Italy weighs restricting AstraZeneca shots in younger people.

https://www.nytimes.com/2021/06/10/world/italy-weighs-restricting-astrazeneca-shots-in-younger-people.html

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Back in April, Italy, acting on a report by Europe’s drug regulator of a “possible link” between the AstraZeneca vaccine and rare blood clots, recommended not giving the shots to people under 60.

But in the ensuing months, as the country put its inoculation campaign into overdrive, AstraZeneca vaccines became the featured attraction of “open days” or “open nights,” which offered shots to younger people weeks ahead of where they would have fallen in the priority schedule. The events — some featuring D.J.s and group selfies — were praised as a great success. But they also raised concerns that Italy seemed to be promoting the AstraZeneca vaccine to younger people despite the regulator’s recommendations.

On Wednesday, the government muddled matters further by publicly mulling whether to introduce stricter limitations on the use of the AstraZeneca shots that would effectively prohibit such events for younger people in the future.

“I think new indications would be appropriate,” Pierpaolo Sileri, an undersecretary at the Italian Health Ministry, told the Italian news website Fanpage, adding that the government would consider a block on administering the vaccine to people under the age of 30 or 40.

Other countries have also struggled to chart a clear policy on the AstraZeneca vaccine.

Though the regulator, the European Medicines Agency, deemed the vaccine safe, the risk of very rare blood clots has led some nations to adapt their approaches. In Britain, where the vaccine was created, more than 35 million doses have been given, but the country has acknowledged the risk by offering younger people an alternative when possible. France only distributes the shots to people who are 55 and older, Belgium to those who are 41 and older.

Germany stopped using the AstraZeneca shots altogether for a few days, before later recommending that they should not be used in people under 60. Now, like Italy, Germany has made the AstraZeneca vaccine available to anyone over 18, as long as they acknowledge the risk.

On Wednesday, a new study published in the journal Nature Medicine showed that people receiving the AstraZeneca vaccine had a slightly increased risk of a bleeding disorder and possibly of other rare blood problems.

Andrea Costa, another undersecretary at the Italian Health Ministry, said on Italian radio on Wednesday that the country was able to rely on “many other vaccines” and that any further limitation “will not hamper the vaccination campaign.”

But some doctors in Italy said they feared that yet another change in direction could prompt more skepticism toward the AstraZeneca vaccine.

“This poor vaccine,” said Dr. Patrick Franzoni, who spearheads the inoculation campaign in the northern region of Trentino-Alto Adige. “With this Ping-Pong of information, we risk completely boycotting it.”

In the past weeks, Dr. Franzoni said that he had helped organize open nights, complete with D.J.s, during which 22,000 younger people, who would otherwise have had to wait weeks for a shot, received the AstraZeneca vaccine.

“When older people saw they had AstraZeneca on their slot they did not book the vaccine,” Dr. Franzoni said, “so we did these open nights” to use up the supply.

“And we had a great response,” he added.

Other Italian regions introduced similar initiatives. In Lazio, which includes Rome, about 200,000 people of all ages got their AstraZeneca shot during open days. And Liguria, in the northwest, offered more than 40,000 doses at similar events.

But when reports spread about an 18-year-old girl who was hospitalized with a cerebral thrombosis after attending an open day in Liguria, many canceled their appointments.

Some doctors in Italy have urged the government to stop distributing the AstraZeneca vaccine to younger people. “With a low circulation of the virus, the risks of AstraZeneca can outweigh the benefits in people below the age of 30,” Nino Cartabellotta, a prominent public health researcher, tweeted.

The Italian government is now discussing possible new and more restrictive recommendations, a spokesman for the Health Ministry said.

Christopher F. Schuetze, Monika Pronczuk and Constant Méheut contributed reporting.