The 2017 Italian reform on mandatory childhood vaccinations: Analysis of the policy process and early implementation

•Implementing the WHO’ guidelines to obtain the herd immunity•Implementing the European Vaccine Action Plan 2015-2020•Increasing mandatory childhood vaccination•Using regulation and coercion to reach vaccination coverage at 95%•Spreading vaccination culture through the use of persuasive tools The data on vaccination coverage for the year 2016 were a cause of concern for the Italian government. For some years, in fact, there has been a growing mistrust of vaccines in the Italy, and consequently vaccination coverage rates have been decreasing. The number of cases of measles has been particularly high. The purpose of this article is to examine the content and the preliminary outcomes of the Lorenzin Decree, which was passed in 2017. This reform embodies a ‘hard’ approach to the issue of childhood vaccinations, based on their mandatory nature and on the intensification of the sanctions against non-compliant subjects. The Lorenzin decree provides for an increase in mandatory infant vaccines from four to ten. Following the reform, unvaccinated children are denied access to nurseries and kindergartens. Parents who do not have their children vaccinated are liable to pay a financial penalty. Data on the preliminary outcomes of the reform show an increase in vaccination coverage. The Italian experience provides some policy recommendations, and could be a source of inspiration for European countries that are tackling vaccine hesitancy and declining vaccination coverage rates. At least for the short term, the 'hard' approach adopted by the Italian government is, in fact, bearing fruit, having reversed the negative trend in vaccination coverage rates.