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Italy approves ‘mix and match’ vaccinations for under-60s as regions issue varying rules on AstraZeneca

The Italian Medicines Agency (Aifa) on Tuesday approved giving people under 60 a combination of Covid-19 vaccines after the government limited use of the AstraZeneca jab.

Published: 15 June 2021 14:17 CEST
Updated: 15 June 2021 17:31 CEST
Italy approves 'mix and match' vaccinations for under-60s as regions issue varying rules on AstraZeneca
Under-60s in Italy may now have the Pfizer-BioNTech or Moderna Covid-19 vaccines instead of a second dose of AstraZeneca. Photo: Marco Bertorello/AFP

The health ministry said anyone under 60 who had already received a first dose of AstraZeneca should now have Pfizer or Moderna – so-called mRNA vaccines – for the second dose.

READ ALSO: Italy limits use of AstraZeneca vaccines to over-60s

Aifa on Monday published its approval for mixed vaccines. The regulator had previously recommended that people get both doses of the same vaccine.

The health ministry stated on Saturday that regional health authorities should stop giving the AstraZeneca jab to under-60s, amid concerns about heightened health risks for younger people.

Italian authorities had previously recommended AstraZeneca be only given to over-60s, but this was not an outright ban and many regions had been giving it to younger people on a voluntary basis. This advice was strengthened after the latest review last week.

However, despite the health ministry’s new instructions, Italy’s regions are continuing to implement their own vaccine programmes with varying rules.

Vials of the AstraZeneca (L) and Moderna Covid-19 vaccines at the pharmacy of the Sant’Andrea hospital in Vercelli, Piedmont. Photo: MARCO BERTORELLO/AFP

Italian news agency Ansa reported “chaos in the regions” on Tuesday, saying the latest rule-change on AstraZeneca had “caused confusion”.

Some Italian regional authorities said they will still continue to allow people to take AstraZeneca if they want to amid concerns about the supply of other vaccines, while Campania said it was banning the use of the Astrazeneca and Johnson and Johnson vaccines altogether.

EXPLAINED: Why has Italy recommended the AstraZeneca vaccine for over-60s only?

Vincenzo De Luca, regional president of Campania, announced that he had written to the health minister saying his region was against giving mixed vaccinations and claiming that the practice “has not been trialled broadly on an international level”.

In an interview with La Stampa on Monday, Health Minister Roberto Speranza stressed that mixing vaccinations was known to be safe and effective, saying: “Our indications are peremptory and must be followed. It is not a political debate. It’s not the prime minister, ministers or a regional president who decides:”

“So-called ‘vaccination crossing’ is something Germany has been doing for two months, which France and Spain have also been doing for some time,” he said. “It’s not made up, these are scientific studies. This is a procedure that has given good results.”

Several other EU countries including Sweden, Norway and Austria are also allowing people to have an mRNA shot for their second dose if they were first vaccinated with AstraZeneca, after those countries also changed their advice on the jab.

READ ALSO: Is Italy really going to offer vaccines to tourists this summer?

The European Medicines Agency (EMA) has stressed that the AstraZeneca jab remains approved for all adults, saying the benefits continue to outweigh the risks.

Meanwhile the Italian region of Puglia said it would allow people to take AstraZeneca if approved by their doctor, and Lombardy’s regional government expressed concerns about the supplies of Pfizer and Moderna vaccines.

Several regions have found themselves with unused doses of the Oxford University vaccine, as people opt to get vaccinated with alternatives that they perceive as safer or that have a shorter interval between doses (or in the case of Johnson & Johnson, require just one shot). 

As a result, some regions had been offering the Covid-19 vaccine to younger adults as part of vaccination “open days”: special vaccination drives, often at evenings or weekends, that allow the youngest age groups to get a shot earlier than they otherwise might.

The latest review of the use of AstraZeneca in Italy came following the news that an 18-year-old in north-west Italy who was vaccinated with AstraZeneca two weeks previously had died after developing a blood clot.

Most of the AstraZeneca side effects observed so far occurred within two weeks of the first dose. The second dose is thought to carry an even lower risk, though more data is needed to know for sure.

Data from millions of people vaccinated with AstraZeneca across Europe and the UK indicates that serious side effects after either dose remain extremely rare.

In a monitoring report released this week, AIFA said that in Italy the incidence of blood clots after vaccination was around one per 100,000 injections of AstraZeneca, mainly in people under 60. 

It has not received reports of any clots developing after the second dose, the agency said.

What are the different types of Covid-19 vaccine available?

AstraZeneca Johnson & Johnson, both so-called ‘viral vector’ vaccines, are authorised for everyone over 18 in Italy and by Europe’s medicines agency, but both have been dogged by reports of rare blood clots. 

The EU and Italy have also authorised two mRNA vaccines: Pfizer/BioNTech and Moderna.

Viral vector vaccines like AstraZeneca and Johnson & Johnson use genetically-engineered version of a common-cold causing adenovirus as a “vector” to shuttle genetic instructions into human cells.

