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Italy debates its ‘mix-and-match’ plan to finish vaccinating AstraZeneca first-dose recipients.

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A fierce debate has erupted in Italy after the government halted use of the AstraZeneca coronavirus vaccine in people under 60 and said that people in that age group who had already received a first dose of that vaccine would get a different shot for their second.

“A mix for cocktails is one thing,” Matteo Salvini, the leader of the nationalist League party, which is part of the government, told reporters on Tuesday as he asked for clear and consistent directions, “A mix of vaccines is a different one.”

The announcement last week was the latest in a series of policy lurches surrounding the AstraZeneca vaccine that have left many Italians confused and angry.

As reports circulated that an 18-year-old girl who received the vaccine had died after having been hospitalized with a thrombosis, the government said it had reassessed the vaccine, and had concluded that because the spread of the virus had slowed markedly in Italy, the benefits of using the vaccine in people under 60 no longer outweighed the risks.

Other countries have also looked at mix-and-match approaches to second doses, especially after safety concerns arose over the AstraZeneca vaccine’s apparent association with some deaths from the rare blood-clotting condition. In France, about 500,000 people became eligible for a different booster dose in April after the government halted use of the AstraZeneca vaccine in people under 55.

Trials are underway around the world to test the mix-and-match approach, referred to by scientists as heterologous prime-boost. Citing data from two clinical trials in Spain and one in Britain, the Italian drug regulatory agency said the approach was safe and effective.

Still, the idea is meeting with opposition in Italy, where almost a million people aged 18 to 59 who have had first doses of AstraZeneca’s vaccine would be affected.

“We are not going to administer vaccines different from the first dose,” Vincenzo De Luca, the president of Campania, the southern Italian region that includes Naples, said in a statement on Sunday. “The current level of confusion risks jeopardizing the very continuation of the vaccination campaign.”

(Mr. De Luca later said his region would comply with the government’s policy, but maintained that there was “communication chaos” around vaccines.)

Public health researchers also raised questions about what they called “creative vaccination.”

“Scientific evidence today on this topic is still preliminary and keeps a certain level of insecurity,” Nino Cartabellotta, the president of GIMBE, a research foundation, said on Italian radio.

Others were more blunt in criticizing the government’s shifting vaccine policies. “We do not understand anything anymore,” Luca Pani, a former director of Italy’s drug regulatory agency, wrote in the Italian newspaper Il Foglio, “besides the fact that, putting one patch above the other, they turned the AstraZeneca saga into a monster.”

The top health care official for the Lazio region, which includes Rome, said that since the policy was announced, about 10 percent of affected people in his area were skipping or canceling their second-dose appointments or were walking out without receiving a shot when told that it would be of a different vaccine. He said the government should allow people to decide for themselves whether to stick with AstraZeneca for their second shot.

Constant Méheut contributed reporting from Paris.

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