Background:
SARS-CoV-2 vaccination represented a breakthrough against the pandemic, but sub-optimal coverage in Italy led to the introduction of obligatoriness for several workplaces and citizens over50. Exemptions have ensured when vaccination is contraindicated. In doubtful cases, physicians could refer to experts’ committees. Aim of this work is to analyse the appropriateness of these kinds of requests received in a Local Health District.

Methods:
In September 2021, the regional group for SARS-CoV-2 vaccination exemptions was established and the procedure for requesting advice defined. From 1/10/2021 to 15/06/2022, 53 requests were submitted in the Health District of Jesi (approximately 100.000 inhabitants). They were independently assessed by 2 physicians expert in vaccination and classified using a structured grid describing query, presence of specialist certification, response time and outcome.

Results:
34 requests (66%) were motivated by known allergies or diseases, 34% by previous adverse reactions to vaccinations. The average response time was 40,3 days. Only 5 (9%) requests received a certificate of temporary unsuitability and 1 (2%) unsuitability for mRNA vaccine. Among these, only 33% carried out the vaccination as appropriate. The remaining 89% of the requests did not justify any contraindication, but only 17% proceeded with the vaccination. 51% of the requests were accompanied by a specialist certificate. Of these, 89% appeared in contrast with the vaccination guidelines and has been assessed as having no contraindications, but in no case did vaccination follow

Conclusion:
This work highlights an excessive use of the specialist committees assessment, which was not justified by the complexity of the case history, but rather by a defensive medicine approach (for specialist certificates misaligned with the guidelines or a lack of knowledge of the latter), with a consequent delay in vaccination suggesting the urgency of reconsider pathways for future mandatory vaccination.