The mRNA or Messenger RNA genetic technology instead trains the body to reproduce spike proteins, similar to that found on the coronavirus. 

When exposed to the real virus later, the body recognises the spike proteins and is able to fight them off.

Member comments

  1. My son is a student in England and has gotten his first Pfizer shot. I am wondering if he can get his second Pfizer shot in Italy as he will be with us for the summer. This is not only a question of logistics but also of reciprocity between the two countries. For example, will he be able to get his Italian green pass if he does the second shot in Italy and will England recognize it? Would appreciate any information on this. Thank you.

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COVID-19 VACCINES

How to get a Covid booster jab in Italy this autumn

Italy's autumn Covid vaccine booster campaign is now underway, along with its seasonal flu jabs rollout.

Published: 2 October 2023 13:08 CEST
Updated: 2 November 2023 12:21 CET
How to get a Covid booster jab in Italy this autumn

The updated Covid vaccine is now available across Italy’s regions, with over nine million doses due to arrive in the country by the end of November.

The first jabs were available in some regions from the start of October: Lazio started its campaign on Monday, October 2nd, while Friuli Venezia Giulia’s launched a few days earlier on September 29th.

As healthcare is managed on a regional level in Italy, each region has its own start date and booking procedure.

The boosters are particularly recommended for over-60s, those who are immunosuppressed or pregnant, and healthcare workers, though jabs may be available to others on request.

The campaign aims to prevent a seasonal spike in infections, with vaccines targeting the new Eris variant as well as new winter flu viruses.

Which vaccines are available?

According to the latest health ministry circular, the government’s Covid booster campaign uses Pfizer and BioNTech’s monovalent Comirnaty vaccine targeting Omicron XBB 1.5, otherwise known as Kraken.

The European Medicines Agency has said the vaccine is also effective against other variants including Eris (EG.5.1), which as of late September had become the dominant strain in Italy at 43.5 percent, according to ISS data.

“Eris is one of the viral forms we are seeing and I am pleased to announce that the latest approved vaccines also protect against variants in circulation, including Eris,” EMA director Emer Cooke reportedly said in a recent press conference on respiratory diseases.

The EMA has said the vaccine is effective against new variants.

The EMA has said the vaccine is effective against new variants. Photo by MARCO BERTORELLO / AFP.

Who are they for?

The health ministry says the campaign is particularly aimed at the following groups:

  • Over-60s
  • Residents of care facilities
  • People who are pregnant or breastfeeding
  • Health and social care workers
  • People of any age with underlying health conditions

Vaccines are also recommended for caregivers, family members, and anyone who lives with a medically vulnerable person.

Anyone who doesn’t fall into any of these these categories but would still like to get a Covid booster can access one on request, subject to availability.

Administration of the booster is recommend six months from the last dose or from the last known Covid infection (as confirmed by testing).

A single dose of the adapted vaccine is also recommended for those who have not yet received any Covid vaccines. For children aged six months to four years who have not yet been vaccinated or infected with Covid, three doses are recommended, each several weeks apart.

How to get the booster

Your first step should be to visit the government’s vaccine booking website and see how the campaign is being conducted in your region (under ‘Prenota vaccino’).

Italy’s healthcare system operates on a regional rather than a national level, so getting a booster in Emilia-Romagna will be a different process to getting one in Lombardy.

In Lazio, for example, priority will be awarded in the first instance to health and social care workers and residents of care homes. The vaccine will be offered to over-80s and the medically vulnerable from October 16th, and other categories from October 30th.

If you can’t see the information you need on your regional authority’s website, it’s a good idea to contact your family doctor or local pharmacist to see what they can tell you about accessing the jab.

With Italy’s previous Covid vaccination campaigns, the websites for most regional health authorities have required patients to input their tessera sanitaria (national health card) and codice fiscale (tax code) numbers in order to make an online booking.

That means that if you don’t have one, you’ll likely need to make a phone call to either your regional health authority.

In the past, readers of The Local reported being able to book an appointment for a Covid vaccine by phone using only their codice fiscale number after explaining the situation (you’ll need the help of an Italian speaker if you don’t speak Italian).

As Italy’s Covid booster campaign is being rolled out alongside its seasonal flu jab campaign, you should be able to get both shots at the same time.

The Covid situation in Italy

According to the latest weekly bulletin from Italy’s National Health Institute (ISS), the number of Covid cases in Italy has increased over the past few weeks, with 38,775 new cases recorded between September 21st-27th, but the infection rate is slowing.

As of the week ending September 27th, the Rt (transmission rate) in Italy was 0.9, below the epidemic threshold,  and the numbers of hospitalisations and of Covid patients in intensive care is also low and stable, the data shows.

However the risk to older members of the population and people with underlying health conditions who become infected remains “severe”, the European Centre for Disease Prevention and Control (ECDC) warns.

“Vaccination saves lives, decreases the chances of being infected and reduces the risk of severe illness from COVID-19 and influenza,” ECDC director Andrea Ammon said in a recent press release encouraging uptake of the vaccines.

Find more information about Italy’s Covid-19 vaccination campaign on the Italian health ministry’s website.

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