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antoniabelli · 5 years

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Should vaccines be mandatory? A look at the Italian case

Vaccination hesitancy in Italy sits at the crossroad of cultural isolation and economic inequality. Now a controversial law making vaccination mandatory might just make the issue even more inflammatory

After years of declining vaccination rates across Europe and mounting political pressure, in 2017 then Italian health minister Beatrice Lorenzin introduced a law to make a number of vaccinations mandatory in order to access public education between the ages of 0 and 16. After a two-year period during which parents could get up to date with the vaccination schedule, the law has recently come into full force. However, this piece of legislation remains controversial, with some claiming that the so-called Lorenzin law violates their civil liberties.

The law was overwhelmingly supported by the Italian scientific community, who described it as a success in the fight against the anti-vax movement, and proof of an improved relationship between health authorities and politicians. Roberto Burioni, a famous immunologist and online personality, has often responded to anti-vaxxers on his facebook page with his now-famous line: “Science is not democratic”.

In Italy, Burioni is seen as the epitome of “the expert”: well dressed, internationally renowned for his work, witty and authoritative. He gained prominence during the height of the vaccination debate by running a popular facebook page, in which he refuted many of the usual arguments made by anti-vaxxers: Andrew Wakefield’s famously discredited study about a supposed link between the MMR vaccine and autism, the presence of toxic substances like mercury and alleged shady corporate interests.

Many users write comments under Burioni’s posts thanking him for being a voice of reason against obscurantism. However, I can’t help but feel a sense of unease seeing this wealthy, educated man publicly shame people who, either because of cultural isolation or simple misinformation, have developed skepticism against institutions and scientific practices. There is an evident subtext of classism in many of his posts or television interviews, and he has often referred to anti-vaxxers as stupid or ignorant. He is a strong supporter of the idea that only medical professionals should speak publicly about issues like vaccination, and has often said so on Italian TV.

A small but vocal minority in Italian civil society remains opposed to the law, deeming it discriminatory against unvaccinated children and a violation of individual liberties. Some members of the German-speaking minority in the Alto Adige region even tried to apply for asylum in Austria to avoid the heavy fines they faced for refusing to vaccinate their children. A spokesperson for the group stated that “Asylum is claimed not just by people fleeing war, but also by people whose rights are being violated”. More recently, the Italian press reported that a mother went on hunger strike when her daughters were refused access to primary school.

The negative attitude against vaccination in Italy is linked to the concept of “casta”, the idea that the cultural and political establishment represents an elite that controls institutions to the detriment of regular citizens. This idea is what fuels the success of populist parties such as Lega and the Five Star Movement. It is no surprise that both these parties campaigned against mandatory vaccination during the last election in 2018, although they eventually failed to repeal the law in parliament. As early as 1998, the former comedian Grillo, who later became the political leader of the 5 Star Movement was incorporating monologues against vaccinations in his shows. In this context, any attempt from the medical community to reach out to the general public with scientific facts and reassurances is perceived at best as condescending and at worst as “covering up their tracts”.

However, skepticism about vaccination is first and foremost an issue born out disenfranchisement, which leaves people vulnerable to fake news or conspiracy theories. Parents who have concerns about vaccination want to be listened to and they might feel that health authorities are either dismissing their fears or are outright hostile towards them. Italian media coverage of the anti-vax movement often depicts these parents as frenzied or irrational, portraying the issue as a personal moral failing rather than an outcome of systemic inequalities, and sometimes refusing to engage honestly with anti-vaxx concerns. Too often, the discourse about vaccination hesitancy is framed simplistically, ignoring the history and complexity of the issue. As early as the beginning of the 20th century there was widespread opposition to mandatory vaccination, for example in Rio de Janeiro in 1904. The concerns of a hundred years ago are the same of today: what is the trade off between individual liberties and the common good? Who gets to decide what risks are acceptable and which not?

The backlash against anti-vaxxers is connected to a deep-rooted anxiety of the social elites regarding the rise of populism and the shifting of cultural capital ever since the end of the first republic in the early 90s. More than a genuine concern for the well-being of the country or of immunodeficient children, it is a longing for a time where the doctor, the nurse, the university professors were the uncontested manufacturers of public consensus. But since the sweeping corruption investigations that started in 1992, the reputation of public servants has never truly recovered. Thirty years on, Italians believe that they live in a society where no one is to be completely trusted or expected to act for the common good without self interest.

What perhaps the establishment fails to see is that the rise of populist sentiment in Italy is only the natural consequence of years of corrosion of the welfare state, of the slow destruction of the healthcare system and public education. Years of corruption scandals and political instability have corroded the relationships of trust that used to hold between doctors and their patients, authorities and citizens. It seems evident that a punishing measure like the Lorenzin law does nothing to rebuild this trust.

Early reports seem to show that the policy is effective in improving vaccination rates. Italy has recently returned near the 95% vaccination rate recommended by the WHO for some diseases. However, until big structural changes are put in place to make sure everyone is able to participate to the cultural and scientific life of the country, anti-scientific sentiments will never truly go away. Pushing people further out of the public sphere by denying their children access to public education only entrenches the inequalities which lie at the root of the problem. A real solution to the vaccination hesitancy problem in the country should involve a broader effort to rebuild the welfare state and trust in public authority.

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