The direct observation obtained from the analysis of the vaccinated cohorts allows us to verify the effectiveness of the recovery vaccination program proposed by Local Health Department “Napoli 3 Sud”. Registration on the platform automatically provides an answer and guides the decision-making processes.

Until 2016, data on vaccination coverage were published every year at 24 months, representing the proportion of children born in a given year who were adequately vaccinated at the time of the survey (for example, the coverage of children born in 2013 is calculated with the vaccinations completed on 31 December 2015 and calculated in 2016). From 2016 to today, however, the 36-month vaccination coverage is also published to update, after one year, the coverage data relating to the same cohort. This data is useful for evaluating the share of children who, at the previous year’s vaccination survey, were non-compliant and who were recovered. Based on the results published at 12, 24 and 36 months of life, in the three-year period 2019–2021, we can confirm that there has been a significant and progressive improvement in all vaccination coverage indices [7]. In particular, for the hexavalent vaccine against diphtheria, tetanus, pertussis, polio, Haemophylus influenzae type b and hepatitis B and for the vaccine against measles, rubella and mumps, both the 24-month and 36-month data show a vaccination coverage that it stands at an average > 94%, which is in line with the objective of the National Vaccination Plan 2017–2019 and of the new National Vaccination Plan 2023–2025. Furthermore, there was an increase in the coverage rates for Rotavirus at 1 year of life in the 2021 cohort (73.71%) and an increase of 9.2% and 20% in the coverage rates for Chickenpox in the 2nd year and 20% in the 3rd year of life. Based on this data, the herd immunization was reached by Hexavalent, MPR, MEN ACWY and Pneumococcus. The worst coverage in our group was reported for Rotavirus according with F. Napolitano et al. [8], who showed that only 15.3% of parents in Italy declared that they had immunized their children against rotavirus infection. Data regarding each single district reported for the children in their first year of life showed an improvement of coverage for Hexavalent, Rotavirus and Pneumococcus. Among the districts, those with the lowest vaccination coverage were the most rural (Number 53 and Number 56).

As we already know, vaccination is one of the most effective ways to prevent presently existing infectious diseases. It prevents 2–3 million deaths a year; a further 1.5 million could be prevented if global vaccination given; it is one of the most important tools of primary prevention, this should be a voluntary and informed choice. However, with progressive decline in vaccination coverage and particularly the increase in number of measles cases, some countries, such as Italy and France, have decided to enact laws that make vaccinations ‘mandatory’, although with different approaches [9, 10]. In the last century, vaccination was widely accepted across European countries because of the social value of immunization for the protection of individual and collective health [11]. The main task of health care workers (HCWs) is to inform the population about the importance of this preventive measure for the individual and the entire community to obtain social acceptance and, consequently, high voluntary vaccination coverage. The strategic vaccine advisory group of WHO (SAGE) identifies complacency, convenience of accessing vaccines, and lack of confidence as underlying reasons for hesitancy [12]. In our study, the analysis of the vaccinated cohorts show the efficacy of the descripted recovery vaccination model. Vaccination coverage in Italy has been decreasing starting from 2015 getting worse during COVID-19 [13] The decision to enact mandatory laws in some countries (such as Italy, France, and, to a lesser degree, Germany) has already resulted in increase in coverage in the pediatric age. Actually, with the enforcement of national laws, vaccination coverage has increased in both Italy and France. However, making vaccinations mandatory should not be considered a definitive approach but rather a temporary decision to tackle hesitancy, based on the epidemiological situation in each country in order to maintain long-lasting herd immunity effects after reaching optimal levels of immunization coverage. The aim is always to guarantee a protection to the general population, and to avoid the spread of infectious diseases. However, this temporary solution may not suit all contexts, and each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background so is necessary to evaluate new strategies to improve vaccination adherence. Our study confirmed the importance of collaboration between Public Health System and Italian Primary care pediatricians. These results appear very encouraging, also because they show the excellent work carried out during the last three years by these 13 districts of Local Health Department “Napoli 3 Sud” in Campania also based on collaboration with family pediatricians and schools. Although it must be taken into account that it is impossible to extract the complete data on vaccination coverage of the cohort of those born in 2021 at the age of 36 months (3 years of life), as not all those born in 2021 have reached 36 months of life at 31/12/2023, so further date updates are needed. This paper is not without limitations: first of all, we don’t have a reliable percentages of coverage rates prior to the recovery program. Moreover, it will be interesting reporting missing data such as 6 years old children and adolescent, so further studies are needed.