Italy's response to vaccine hesitancy: An innovative and cost effective National Immunization Plan based on scientific evidence.

roved). The debate around vaccines has been in the spotlight in Europe over the last few years, both within the scientific community and the general public. In times where vaccines are losing public confidence and several international organizations (WHO, EU, ECDC) warn against the growing phenomenon of ‘vaccine hesitancy’ and its impact on decreasing vaccine coverage trends [1–3], National Health Authorities have been addressed by the Council of EU to take action to promote and support vaccination policies [4]. The case of Italy was raised on international journals in 2015 [5]. Today, after a two-year long administrative process, Italy achieved the final approval of the new National Immunization Prevention Plan (PNPV) 2017–19 [6]. Throughout this period the Italian Ministry of Health and the Government at large have showed considerable commitment to push the Plan forward and to raise the economic resources needed to support its implementation; this because the Italian National Health Service has always fully financed vaccination programmes for both children and adults [7]. The contribution of the scientific community with a strong partnership of four national scientific and professional associations (the Italian Society of Hygiene, Preventive Medicine and Public Health – SitI, the Italian Society of Pediatrics – SIP, the Italian Federation of Family Pediatricians – FIMP – and the Italian Federation of General Medicine – FIMMG) active in the field has been relevant with the publication of an innovative life-time immunization schedule [8] which contributed to grant a solid basis for the PNPV development. The new PNPV combines the most evidence-based immunization offer with an innovative approach to its implementation in all Italian Regions and Autonomous Provinces (R&AP). Among the innovative aspects of the PNPV: the introduction of new vaccines, new target populations, the implementation of electronic immunization registries, better training for healthcare professionals (including specific courses in the Schools of Medicine) [9], information campaigns, the encouragement to sanction physicians who do not recommend vaccinations and new laws to limit pre-school admissions for unvaccinated children. New vaccinations (Table 1) were added, compared to the previous 2012–14 Plan [3]: immunization against meningococcus B, rotavirus and varicella for children; the quadrivalent meningococcal and HPV vaccines extended to males in adolescence and zoster and anti-pneumococcal disease immunization for elder and at risk populations. The new schedule suggested is illustrated in Fig. 1. Although some of the new immunization programmes were already recommended in selected R&AP [10,11], the new schedule extends them to the whole country thanks to the inclusion in the new list of Essential Levels of Care (LEA), approved by the Parlament in early 2017 and effective from April 4th, 2017. Not only the Italian PNPV can be considered one of the most modern and updated immunization schedule on the European scene, but it is also a symbol of equity (all vaccines are offered actively and free of charge). However, the significant increase of vaccinations and sessions compared to the previous schedule (estimated to be +65% to +90%) now poses new challenges to the Ministry of Health and R&AP Health Authorities that will need to be faced in the months to come to ensure that the ambitious vaccine coverage targets set in the PNPV can be met.