Smallpox monkeys, insufficient doses: from Italy vaccination tourism across the border

In the weeks preceding the arrival in Lombardy of the first tranche of vaccines against monkeypox "There was a lot of anticipation in Milan. Since the first immunization campaigns in Europe began - some countries started a few weeks earlier than us - we have been inundated with phone calls, emails, messages on social networks from our users and people who wanted information. The days before the 'click day' to book the first doses were a delirium ". To tell the Adnkronos Salute is Daniele Calzavara, of Milan Check Point, a space dedicated to sexual health, where you can do tests for HIV and other infections or undertake a PrEP path, that is, pre-exposure prophylaxis for HIV, a pharmacological intervention put in place preventively to avoid contagion in high-risk people.

"There were about a hundred calls a day - he recalls - And in fact the first 2 thousand doses received by our Region have already been booked. Now the vaccinations are in progress. Surely the quantities to date are insufficient. They are global, and in Italy especially if we look at neighboring countries such as France and the UK ". in France and the UK that several Italians flew to get vaccinated as soon as possible. Cross-border 'vaccine tourism' has cities such as Paris, Nice or London as its destination, and the countries that have fewer doses available as a starting point in general. Not only the tricolor Peninsula.

As reported for example by the 'New York Times', there are differences: Spain, although it was one of the centers of the epidemic in Europe, until last week had had access to only about 5 thousand vaccinations. France, with less than half of the confirmed cases, had already vaccinated 27,000 people. "It happened - confirms Calzavara - that some people, including Italians, went to have the vaccination in London or in some French 'drop-ins' where it is offered freely". In these realities the anti-monkeypox vaccination was also done in some rooms or in a gazebo, thus opening to everyone.

"Where, on the other hand, the number of doses is much lower, there is no such possibility. For example in Germany, where a large quantity of doses is now expected, you can only put yourself on a waiting list if you have access to the health system. German, in Spain only if you have a Spanish health card, a bit like us ", explains Calzavara.

"It should be remembered however - he warns - that 14 days must pass from the second dose to have complete coverage. After the first dose there is a coverage of about 30%. I underline this thinking of many phone calls received before the 'click day' "of reservations." There were those who told us: I have to get the vaccine because then I go on vacation. Here, we hope that everything goes well, but it is not certain that with a dose of vaccine we cannot acquire the infection. "Calzavara's call to caution. The Milano Check Point is among the realities that the first to August were involved by the Region as members of the task force "on Monkeypox.

The pool of experts has met "so far once to find guidelines and methods for vaccination. In Lombardy, apart from about twenty doses for the laboratory staff that treats orthopoxvirus and therefore Monkeypox and the remaining over 1,900 it has been possible to book them. Were intended for gay men, trans people or bisexual men who have sex with men and who fall into one of the additional risk cases declared by the ministerial circular, that is to have multiple partners; go to places where you have sex such as clubs, cruising, saunas; have had recent episodes of group sex; have had a sexually transmitted infection in the last year, or still have 'chem sex', "Calzavara lists.

"We definitely expected such a massive response" to the vaccine offer, he admits. "There was expectation. E the 'no-vax' among our users are residual cases. If I think of those who do the PrEp - we currently follow about 750 people - at the beginning of the path the vaccination plan for hepatitis A, B or for HPv is drawn up, if these vaccinations have not been made. Adhesion is very high, over 90%. Let's say that the 2 thousand doses of anti-Monkeypox vaccine arrived are practically symbolic at this stage, given the demand that exists, and in fact they have all been booked ".

"The next doses should come from the collective purchase made" by the European authority Hera "for all EU states, of which Italy will receive a share. Delivery should be between the end of August and the beginning of September". Meanwhile, in Lombardy "the task force's decision was to use the entire first tranche received as first doses, without setting aside the second ones, to vaccinate 2 thousand people instead of a thousand. And almost all the centers have made an appointment for 1 month and a half for the second dose. With the second arrival, I believe there will be vaccines for about 1,500-2 thousand people, unfortunately I don't think more ", continues Calzavara.

Vaccinations at the moment "are insufficient", he repeats. But, "despite this, it must be said that the Ministry of Health has been quite active, the Regions have also moved quickly and rather well. Given the epidemiological data, I think it was correct to allocate the few doses to the most at risk people, precisely to seek to contain the infection and try to reduce the curve of infections. I understand it is scary to hear about so-called categories - he observes referring to the criticisms of the language used in the circulars, advanced by activists who fear a step backwards, a return to the 80s - but here we are talking about men having sex with men, but with additional risk behaviors. The work being done is in line with other European and North American countries where vaccination is offered to the same people with the same risk".