Management of vaccinations in Italy: a national survey after healthcare regionalization

Abstract

Objectives:

The main aim of this study was to describe the effects of regional organization and performance in managing vaccinations, in the light of the institutional devolution recently introduced in Italy.

Methods:

We analysed (1) the general organization of regions for vaccination programmes, (2) the management of four vaccination programmes (combined measles-rubella-parotitis, varicella for children, influenza, and pneumococcal 23-valent for adults).

First, we conducted preliminary face-to-face interviews with 16 regional managers of the infective disease prevention departments. Subsequently, we sent them a standardized questionnaire to obtain comparable information on general organization and on the four specific vaccination programmes considered. In all, 14 regions were eventually included.

Results:

The survey showed a widespread lack of regional staff involved in the management of vaccinations and a geographical variation in the availability of computerized data collection. We recorded poor coverage for varicella and pneumococcal 23-valent vaccinations compared to MRP and influenza. Prices of the four vaccines varied widely among regions, with only a weak correlation between prices and volumes.

Limitations and conclusions:

The major limitation of the survey was the lack of information available at regional level. The piecemeal diffusion of computerized systems and the widespread lack of sufficient staff should mainly explain this.

Economic incentives could be offered to regions that achieve national targets. Such incentives should encourage collaboration between central and regional authorities consistent with institutional trends in regional devolution.

Key words::

• Italy
• Regions
• Vaccination

Transparency

Declaration of funding

CESAV received unrestricted grants for contract research and continuing medical education programmes from a few pharmaceutical companies, including the Italian subsidiary of Sanofi-Pasteur MSD. The sponsor had no role in the preparation of this article.

Declaration of financial/other relationships

L.G., A.P., G.C. have no financial/other relationship to declare.

Acknowledgements

The authors thank the interviewees of the regional infective disease prevention departments: Tamara Agostini, Claudio Angelini, Emanuela Balocchini, Antonella Barale, Roberto Carloni, Michele Dagostin, Manuela Di Giacomo, Lorenza Ferrara, Linda Gallo, Francesco Lo Curatolo, Giancarlo Malchiodi, Mario Palermo, Maria Grazia Pascucci, Clara Pinna, Rosa Prato, Francesca Russo, Salvatore Scondotto, Luigi Sudano, Giuliano Tagliavento.

However, any opinions expressed in this article are those of the authors alone.

Special thanks go to Katelijne Van de Vooren, for help with manuscript revision.