[The new National Immunization Program 2017-2019 and the Essential Care Levels: what is going to change?].

Italy is witnessing relevant challenges in the field of prevention and control of vaccine-preventable diseases. The worrying and growing phenomenon of "vaccine-hesitancy" has contributed to the reduction of vaccination coverage, undermining goals reached thanks to vaccines introduction. The new Italian National Immunization Plan (NIP) 2017-2019 and the update of the list of Essential Care Levels (LEA), approved in the current year, extend the vaccination offer based on the latest scientific evidence with the introduction of new vaccines and the enlargement of target population. The decree-law containing urgent measures in immunization field issued in June 2017 represents a tool to achieve the goals reported in global and national immunization plans. Among others it has increased mandatory vaccinations from 4 to 10 and has made them compulsory for pre-school admission. Following the global and European vaccination goals, the priorities identified by the Italian NIP are to: maintain the polio-free status; pursue the elimination of measles and congenital rubella; ensure an active and free of charge vaccination offer, the access to services and the availability of vaccines; target hard to reach populations with low vaccination coverage; develop an institutional communication plan on vaccinations. Regarding the vaccination offer, the main novelties introduced by the NIP 2017-2019 include the introduction of: vaccines against N. meningitidis B, rotavirus and varicella in newborns; tetravalent meningococcal vaccine (ACWY135) and a booster dose of anti-polio in adolescents; pneumococcal vaccines (PCV13 + PPV23) and anti-Zoster in subjects aged sixty-five. Furthermore, the NIP 2017-2019 establishes to extend HPV vaccination to male adolescents. The cost of new vaccinations, funded by the National Health System, is about 100 million euros in 2017 but, thanks to the new vaccination schedule, it is estimated that approximately 200 million euros will be saved because of the annual reduction of direct costs of vaccine-preventable diseases. Furthermore, the NIP tries to act against the growing public skepticism in vaccines, proposing solutions to counteract the fall in vaccination coverage by promoting a culture of vaccination and the empowerment of both health workers and general population. In this perspective, the NIP proposes to promote institutional communication campaigns, based on transparency, conveying information about vaccines risks and benefits and the ethical and social value of vaccinations. It is further proposed to strengthen the training of healthcare professionals, jointly with disciplinary actions against physicians who do not recommend vaccinations. Particular attention is also placed on the implementation of vaccines registries for the homogenization of data recording that allows to evaluate and to monitor vaccine policies. The update of LEA, which include a list of services provided by SSN, has adopted the innovations of the NIP and overcomes the criticism of regional inequalities in vaccination offer guaranteeing the same offer all over the Italian country. In conclusion, the NIP 2017-2019 and the new LEA are fully integrated into the current epidemiological and cultural scenario. They envisage a supply of evidence-based vaccinations, ensuring a free, equal and uniform vaccination offer on a national scale and striving for the promotion of a culture of vaccination.