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TematicheItalia ed EuropaWhy is Italy Ahead of the United States in...

Why is Italy Ahead of the United States in the Vaccine Rollout of First Doses?


As of July 1, 2021, the percentage of fully vaccinated people in the United States (US) is 47% while in Italy is 31%. But why the percentages are 54% and 56%, respectively, for first doses? Surveys indicate that vaccines approval rates in both countries are similar. Then what does explain such differences?

Between December 2020 and February 2021, the vaccines distribution plans in the US and in Italy were quite different. The US—like the UK—bought doses from pharmaceutical companies before vaccines went through emergency use authorization. Italy—like other countries of the European Union (EU)—had to accept the risk-averse approach of the EU: Only when vaccines were granted emergency use authorization by the European Medicines Agency (EMA), EU countries could buy the doses. The US was ready to distribute doses immediately after the Centers for Disease Control and Prevention (CDC) granted authorization. Additionally, in Italy, after a month from the first dose administered on December 27, 2020, the vaccination rollout stalled because of a cut in the Pfizer-Biotech deliveries.

Because of the latter experience, the lacking supplies, and in the view of vaccinating more people as possible, Italy authorized the administration of the second dose of two-shot vaccines, with a larger timeframe in between. Instead of 21-28 days for Pfizer-Biotech, Italy authorized a gap of up to 40 days. This can explain differences in the percentages of fully vaccinated people between the US and Italy, as the number of people waiting for the second dose in the US is 8% while in Italy is 26%. 

That can explain why, Italy, is registering a higher percentage in first doses. By adding the percentages of people waiting for the second dose in the two countries, Italy ends up with 57% while the US with 55%. That way, the current picture would see Italy ahead of the US even in fully vaccination rates. However, as both countries have approved a single-dose vaccine, Johnson & Johnson, the percentages of fully vaccinated people in the two countries may slightly change. Can we conclude that vaccines rollouts in Italy and the US are going towards the same path? Not really.

Experts said when countries reach about 70% of vaccinated people, COVID-19 can be eradicated. According to a global survey published on Nature Medicine in October 2020, both the US and Italy have more than 70% vaccination approval rates. That would suggest that with current percentages of vaccines rollout and supplies available, the curve should keep going up. Why is this happening only in Italy? By looking at the NYT graphs, the US curve is flattering, opposed to Italy’s (almost) vertical curve. There may be two opposite trends pushing Italy towards higher vaccination rates and the US towards lower ones. And perhaps—let me be a stickler social scientist for a moment—some additional consideration about surveys’ methodologies are needed to explain why surveys and tendencies are not going to the same way

On an interesting side, surveys have highlighted how, across U.S. states, there are differences among vaccines approval rates and especially, there is among people who are registered voters for the Democratic or Republican party. Among Democrats, the likelihood of getting a vaccine is 83%, which drops to 56% among supporters of the GOP. On the other side, surveys have subjectively classified Europe. Indeed, there is a difference between Europe intended as a continent, and European Union intended as the 27 member states that are part of the transgovernmental organization and are subject to its regulations. Therefore, affirming that 36% of Europeans think that the vaccine is safe when, the sample includes Ukraine, it may be misleading as Ukraine, a non-EU member, is not subject to EU regulations (and consequently, it is not of EMA vaccine emergency use authorization procedures which grant vaccines safety). 

Aside from surveys methodologies, what can additionally explain such different tendencies between Italy and the US? On April 13, 2021, the US paused the administration of the one-dose Johnson & Johnson vaccine because of a series of severe side effects. Once the investigation concluded that the vaccine was safe and it was possible to resume its rollout, people already lost trust towards it and—more in general—vaccines overall. It is also true that we may never know whether the slowing trend in the rollout of the vaccine in the US is a result of the Johnson & Johnson Effect or just of the point in which no more people want to be vaccinated. If so, data suggest that that point is higher for Italy—which already surpassed the US—than for the latter. 

There may be at least three reasons why, overall, the vaccine approval rate is higher in Italy, than in the US. First, Italy was the first Western country to be hit by the pandemic, registering a high number of cases as early as early March of 2020. Second, Italy registered a higher number of deaths caused by COVID-19, even compared to other EU countries. Last, Italy’s economy needs to get back on track, and vaccines are perceived as a means to get back to normal. And they should.

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