Increase In Measles in Italy Linked to Austerity Measures Interview with:


Veronica Toffolutti PhD
Research Fellow in Health Economics
Bocconi University What is the background for this study? What are the main findings?

Response: Austerity has been linked to several health damaging effects such as suicides, increase in unmet needs, disease outbreaks that affect vulnerable peoples such as malaria in Greece, HIV in Greece and Romania during the current economic crises or in the earlier economic crisis cuts in public health expenditure have been linked with diphtheria and TB.

Europe is experiencing declining vaccination rates and resurgences in measles incidence rates. Italy appears to be particularly affected reporting the second largest number, second to Romania, of infection in Europe in 2017. Starting from the point that the primary reason for the outbreak in the decline in the measles vaccination we test the hypothesis that large budget reductions in public health spending were also a contributing factor.

Using data on 20 Italian regions for the period 2000-2014 we found that each 1% reduction in the real per capita public health expenditure was associated with a decrease of 0.5 percentage points (95% CI: 0.36-0.65 percentage points) in MMR coverage, after adjusting for time and regional-specific time-trends. What should readers take away from your report?

Response: Our findings highlight the risks of disinvestment in public health services. Our analysis suggests that austerity measures adopted in Italy contributed significantly to the resurgence of measles. Importantly, the declines were concentrated neither in the most deprived nor most affluent regions, but in those which experienced the greatest reductions in the real public health expenditure. What recommendations do you have for future research as a result of this work?

Response: One of the main limitation of our study is that we did not evaluate infections but vaccination coverage, ideally future studies should evaluated the impact of reduction in public health expenditures on measles hospitalization and incidence rates. At the moment those data are not available for Italy. Is there anything else you would like to add?

Response: We believe that the new law adopted in Italy would have important implications. This law made vaccination mandatory for children entering public primary schools and it was enrolled in July 2017. It is still too early to know whether the new immunization plan will be effective. However, early signs are promising, with coverage data presented at the end of December 2017 estimating a national increase from 87.9 to 92.2% at 36 months of age.


Veronica Toffolutti, Martin McKee, Alessia Melegaro, Walter Ricciardi, David Stuckler. Austerity, measles and mandatory vaccination: cross-regional analysis of vaccination in Italy 2000–14. European Journal of Public Health, 2018; DOI: 10.1093/eurpub/cky178

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Sep 13, 2018 @ 10:57 pm

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