Has Italy been vaccinating the wrong people? Its daily coronavirus death tolls suggest so.
By Chico Harlan and Rick Noack,
Andrea Merola EPA-EFE/REX/Shutterstock
ROME — Looking at the day-by-day chart tracking Italy’s relentless coronavirus death toll, it would be impossible to tell that the country has been armed since late December with vaccines.
At a point when the pandemic has become a race between those vaccines and a more lethal variant, most Western European nations have managed to push down their death rate through a combination of lockdowns and vaccinations. Italy’s death rate, though, is much the same as it was 3 1/2 months ago, despite receiving the same proportion of doses as other European Union members. On Wednesday, the country reported another 627 victims of the virus, the highest daily figure since early January.
The question of what’s gone wrong in Italy is now perplexing a hard-hit nation that had thought it was over the worst. There are numerous factors at play. Italy, the second-grayest country on earth, has more elderly to vaccinate than most. In February, according to mobility data, it was slightly more open than other major European countries, leading to a higher spread of the virus; it has since clamped back down. At the same time, the more lethal variant first detected in Britain has gained dominance here and elsewhere across the continent.
But some scientists and data analysts say that Italy’s vaccination campaign also deserves blame. The country, they say, has been vaccinating too many of the wrong people, overprioritizing young workers and leaving the elderly vulnerable.
“Things have not been done appropriately in the last three months, that is clear,” said Sergio Abrignani, an immunologist and a new member of a scientific committee advising the government. “Otherwise we wouldn’t be having 300, 400 deaths every day, as we have now.”
Italy’s predicament has lessons for other countries facing their own tough decisions about whom to prioritize with a limited vaccine supply. European countries, including Italy, have mostly been aligned in devoting the first doses to front-line health-care workers and nursing home residents. But if the primary goal is to avert deaths, the takeaway from Italy seems to be: Once that work is done, keep giving doses to the old, and be very selective about which younger workers might be eligible.
People seek vaccines at a hub set up in Naples.
The data shows why Italy remains so exposed: Among European Union countries, it ranks toward the very bottom in inoculating people in their 70s — a group that is still highly vulnerable to the ravages of the virus. Only 2.2 percent of that age group is fully vaccinated. Every other age group in Italy — including people in their 20s and 30s — has received a higher proportion of full protection.
It is also paying for an initial decision to devote its first phase solely to health-care workers — whether on the front lines or not — rather than vaccinating that group more slowly while simultaneously addressing the elderly. Most people in their 80s had no protection into March, a pace that put it behind other European countries. It has since raced to catch up. But it is the people infected weeks ago who are now dying.
As a result, the profile of the average victim has changed little. In late December, that victim had a mean age of 81. Now, the mean age is 79.
“Every minute of these delays [in vaccinating the elderly], it leads to a dramatic loss of human life,” said Piero Ragazzini, the secretary general of a union for retirees.
The sharpest contrast to Italy comes from France, which has devoted the overwhelming majority of its doses to seniors and has given at least one dose to 50 percent of those in their 70s. Though France is well-known for its vaccine skepticism and got off to a slow start, Prime Minister Jean Castex insisted in late February that the country was ahead of others by vaccinating “the right people.” Anyone in France aged 70 and over became eligible for a vaccine late last month.
The countries make for a good comparison because they have been fairly similar in terms of lockdown rules and mobility in recent months.
Over the past week, France has recorded 1,900 covid-19 deaths. Italy has recorded 3,000.
“We need to continue the vaccination of people over 75 years of age and increase the vaccination of people with comorbidities, because statistics show us that they have a higher probability of being hospitalized or seriously affected,” Castex said.
In assessing why Italy has gone off course, some experts point to a decentralized system of health care, in which the nation’s 20 regional governments have wide latitude to determine who gets shots. Though the central government’s Health Ministry laid out guidelines for whom to prioritize at the beginning of the rollout — front-line health workers, nursing home residents, people over 80 and then essential workers — some regions have opened the doors wide to midcareer workers, while barely beginning to administer doses to those 70 and older.
People fill out paperwork ahead of receiving coronavirus vaccines in Milan.
In recent weeks, Italian newspapers have been full of stories about the vaccinations of chefs, models and magistrates. Several regional investigations have been launched. Italian Prime Minister Mario Draghi, who took office in February, in Parliament two weeks ago accused some regions of “neglecting” the elderly, instead favoring groups “that have probably gained priority on the basis of their contractual strength.”
For several weeks, Italy was giving shots to middle-aged workers because it had little other choice. The national drug regulator had advised that the Oxford-AstraZeneca vaccine be used only for those 55 and younger. But officials say even after that guidance was lifted — with AstraZeneca approved for the entire population — regions were slow to adjust their strategies.
There are also questions about why certain young people received their shots. According to the government’s data, some 250,000 people in their 20s and 30s have been given doses even though they are not teachers, health-care workers or law enforcement members — the essential groups. The Health Ministry did not respond to a question about the rationale for vaccinating those people. In the government data, they are categorized as “other,” or “altro.”
“In some regions, they vaccinated journalists. In others, they vaccinated lawyers,” said Roberto Burioni, a professor of microbiology and virology at Vita-Salute San Raffaele University in Milan. “University professors have been vaccinated now, and they are working remotely. I don’t see the rationale behind this. It’s so foggy.”
Abrignani said that in the wake of Draghi’s comments, the situation appears to be improving. Doses given to people 70 and older have accelerated over the past week.
But Matteo Villa, a research fellow at the Italian Institute for International Political Studies, who has followed the coronavirus, said that earlier mistakes — particularly the slowness of vaccinating those 80 and older — are for the moment still playing out.
Villa projects that Italy has so far saved 4,000 lives with its vaccine campaign but that this could have been as high as 12,000, under the optimal model.
He said there is an argument for inoculating key workers during subsequent phases but that those doses should be given to people only above a certain age.
“I can tell you they’ve been vaccinating the wrong people because they vaccinated me, as well,” Villa said.
He is 37. He received his vaccine appointment weeks after a dose was given to his grandmother, who is 92. Neither of his parents, who are in their 60s, have been inoculated.
“If you look at the lethality of the virus, I should not be getting a vaccine right now,” he said.
Noack reported from Berlin. Stefano Pitrelli contributed to this report.