And confidence soars!

This article was published in La Verità on 3 July 2019.

A little more than two years have passed since the entry into force of the Lorenzin decree on the obligation to vaccinate children. While the forces of the Gialloblù government announce that they want to replace it with a new law with still uncertain outlines , some (few, actually) try to take stock of the provision and its consequences, not just regulations. With the more than duplication of compulsory vaccinations and the introduction of economic sanctions and school suspensions for small defaulters, the decree has sparked debates and sparked conflicts both between citizens and institutions (especially health ones, forced to the role of health "gendarmes" ) and within a public opinion divided between the supporters of an all-encompassing "science" and the so-called "novax" recipients of anathemas and censorship. School suspensions from kindergartens, in some cases of dubious legitimacy, have produced marginalization and discomfort in reluctant families, the number of which seems to be anything but marginal. By projecting the data released by some regions, minors between zero and sixteen who do not comply with the vaccination calendar could in fact amount to 1.2 million units : 13% of the cohorts concerned. It therefore becomes urgent to understand if it was worth it and to reflect on how appropriate it is to insist in the direction drawn.

The mandatory premise is that the objective of the law, to increase membership to ten – not twelve or seven, or fifteen – childhood vaccinations, is a health policy objective, that is, it expresses one of the many possible visions of public health and tools to promote it. Equally legitimate, as long as democratically shared, would have been, for example, the desire to promote other vaccinations, or to reserve some only for those most at risk, or to invest in other forms of protection, or else. Limiting the analysis to the declared objectives of the provision, a report by the GIMBE foundation last March estimated that between the 2015 cohort (survey in mid-2018, post Lorenzin) and the 2014 cohort (survey at the end of 2016, pre Lorenzin), vaccination at 24 months increased on average by 2 percentage points for the hexavalent, by 7.4 points for the trivalent measles-mumps-rubella (MMR) and by 12 points for antivaricella, with peak increases in the Valle d ' Aosta and in the Province of Bolzano. The ISS reports that in 2018 the 24-month hexavalent exceeded 95% coverage in 13 out of 18 surveyed regions (average: 95.46%) and MPR in 6 out of 18 (average: 94.15%) . This is a result never achieved in Italy, which however has not been followed by an appreciable epidemiological relapse: if measles infections have halved from 2017 to 2018, the number (2526) has remained just above the average of the last ten years and just below that of the last twenty years.

It is more difficult to quantify the aforementioned negative externalities of the measure in terms of discomfort, conflict and credibility of the institutions, the effects of which can generally be reflected in the trust that the population places in vaccination prophylaxis. A survey conducted for Eurobarometer in June 2018 – 12 months after the entry into force of the decree – showed that in our country vaccine confidence had increased on average compared to 2015-2016. At that time, for 85.3% of our compatriots the vaccines were "safe" (EU average: 82.1%). But today, less than a year later (March 2019), here is the surprise : according to the latest Eurobarometer focus , 32% of Italians believe that "vaccines overload and weaken the immune system" (EU average: 31%) and almost half (46%) that "vaccines can often produce serious side effects" (EU average: 48%). The latter figure rises to 60% in France, the only European country to have followed the Italian example so far (with 11 compulsory vaccinations, under penalty of not being admitted to asylum … which is mandatory!) And together last in the world, according to a recent Gallup-Wellcome survey , for confidence in vaccines.

Although partially flawed by the different formulations of the question, the result is worrying. If confirmed, it would mean that in our country every percentage point recovered by joining the MPR has "cost" 3.6 points of trust . Or that today 4 out of 10 parents fear adverse and frequent events when they have their children vaccinated. This abrupt change of attitude represents a defeat first of all for those who had proposed to increase the propensity for vaccinations with massive communication campaigns globally. But it is at the same time difficult not to relate precisely to the tones of those campaigns and to the connected temptation to introduce obligations, conditions and sanctions that today seem to tickle, with curious synchronism, the chancelleries of half the world.

And the opposite would be amazing . Even leaving aside the serious problem of having transformed a right and an opportunity that is almost universally welcomed into a duty to which other rights must be subordinated, the sudden way in which the issue has jumped to the top of the agenda of governments and mass media – as if before 2017 we lived in the medical Middle Ages – to the sound of "emergencies" that there are and "epidemics" of which there is no trace (the alleged measles of 2017, for example, has never been recorded by WHO ). Nor does it seem proportionate that more than a million people have suddenly become "greasers" on the front pages of newspapers or "murderers" according to some commentators, or that all doctors have had to align themselves with a message in order not to be disbarred, as happens only in rare cases of conduct – not of opinion! – very serious. Or again, it would be unnatural not to question the reasons for a promotional anxiety with hyperbolic contents such as, among others, that of the 470 children who died of measles in England in 2013-2014 according to the then Minister Lorenzin ( here and here , while in that two years only one person died of measles, and was an adult), or the denial of serious iatrogenic effects even when recognized and compensated by the state. But above all, the declared intent to protect public health, even by force, does not reconcile with the obstinate definition of a "public health [which], neglected by politics, falls apart" ( GIMBE, 4th report ) where wards are closed, avoidable deaths from nosocomial infections reach seven thousand cases per year and the reduction of pediatric nurses in some wards would increase the mortality of young patients by 25% . Nor is there any concern that schools forbidden to healthy children for fear of hypothetical epidemics are 40% without the static test certificate and 50% with the certificate of practicability and fire prevention (source: Associazione Presidi), with a average of three collapses a day (source: Save the Children), while the presence of asbestos in numerous structures puts the health of more than 350,000 students at risk (source: National Asbestos Observatory). Not to mention that for other much more serious pathological determinants – smoking, alcohol, pollution, junk food, etc. – the most seraphic laissez-faire applies. The macroscopic incongruity of putting these and other emergencies in line with the recovery of a few vaccinations cannot fail to have created confusion and stiffening in the public.

The problem is that the growing mistrust of vaccination policies leads to a more serious mistrust of the institutions that promote them: governmental, of course, but unfortunately also medical-scientific. There is a strong risk that the latter appear to citizens as the disciplined executors of political or industrial instances with opaque motives, thus setting the stage for conspiracy. The stakes, as Ivan Cavicchi has often denounced, are therefore not immunizations against measles or other diseases, but the therapeutic alliance between doctor and patient on which the very possibility of health in every field is based . The health obligation, in the face of epidemiological progress so far intangible and with its corollaries of discrimination for citizens and intimidation for doctors, is contributing to aggravate a climate of suspicion that promises to extend from vaccinations to any other treatment, with incalculable and lasting damage. The politicians who today are preparing to "overcome" it therefore have the difficult but crucial task of rearranging the priorities of health so that it returns to being a right, not an imposition or a pretext to take away other rights, and the rescue of a small brick – the few extra percentage points of coverage – do not claim the collapse of the whole building.

This is a machine translation from Italian language of a post published on Il Pedante at the URL on Sat, 06 Jul 2019 16:01:00 PDT.