By Gianluca Mezzofiore
August 7, 2018
An amendment from Italy's anti-establishment government that removes mandatory vaccination for schoolchildren is sending shock waves through the country's scientific and medical community.
It suspends for a year a law that requires parents to provide proof of 10 routine vaccinations when enrolling their children in nurseries or preschools. The amendment was approved by Italy's upper house of parliament on Friday by 148 to 110 votes and still has to pass the lower house.
The law had originally been introduced by the Democratic Party in July, 2017 amid an ongoing outbreak of measles that saw 5,004 cases reported in 2017 -- the second-highest figure in Europe after Romania -- according to the European Centre for Disease Prevention and Control (ECDC).
Italy accounted for 34% of all measles cases reported by countries in the European Economic Area, the center said.
Italy's Five Star movement and its coalition partner, the far-right League, both voiced their opposition to compulsory vaccinations, claiming they discourage school inclusion.
League leader and Interior Minister Matteo Salvini said in June that the 10 obligatory vaccinations, which include measles, tetanus and polio, "are useless and in many cases dangerous, if not harmful," according to ANSA news agency.
"I confirm the commitment to allow all children to go to school," he added. "The priority is that they don't get expelled from the classes."
Health Minister Giulia Grillo, a Five Star member, said the government wants to "spur school inclusion and simplify rules for parents."
Why It's Dangerous
Doctors and experts have warned that the amendment might invert a positive trend that saw Italy's inoculation coverage rising after spending years lagging behind the World Health Organization's recommended 95% coverage level to ensure "herd immunity."
"Italy's measles vaccine coverage was par with Namibia, lower than Ghana," said Roberto Burioni, a professor of microbiology and virology at San Raffaele University in Milan. "But the law was working, the coverage was improving. We should strengthen it, not weaken it. Now, children who are not vaccinated will endanger other children at school who are too small for vaccines or cannot be vaccinated because they suffer from immunosuppressive diseases."
Measles tripled in Europe in 2017, European CDC reports
In 2015, child immunization rates in Italy for the first dose of the measles vaccine was 85%, according to World Health Organization figures. The second dose was 83%.
Italians' trust in the efficacy and safety of vaccinations was affected by an infamous ruling in 2012 from a Rimini court that established a link between autism and the combined measles, mumps and rubella vaccination, experts say. While the ruling was overturned three years later, it helped anti-vaccination theories to spread in Italy -- and globally.
"Italy is part of a global trend of distrust in mediators -- doctors and scientists -- who can interpret and explain data," said Andrea Grignolio, who teaches the history of medicine and bioethics at La Sapienza University of Rome.
"With the advent of the Internet, people have the illusion they can access and read data by themselves, removing the need for technical and scientific knowledge."
While European countries behave differently as far as mandatory vaccinations are concerned, and the actual efficiency of forcing parents to inoculate their children is disputed, Grignolio and Burioni agree that, in the case of Italy, the law was having the desired effect.
By 2017, child immunization rates for the first dose of the measles vaccine had increased to 92%, though the second dose remained low at 86%.
The majority -- 89% -- of measles cases in Italy in 2017 were among unvaccinated people, and 6% of infections affected people who received only one dose of vaccine, according to a report from the ECDC.
Distrust in Institutions
Others maintain that the skepticism about vaccines is in line with a more general lack of trust in Italy's institutions, a sentiment that the populist Five Star Movement was able to channel in its political agenda, winning support at the latest general elections.
"Distrust in vaccines is one of the symptoms of a more general distrust in institutions," says Riccardo Saporiti, a data journalist and contributor to Wired Italy who has written about vaccine coverage in Italy.
Saporiti argues that distrust in Italian institutions started in Italy with what was called Tangentopoli (Bribesville), a corruption scandal that shattered the postwar political establishment in the 1990s.
"It destroyed Italians' trust in politics, and then it spread to anyone with a specific expertise," he said. "Five Star's slogan at the 2013 elections was 'One is worth one,' which is the denial to any concept of competence and merit."
In a data analysis for Wired, Saporiti uncovered that in some areas in Italy, one in two children born in 2013 did not get the MMR vaccination.
However, the future is not all dark, according to Grignolio, who says 10% of Italians who are somewhat hesitant about vaccinations that can be convinced to inoculate their children.
"When there's an obligation, they will comply. But the newly approved self-certification is a joke," he said.