arguing over the laws in place – which can be improved and updated, but certainly not scrapped.”

Meloni, meanwhile, told a recent interviewer that “I never said I want to modify Law 194, but that I want to apply it”. That includes supporting women who feel obliged to abort for economic or practical reasons, she said – as well as supporting health workers who refuse to provide the procedure. 

Why are activists worried a new right-wing government could threaten abortion rights in Italy?

The problem is that Law 194 perhaps does need an overhaul if it is to guarantee access to safe, legal abortions across Italy. 

Those who support women’s right to choose have long complained that the 44-year-old law – whose primary objective, the Italian Health Ministry’s website states, “is the social protection of motherhood and the prevention of abortion” – is not fit for purpose.

A demonstrator holds a sign reading ‘free to choose’ at a rally in defence of Italy’s abortion law. Photo by FABRIZIO VILLA / AFP

Law 194 “does not establish in a strong sense women’s right to choice and self-determination: it establishes when access to it is permitted and granted,” Chiara Lalli, a writer and academic with a focus on abortion, told Il Post

The multiple doctor visits, mandatory counselling session and seven-day “reflection” period are attempts to interfere with women’s decisions, activists say. 

READ ALSO: ‘Ugly act’: Outrage in Italy over discovery of foetus graves marked with women’s names

Separately, watchdogs including the United Nations Human Rights Committee, Human Rights Watch and the Council of Europe’s committee of social rights have flagged the high rates of conscientious objectors as a persistent barrier to abortion access in Italy.

While authorities are supposed to ensure that women can access terminations and that objecting doctors can’t refuse care beyond the procedure itself, with no mechanisms to enforce these requirements specified in the existing law, in practice women report facing long delays or being denied assistance altogether. 

In the past, both Brothers and Italy and the League have resisted attempts to help the problem, such as by recruiting specifically non-objecting doctors.

While these problems are longstanding, there have been attempts in recent years to put more obstacles between women and abortions – mainly from regional or municipal politicians, who tend to be more explicit in their opposition than those on the national stage.

Many of these have come from members of the three main right-wing parties, which together have governed 14 of Italy’s 20 regions for the past two years.

And with each region largely in charge of managing its own public health service, regional governments have the power to make decisions that significantly affect how and where women can access abortions.

In Le Marche, headed by the Brothers of Italy, the regional government refused to implement 2020 national guidelines from the Ministry of Health that would have extended the window for medical abortions from seven to nine weeks and made it possible for women to obtain abortion pills in outpatient clinics and family planning centres instead of going into hospital. 

Abruzzo, whose council is also led by Brothers of Italy, as well as Piedmont and Umbria, two regions governed by the League, resisted the change too.

Priests join an anti-abortion demonstration on May 21st 2022 in central Rome. The placard reads “Human Rights are born in the womb”. Photo by Alberto PIZZOLI / AFP

Piedmont has further allowed anti-abortion groups to set up stands in public hospitals, and councillors have proposed funnelling public funds to groups that would pay women not to abort

The League-run council in Verona declared it a “pro-life city” and called for funding for anti-abortion projects to be written into the town budget, as well as authorizing anti-abortion groups to display promotional material in council buildings. 

In the wider region of Veneto, such groups are allowed to offer family counselling services alongside those providing neutral information – a move the League’s manifesto suggests extending when it talks about involving non-profits in “the promotion of life”. 

To those who support abortion, it all starts to look like a pattern. “As soon as a right-wing council takes charge, it seems like these issues are at the top of the agenda,” Beatrice Brignone, head of the small left-wing party Possibile, told L’Espresso back in 2020.

READ ALSO: Why an Italian woman was forced to go to 23 hospitals to have an abortion

With threats to abortion access in Italy emerging locally and unchecked at national level, some activists say they would in fact welcome putting Law 194 up for debate under the next government.

“As much to better implement it as to make the necessary modifications … it is time to begin an informed discussion on abortion and free ourselves from the prejudice that the law is untouchable,” comments the Luca Coscioni Association, which advocates for freedom of scientific research and backs abortion rights.

Meloni and her allies have already made clear that such a discussion will not be among their priorities if they win this weekend. 

What do other parties say about abortion?

Abortion isn’t an issue for either the centrists Italia Viva or Azione, nor for the populist Five Star Movement.

The centre-left Democratic Party promises the full application of Law 194 throughout the country, without going into further details.

The only concrete proposals come from much smaller parties on the left: Possibile proposes establishing a quota of at least 60 percent of non-objecting staff in each health facility, as well as tracking the service provided by each region and punishing those who fail to meet minimum standards. 

The Greens and Left Alliance wants to change recruitment rules to hire more non-objecting medical staff, while +Europa suggests partnering with private clinics to expand access and making medical abortion more widely available as an outpatient procedure.

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