Amid Measles Outbreak, Italy Makes Childhood Vaccinations Mandatory

Jun 19, 2017
Originally published on July 3, 2017 7:42 am

Emma Carpita is just 2 weeks old. Her parents, Federico and Loredana, have brought the crying infant to her first medical checkup.

Dr. Patrizia Franco, Emma's pediatrician, hands them a list of vaccine centers in the area. "Do you have any questions or concerns?" she asks.

"No," says Federico. "We think all parents should be obligated to vaccinate their children."

But not all Italians agree — including Franco herself. The pediatrician is a vocal advocate for the "freedom to choose" whether or not to vaccinate, an increasingly popular sentiment in Italy in recent years.

"What I care about is the patient's health, and to first do no harm," Franco explains. "Every medical procedure has a risk. That includes vaccines."

But last month, Italy made vaccines against 12 diseases — including measles, tetanus and rubella — mandatory. Kids up to 6 years old won't be accepted into nursery schools without them. And parents sending their children to school after that age without vaccinating them first will now face fines of up to $8,380. Repeat offenders can even lose parental custody.

The law has sparked protests. On a recent summer day, parents and other protesters demonstrated in front of the Italian Parliament, chanting "Freedom!" and accusing the government of going too far.

"No to mandatory vaccines! Yes to the freedom to choose," they shouted into megaphones.

Such skepticism about vaccines is helping fuel a measles outbreak that is hammering Italy, says Roberto Burioni, a professor of microbiology and virology at Vita-Salute San Raffaele University in Milan.

"People are not vaccinating their kids. This is the simple reason," he says. "When the vaccination rate is around 95 percent, the virus is not able to circulate in the population. We are well below that threshold, and this is causing the outbreak, which can be very dangerous."

Measles is highly contagious. It can cause serious complications, including pneumonia, blindness and encephalitis, and can be deadly.

According to Italy's National Institute of Health, measles vaccinations among 2-year-olds rose steadily until 2010. That year, the vaccination rate was just above 90 percent. It dropped to 88 percent in 2013, 86 percent in 2014 and 85.3 percent in 2015.

So far this year, the Italian Health Ministry has recorded more than 2,500 measles cases — already a tenfold spike from just two years ago. The outbreak prompted the Centers for Disease Control to issue a U.S. travel advisory for Italy in April. It eventually led Italy's lawmakers to enact the country's strict new law on May 19.

So why the growing vaccine skepticism?

Italian officials point to Beppe Grillo, a wildly popular stand-up comic and the leader of the country's major populist party, the 5-Star Movement.

In a routine from 1998, he mocked vaccines for "weakening children's immune systems" and alleged, without evidence, that they are a Big Pharma scam.

More recently, he and members of his party have drawn unfounded ties between vaccines and autism.

Italy's health minister, Beatrice Lorenzin, has accused them of fomenting "grave and dangerous anti-scientific disinformation ... that in recent years has driven people not to get vaccinated."

"I think we have made a lot of mistakes," concedes Elena Fattori, a senator with the 5-Star Movement. "At the beginning, we thought we should give voice to everybody. But now I'm convinced that sometimes some things are so scientific, that you cannot give voice to everybody. Science is not democratic."

But to believe this is the 5-Star Movement's last word on vaccines is a misunderstanding of its uncanny ability to shape-shift, says Marco Cattaneo, the editor-in-chief of the Italian editions of Scientific American and National Geographic.

"They don't have a single and definite position on almost anything," he says. "So they can say, 'You're right' to someone who says [vaccines are] OK, and 'You're right' to someone who says, 'I have some doubts.' So they try to get both votes."

Right now, the 5-Star Movement leads in the polls. National elections may take place later this year. Meanwhile, the measles outbreak continues to spread.

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STEVE INSKEEP, HOST:

Some other news now - Italy has introduced one of the toughest vaccine measures in the world. Parents who do not vaccinate their children face steep fines and even risk losing custody of the kids. This measure comes in response to a measles outbreak after years of falling inoculation rates. So far, two children have died this year from the disease.

