Hit Me with Your Best Shot: Mandatory Vaccinations in Italy Become a Reality

By: Kathryn Bristor

1 billion.  The number of bacteria, viruses, and microorganisms contained within the human body.[1]  In a world of constant human interaction, it is hard to imagine something so innocent as shaking one’s hand could transmit these unwanted “bugs” into our system.  Every year, over three million people die from vaccine-preventable diseases, half of which are of children under five years old.[2]  Of the top 10 most common causes of death in children under five, several are infectious with the ability to spread.[3]  So in this modern-day age where international communication is as easy as the touch of a button, what can we do to lower this number and keep ourselves from becoming a statistic?  Recently, Italy has taken a stand on this issue in the form of a controversial mandatory vaccination law with the hopes of fighting back against this unseen threat.

Halfway through 2017, the Italian Health Ministry had already recorded over 2,500 cases of measles, ten times the amount of 2015.[4]  When 95 percent of a population is vaccinated, it is impossible for a virus to circulate; however, with the Italian population well below that number, an outbreak becomes not only possible, but likely.[5]  In response to this outbreak, the Italian government took matters into its own hands by way of a vaccination law.[6]  By a 296-92 vote, “the Italian Parliament approved the Decree-Law Containing Urgent Measures on the Compulsory Vaccination of Children, [making] vaccinations mandatory for children as a condition of school registration.”[7]  The original law mandating 12 vaccinations including polio, measles, and tetanus, has since been relaxed to a list of 10 with the removal of meningitis B and C.[8]  The enactment of this law causes Italy to have the highest amount of mandatory vaccinations in Europe.[9]  This has, however, been supported by the Institute of Health due to “the situation’s urgency and the emergency caused by a decline in vaccinations and by the national epidemic.”[10]

Under this new law, parents must provide proof of vaccination if they hope to enroll their children in preschool, and noncompliance of school-age children up to 16 years old results in fines ranging from 500 to 3,500 Euros depending on the number of unfulfilled immunizations.[11]  Parents who engage in continual noncompliance run the risk of being reported and can eventually lose custody of their children.[12]  Furthermore, noncompliance leaves no room for conscientious objection and is only appropriate “in cases of proven danger to the health of the child, when specific clinical conditions, duly documented, are presented.”[13]  Children who are not vaccinated are reported to health authorities and are kept in rooms away from those who are immunized.[14]

While many parents, health authorities, and governmental figures have praised this law, not everyone has shared a similar sentiment.  While general fears about this new law exist, such as it signaling a return to fascism and concerns about safety and effectiveness, much of the pushback has roots in a larger movement.[15]  At the forefront of the anti-vaccination campaign is the nation’s major populist party, the 5-Star Movement.[16]  Led by the famous comedian, Beppe Grillo, the 5-Star Movement was established as an atypical political party with allegiance to neither the right nor the left.[17]  Having already won local elections around the country, the 5-Star Movement is undoubtedly in the public eye in an influential way.[18]

The publication of a paper fraudulently claiming a link between immunizations and autism was enough to fuel the 5-Star Movement’s anti-vaccination protest by distorting public perception.[19]  As word of these claims spread, Grillo and other members of the 5-Star Movement began encouraging parents to resist vaccinations on behalf of their children.[20]  Aware of the heightened presence of misinformation, Italy’s highest court, along with the European Medical Agency, issued a ruling during the legislative process finding “no connection between childhood vaccines and autism” as it had been “widely dismissed by the scientific community.”[21]  Realizing the widespread negative impact these claims had, Fattori, a senator of the 5-Star Movement, agreed that the party has “made a lot of mistakes” and is now “convinced that sometimes some things are so scientific" they cannot be disputed.[22]  While the damage of these false claims may be beyond repair, the majority of people understand the benefit of vaccinations far outweighs any possible risks.

While Italy’s new law only allows for one category of children to opt-out – those with cases of proven danger to their health – the government’s underlying purpose of the mandatory law is herd immunity.  As previously mentioned, when less than 95 percent of a population is not vaccinated, a virus has a dangerously high probability of circulating.[23]  As a result, prevention of these illnesses is a matter of collective public interest and must be treated as such.  Herd immunity “occurs when the vaccination of a significant portion of a population (herd) provides a measure of protection for individuals who have not developed immunity.”[24]  Understood through this light, immunizations are not nearly as effective if the majority does not participate, as evidenced by Italy’s measles outbreak.  However, when herd immunity is accomplished, “an infected individual will be able to transmit the disease to less than one other person on average, which results in the disease dying out instead of continuing to spread.”[25]  Recognizing that the country is only as strong as its “weakest” members, this vaccination law is meant to serve as a channel to that 95% threshold.

