A year after Italy’s governing parties took power pledging to repeal mandatory vaccinations, they can’t figure out how to meet that promise.
While the 5Star Movement and the League are united in their pledge to not force parents to inoculate their kids, they’ve so far been unable to forge a policy that satisfies both public health concerns and their populist base.
“Our position has always been that we are for reaching the maximum vaccine coverage through the approach of advising the population,” said Piernicola Pedicini, a 5Stars member of the European Parliament, in an interview in Italian. But, he added, “This is a long process … It is costly and hard.”
A persistent measles outbreak is complicating the government’s effort to unwind Italy’s compulsory vaccination law after the country recorded the second highest number of new infections among EU countries in 2018.
The 2017 Lorenzin decree, named after former Health Minister Beatrice Lorenzin, made 10 vaccines mandatory for children between 0 and 16. It mandated children between 0 and 6 be excluded from day care and kindergartens if their parents don’t provide a proof they were vaccinated, and fines for parents of children between 6 and 16 years old.
“I will never be complicit in a death that could be avoided thanks to the use of vaccines” — Giorgio Trizzino, doctor and a 5Star member of the Italian chamber of deputies
The Italian Senate is working on finalizing a draft law to repeal the bill this month, but policymakers are squabbling over new amendments put forward in late March.
The draft law, proposed in August by five senators from both the 5Stars and the League, would shift the country’s vaccine policy to one of “flexible obligation.” It aims to convince people to vaccinate “through communication plans inspired by the principles of transparency and independence of information sources, in order to consolidate the trust in the National Health Service in the matters of vaccination prevention and its reputation,” the text reads.
The draft law leaves open the door for the government to temporarily introduce an obligation to vaccinate for emergencies such as measles outbreaks.
However, a new amendment put forward by 5Stars senator and president of the Senate’s health committee, Pierpaolo Sileri, as well as two League senators, undermines potential emergency measures by abolishing the need to provide proof of vaccination for children to go to school even if there’s a public health emergency.
The amendment has caused a political rift by challenging a fundamental tension in the proposal: how to ensure that kids don’t lose their right to education because of their vaccination status, while ensuring any emergency requirements still have teeth.
“The only reason to make a monovalent vaccine would be a political reason, because someone without rational reasons asks for it” — Roberto Burioni, Italian virologist
“If you remove from the law the obligation to provide a certification of vaccination for kids to have access to day care and kindergarten, there will be no deterrent for parents who do not want to have their children vaccinated even when [and where] vaccination is compulsory,” said Vincenzo Salvatore, a lawyer leading the health care and life sciences team at Italian law firm BonelliErede.
The amendment seems in line with the position of League leader and Deputy Prime Minister Matteo Salvini, who in early March asked Italy’s Health Minister Giulia Grillo to postpone the deadline for vaccination certificates to be required under the Lorenzin law. She refused that request.
Giorgio Trizzino, a doctor and a 5Star member of the Italian chamber of deputies, vowed to oppose the new amendment. “I will never be complicit in a death that could be avoided thanks to the use of vaccines,” he wrote on Facebook on Sunday. Stating that “absurd ideological positions could cause avoidable deaths,” he said: “I cannot allow that on our conscience.”
The GIMBE Foundation, a non-profit working on health issues, slammed the amendment as proof that children’s health is being held hostage to political compromise between the two governing parties. It suggested in a statement Monday that Sileri proposed the amendment to please anti-vaxxer politicians among the 5Stars and the League.
In response to the outrage, Sileri said Tuesday he is considering a U-turn. “We are working on a possible modification of the amendment to the vaccine bill, maintaining the compulsory vaccination certification for school attendance only for measles,” he told news agency ANSA.
That in itself leads to a new problem: The measles vaccine is not provided in itself, but as one component of a shot also including mumps and rubella.
“I [want to] inform you that the measles-only vaccine does not exist, it will never exist and if it existed one day only the madmen would inject it for reasons that I will explain to you soon,” said Roberto Burioni, a well-known Italian virologist. He explained in a radio show this week that the trivalent vaccine has proven safe and effective, and that breaking the three jabs into single shots would mean more injections for children, a cruel measure that also increases the risk for infections. “The only reason to make a monovalent vaccine would be a political reason, because someone without rational reasons asks for it,” he said.
How far, how fast
Italy saw 2,600 measles cases reported between February 2018 and the end of January 2019 — second only to France, a country that also raised the number of mandatory vaccines from three to 11 last year.
Italy’s government in February noted the success of its mandatory vaccination plan, saying that coverage for children increased in the first six months of 2018 compared to the end of 2017. “In several cases the minimum threshold recommended by the World Health Organization of 95 percent has been reached and exceeded,” the health ministry said.
But GIMBE says the country is still not yet out of the woods and that it would be premature to roll back the obligation to vaccinate.
A study released by the foundation in March pointed to widespread variations between regions in coverage in mid-2018, even as it reached almost 95 percent nationwide for nine of the 10 mandatory jabs. Coverage for chickenpox remained below 60 percent.
“The abrupt transition to a model based on recommendation and persuasion requires massive investments in information and education, severe penalties for those who spread anti-vax messages and accurate vaccination registries that allow to know the coverage status in real time,” GIMBE President Nino Cartabellotta said in an interview.
As health campaigners urge caution, those opposed to vaccines have also been making their voices heard by protesting at comedy shows by Beppe Grillo, the comedian-turned-5Stars politician who adopted anti-vaxxers’ rhetoric during the late ’90s.
“He is a clown. Some time ago he was talking differently. He says he is close to the people, that he is one of us, but that doesn’t seem to be the case to me,” one woman who contested him during a show in Milan in January told Italian media. Grillo, who has distanced himself from the party he founded, has said he is not against vaccines but that he opposes forcing people to vaccinate.
The health ministry said Giulia Grillo has always considered the current mandatory requirements an emergency remedy that must be replaced by a long-term framework on prevention through vaccination, adding that such a framework is indispensable for Italy.
“If the anti-vaxxers think that we have betrayed them, they misunderstood our will,” 5Stars’ MEP Pedicini said. “Once vaccines have received all the [necessary] safety and efficacy assessments, they need to be used.”
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