The government accuses a populist, anti-establishment political party of fueling a plunge in vaccine rates. The party has been spreading anti-vaccine fears, a familiar story in some ways to Americans who've also argued over vaccines. Christopher Livesay has the story from Rome.

(SOUNDBITE OF BABY CRYING)

CHRISTOPHER LIVESAY, BYLINE: Emma Carpita is just two weeks old. Her parents, Federico and Loredana, have brought her to her first medical checkup.

PATRIZIA FRANCO: (Speaking Italian).

LIVESAY: Pediatrician Patrizia Franco hands them a list of vaccine centers in the area and asks if they have any concerns.

LOREDANA CARPITA: (Speaking Italian).

LIVESAY: "No," they say. "We think all parents should be obligated to vaccinate their children."

But not all Italians agree...

FRANCO: (Speaking Italian).

LIVESAY: ...Including their own pediatrician, as she explains between patients.

FRANCO: (Through interpreter) What I care about is the patient's health and to first do no harm. Every medical procedure has a risk. That also means vaccines.

LIVESAY: She's an advocate for the freedom to choose. But such freedom is now a thing of the past. Italy has made 12 vaccines mandatory. Kids up to 6 years old won't be accepted into nursery schools without them. And parents sending their children to school after that age without vaccinating them first will now face fines. Repeat offenders can even lose parental custody.

UNIDENTIFIED PROTESTERS: (Chanting in Italian).

LIVESAY: These parents and protesters outside the Italian Parliament believe it's gone too far.

UNIDENTIFIED MAN: (Speaking Italian).

LIVESAY: But such skepticism is helping to fuel a measles outbreak that's hammering Italy, says Roberto Burioni. He's a professor of microbiology and virology in Milan.

ROBERTO BURIONI: Because people are not vaccinating the kids. I mean, this is the simple reason because, where the vaccination rate is around 95 percent, the virus is not able to circulate in the population. We are well below that threshold, and this is causing this outbreak, which can be very dangerous.

LIVESAY: Measles can cause encephalitis, blindness, even death. So far this year, two children have died. The Italian health ministry has recorded over 2,500 measles cases, already a tenfold spike from just two years ago. That prompted the Centers for Disease Control to issue a travel advisory for Italy and lead to Italy's strict new law. So why the growing vaccine skepticism?

(SOUNDBITE OF ARCHIVED RECORDING)

BEPPE GRILLO: (Speaking Italian).

LIVESAY: Italian officials say one reason is Beppe Grillo, a wildly popular standup comic and the leader of Italy's major populist party, the Five Star Movement.

(SOUNDBITE OF ARCHIVED RECORDING)

GRILLO: (Speaking Italian).

LIVESAY: In this routine from 1998, he mocks vaccines for weakening children's immune systems and for being a Big Pharma scam. In more recent years, he and members of his party have drawn unfounded ties between vaccines and autism. The health minister has accused them of fomenting grave and dangerous anti-scientific disinformation. That, in recent years, has driven people not to get vaccinated.

ELANA FATTORI: I think we have made a lot of mistakes, yes.

LIVESAY: Elena Fattori is a senator with the Five Star Movement. She admits it has offered a platform to anti-vaccine voices. But that was before it became Italy's biggest party.

FATTORI: We thought from the beginning that we should give voice to everybody. But now I'm convinced that, sometimes, some things are so scientific that you cannot give voice to everybody. Science is not democratic.

LIVESAY: But if you think that's the Five Star Movement's end-all, be-all on vaccines, you haven't understood it's uncanny ability to shape-shift, says Marco Cattaneo. He's the editor-in-chief of the Italian edition of Scientific American and National Geographic.

MARCO CATTANEO: They don't have a single and definite position on almost anything. So they can say you're right to someone who says vaccines are OK and you're right to someone who says, well, I have some doubts. They try to get both votes.

LIVESAY: Right now the Five Star Movement leads in the polls with elections taking place as soon as this year. And the measles outbreak is spreading. For NPR News, I'm Christopher Livesay in Rome.

(SOUNDBITE OF THE BEST PESSIMIST'S "IT'S ONLY WORDS") Transcript provided by NPR, Copyright NPR.