ArticleEuropean journal of public health2019
Austerity, measles and mandatory vaccination: cross-regional analysis of vaccination in Italy 2000-14.
Article in European journal of public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Austerity policy and child health in European countries: a systematic literature review.BMC public health · 2020Pooled it
- Child poverty and declining measles, mumps and rubella (MMR) vaccination in England, 2015 to 2024. A longitudinal ecological study at local area level.medRxiv : the preprint server for health sciences · 2026Article
- Decline in UK childhood vaccine uptake.BMJ (Clinical research ed.) · 2025Article
- Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019).Human vaccines & immunotherapeutics · 2022Article
- The impact of local vaccine coverage and recent incidence on measles transmission in France between 2009 and 2018.BMC medicine · 2022Article
- Article
- An exploratory study to assess patterns of influenza- and pneumonia-related mortality among the Italian elderly.Human vaccines & immunotherapeutics · 2021Article
- The Implementation of the Professional Role of the Community Pharmacist in the Immunization Practices in Italy to Counteract Vaccine Hesitancy.Pharmacy (Basel, Switzerland) · 2020Review
- The introduction of 'No jab, No school' policy and the refinement of measles immunisation strategies in high-income countries.BMC medicine · 2019Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
Background: Italy has experienced a resurgence in measles since 2015. Although much emphasis has been placed on the role of individuals opting out of vaccination, here we test the hypothesis that large budget reductions in public health spending were also a contributing factor. Methods: Multi-variate statistical models were used to assess the relationship between measles, mumps and rubella (MMR) coverage and real public health expenditure per-capita across Italy's 20 regions covering the period 2000-14. Results: Between 2010 and 2014 Italy's public health expenditure fell by over 2%, although varying among regions. Fixed effects models estimate that each 1% reduction in 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. The consequences can be illustrated by comparing two regions, Lazio, where public health spending fell by 5% and MMR coverage by over 3 percentage points, and Sardinia, a historically deprived region, where public health spending partly rose and MMR rates remained approximately steady. Conclusion: Adoption of austerity policies in the Italian health system was found to be significantly associated with declining vaccination rates for MMR. However, the recent introduction of mandatory vaccination for Italian children may help counteract this trend.
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