While not everyone is in agreement on this law, its future lies in the hands of a government committee.[26]  Upon tracking medical data and levels of vaccine coverage for the next three years, the number of mandatory vaccinations has the possibility of being altered.[27]  In the meantime, the Italian people must consider the facts.  According to the World Health Organization, the measles vaccination prevented over 20 million deaths from 2000 to 2015.[28]  The most serious reactions to vaccinations occur in less than one million people.[29]  Measles, on the other hand, kills two in every 1,000 children, from which one out of every 1,000 develops encephalitis.[30]  Italian citizens must decide which statistic they would rather live with.

[1] Rob Stein, Finally, a Map of all the Microbes on your Body, NPR (June 13, 2012), http://www.npr.org/sections/health-shots/2012/06/13/154913334/finally-a-map-of-all-the-microbes-on-your-body.

[2] Global Immunization: Worldwide Disease Incidence, Children’s Hospital of Philadelphia (Dec. 1, 2014), http://www.chop.edu/centers-programs/vaccine-education-center/global-immunization/diseases-and-vaccines-world-view.

[3] Id.

[4] Christopher Livesay, Amid Measles Outbreak, Italy Makes Childhood Vaccinations Mandatory, NPR (June 19, 2017), http://www.npr.org/sections/parallels/2017/06/19/533481635/amid-measles-outbreak-italy-makes-childhood-vaccinations-mandatory.

[5] Id.

[6] Id.

[7] Dante Figueroa, Italy: Vaccinations for Children Made Mandatory, Library of Congress (June 13, 2017),

http://www.loc.gov/law/foreign-news/article/italy-vaccinations-for-children-made-mandatory/.

[8] Colleen Barry, Italy Approves Hotly Contested Mandatory Vaccine Program, U.S. News (July 28, 2017),

https://www.usnews.com/news/world/articles/2017-07-28/italy-approves-hotly-contested-vaccine-program.

[9] Zoe Tidman, Vaccination Law Amendment Fuels Protests, The Italian Insider (July 17, 2017), http://www.italianinsider.it/?q=node/5652.

[10] Id.

[11] Id.

[12] Figueroa, supra note 7.

[13] Id.

[14] Id.

[15] Barry, supra note 8.

[16] Livesay, supra note 4.

[17] John Follain & Chiara Albanese, Everything you Need to Know About Italy’s Five Star Movement: Quick Take Q&A, Bloomberg (Dec. 5, 2016), https://www.bloomberg.com/news/articles/2016-12-05/why-five-star-is-bane-of-italy-s-establishment-quicktake-q-a.

[18] Id.

[19] Italy Makes 12 Vaccinations Compulsory for Children, BBC News (May 19, 2017), http://www.bbc.com/news/world-europe-39983799.

[20] Livesay, supra note 4.

[21] Italy to Make all Childhood Vaccinations Mandatory, Business Insider (July 28, 2017), http://www.businessinsider.com/ap-italy-approves-hotly-contested-vaccine-program-2017-7; EMA Reassures Member States on Influenza Vaccine Safety, World Health Organization (Aug. 12, 2014), http://www.euro.who.int/en/countries/italy/news/news/2014/12/ema-reassures-member-states-on-influenza-vaccine-safety.

[22] Livesay, supra note 4.

[23] Alberto Giubilini, Italy has Introduced Mandatory Vaccinations – Other Countries Should Follow its Lead, The Conversation (June 2, 2017), https://theconversation.com/italy-has-introduced-mandatory-vaccinations-other-countries-should-follow-its-lead-78576.

[24] Ellen Tolsma, Protecting our Herd: How a National Mandatory Vaccination Policy Protects Public Health by Ensuring Herd Immunity, 18 J. Gender Race & Just. 313, 334 (2015) (quoting What is Herd Immunity?, VaccinesToday (Feb. 7, 2015), http://www.vaccinestoday.eu/vaccines/what-is-herd-immunity/).

[25] Frej Klem Thomsen, Childhood Immunization, Vaccine Hesitancy, and Provaccination Policy in High-Income Countries, 23 Psychol. Pub. Pol'y & L. 324, 325-26 (2017) (quoting Paul Fine et al., Clinical Infectious Diseases, 911-16 (2011)).

[26] Italy Set to Relax its Controversial Child Vaccine Law, The Local (July 5, 2017), https://www.thelocal.it/20170705/italy-set-to-relax-its-controversial-child-vaccine-law.

[27] Id.

[28] Giubilini, supra note 23.

[29] Id.

[30] Italy Set to Relax its Controversial Child Vaccine Law, supra note 26.