Forty years (1978-2018) of vaccination policies in Italy

The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications and the introduction of hepatitis B and acellular antipertussis vaccines; the second (1999-2008) coincided with the first national vaccination plans and with the hypothesis of a progressive transition from mandatory vaccinations to nudging initiatives with the relevant experimentation in the Veneto Region; the third phase (2009-14) was characterized by the spread of health information on the web and social networks, by anti-scientific judgments and by an increasingly vaccines hesitancy that led to incorrect perceptions, falls in coverage rates and re-ignition of some epidemics; in the last phase (2015-18) there was a strong political committment that led to the approval of the National Plan (PNPV) 2017-19, to the extension of the mandatory vaccinations and to the sanctions against the anti-vaxxers doctors. This has led to a rapid rise in coverage, but also to a heated political and media debate on the ethical and social aspects linked to the admission bans and sancions of unvaccinated children in schools.