Diphtheria: more than half of the regions are below the safety threshold for vaccinations

There are as many as 13 regions in Italia which, in 2025, failed to reach last year’s ‘safety threshold’ of 95 per cent of children vaccinated against diphtheria and other infectious diseases – from whooping cough and tetanus to polio – a vaccination coverage rate that the WHO considers the minimum threshold for achieving herd immunity and thus preventing the circulation of viruses and bacteria that are often dangerous, if not lethal. Such as diphtheria, which fatally claimed the life ofthe four-year-old girl from Palermo on 20 August, whose funeral was held yesterday: the last death among children aged under five in Italia had occurred 11 years earlier, in 2015. But even before that, there had been no recorded deaths, a situation that had persisted since the late 1970s thanks to vaccines which, according to a study by the Istituto Superiore di Sanità, have since prevented 2,000 deaths a year. Even the number of infections could be counted on the fingers of one hand in recent years: zero in 2020–21, three cases between 2022 and 2023, and five in 2024 – compared with 362 cases in 2022, 237 in 2023 and 151 in 2024 across the whole of Europe. Furthermore, according to the ISS, vaccines have prevented around 2 million cases in Italia from the 1930s up to 2015.

The case of the little girl from Palermo therefore serves as the classic warning sign of the risks involved in letting our guard down when it comes to vaccinations – particularly by falling just below that 95 per cent threshold considered necessary to limit the spread of certain infectious agents within the population, starting with children but also to protect, through a sort of ‘protective barrier’, those vulnerable patients who cannot be vaccinated. And whilst the national average for diphtheria vaccination – as shown by the very latest figures from the Ministry of Health, which are due to be published – stands at just under 95 per cent, Sicily brings up the rear with 85.88 per cent, closely followed by Bolzano at 87.39 per cent. And it is the South that records the lowest vaccination rates: from Puglia (91.72 per cent) to Abruzzo (92.33 per cent), Molise (92.53 per cent), Sardinia (92.82 per cent) and Basilicata (92.93 per cent), with the exception of Friuli (92.57 per cent) and Valle d’Aosta (93.76 per cent). In the North, by contrast, vaccination rates for children are close to 100 per cent, as in Tuscany (97.90 per cent), Lombardy (97.56 per cent) and Trento (97.18 per cent).

These figures also apply to other infectious diseases besides diphtheria, namely tetanus, whooping cough, polio, hepatitis B and Haemophilus influenzae type b, against which children are protected by the hexavalent vaccine, which protects against bacteria and viruses. This vaccination is subject to a compulsory requirement introduced in 2001, which was subsequently confirmed and extended to a total of 10 vaccinations by Law No. 119/2017. Just last July, the Ministry of Health received a recommendation from the Higher Health Council, in which the ‘experts’ called for the mandatory quadrivalent paediatric vaccination to be maintained; according to *Il Sole 24 Ore*, is expected to receive a positive response shortly from Minister Orazio Schillaci’s technical team. Sources at the Ministry of Health also reiterate the Minister’s position, as he has consistently spoken out in favour of vaccines and the harmonisation of vaccination strategies at national level to ‘ensure that all citizens have access to more accessible and effective protection and immunisation measures’. Moreover, in 2023 itself, the National Vaccination Prevention Plan was renewed following an agreement at the State-Regions Conference; this plan “remains in force until the end of the year” and “the vaccination schedule has been confirmed, including, of course, that for young children”.

In short, the tools are there; the task now must be to overcome vaccine hesitancy and vaccine fatigue – a heavy legacy of the Covid pandemic – which is leading many Italians not to vaccinate their children.