ROME — Over a decade ago, an activist in Italy’s Five Star Movement wrote to the nascent party’s leaders to tell them that his law firm, after years of seeking “damages from vaccination,” had convinced a judge that a vaccine was a potential source of autism.
“We’re dealing with a historic legal precedent,” he wrote emphatically.
Today that lawyer, Alfonso Bonafede, is the Italian justice minister, and his populist Five Star Movement leads the government.
The Five Star’s long history of sowing doubt about vaccines may have made its job that much harder as it seeks to convince Italians that a mass inoculation program is necessary to beat back a pandemic that has killed nearly 2 million people worldwide and shuttered entire economies.
The irony is not lost on Italians, who are not even Europe’s most skeptical population when it comes to the benefit of vaccines. While 62% of Italians have said they would get an available vaccine, according to figures by Ipsos, a polling firm, in France only 40% said they would be.
But it is Italy where a party that explicitly trafficked in anti-vaccine skepticism currently holds power. With Five Star’s rise, anti-vaccine campaigns are no longer merely an easy tool wielded by the political fringe to tear down established parties and gain power. They are a key factor that could determine the health and vitality of the nation at a critical juncture in the pandemic.
The first European country hit by the coronavirus, Italy is still struggling to control its spread. Like other nations, it has looked for salvation in the vaccines already available to health care workers.
But a significant number of nursing home workers appear reluctant to get the shot, prompting concerns that entrenched skepticism and confusion about the safety of vaccines may undercut the rollout.
“I’m one of those who is really dubious,” said Frida Faggi, an orderly in a nursing home in northern Italy, adding she probably would not get the vaccine.
A Five Star supporter, she worried that pharmaceutical companies had developed the vaccine too fast, that it might sicken her with autoimmune diseases and that negative reports had been censored. Others feel the same.
“Many are very skeptical,” said Barbara Codalli, who runs a nursing home in the northern province of Bergamo where 34 of the 87 residents died during the first wave. “The ignorance is immense.”
After a slow start, Italy’s vaccination program is picking up speed. More than 730,000 people have been inoculated, or more than 1% of the population — a higher rate than Germany’s.
But some critics wonder if things would be better if Italian populist forces had not spent nearly a decade questioning vaccines.
In particular they had entertained a connection between vaccines and autism — a belief that caught fire after a 1998 paper in the British medical journal, The Lancet, which was subsequently retracted and discredited. The study’s author lost his medical license.
The scientific consensus, supported by many rigorous studies, is that vaccines are not a cause of autism, and are safe and recommended in most cases. But doubts flowered on the internet, and among some Five Star supporters.
Since entering power, Five Star has tried to back away from some of its anti-vaccine propaganda. But Roberto Burioni, a prominent virus expert at San Raffaele University in Milan, said that the government had yet to forcefully clarify the issue and that it did not “have a stance” on whether vaccinations should be required for health workers. The result remains confusion and misunderstanding.
“Unfortunately, the damage was done in the past,” said Burioni, who spent years publicly criticizing Five Star for its excoriation of doctors as a self-interested elite and for its doubts about vaccines, which he said eroded faith in science.
“When you destroy the trust in something,” he said, “it’s not something you can rebuild in a few days.” Italy was an early adopter of vaccines. In the early 1800s, Dr. Luigi Sacco, once called the “most extensive vaccinator in the world,” inoculated hundreds of thousands of Italians against smallpox. His drawings and wax models of cowpox infections stand in Pavia University’s medical museum. The Milan hospital treating many coronavirus patients is named for him.
In 1973, when cholera broke out in Naples, authorities vaccinated about 1 million people in one week.
But between 2010 and 2015, vaccination rates for the measles-mumps-rubella shot fell from nearly 94% to 85%, one of the lowest in Europe. That coincided with the rise of internet conspiracy theories about vaccinations, among other things, that eroded trust in traditional government institutions and led to surging support for Five Star.
Five Star’s co-founder, comedian Beppe Grillo, liked to riff on safety suspicions, suggesting that vaccines weaken children’s immune systems, and claiming that the pharmaceutical industry had pushed them for profit.
Its members campaigned against laws making vaccines obligatory and professed a link between vaccines and cancer and allergies, as well as autism. Affiliated websites drew traffic, and advertising revenue, with posts by vaccine skeptics. One party leader called vaccine scars “branding for beasts.”
And Five Star was not alone. By 2015, Matteo Salvini, the leader of Italy’s nationalist League party, had gotten in on the anti-vaccine action. “Obligatory vaccinations, sanctions on the doctors who advise against it. What do you think?” he asked his Facebook and Twitter followers, market testing the issue.
Five Star and the League created an alliance that fell apart in 2019. By then, Five Star had begun to shed its anti-establishment and anti-vaccine rhetoric. Some of the party’s vaccine doubters left or were forced out. Others who remained kept mum or changed their tune.
“As a lawyer I limited myself to providing information about a decision handed down in the context of a lawsuit followed by a colleague in my office,” said Bonafede, the justice minister, in a statement about his enthusiastic note to Five Star leaders 10 years earlier
“I personally never questioned the importance of vaccines, and I wholeheartedly support the ongoing vaccination campaign, with respect to which I am waiting for my turn,” he said.
Five Star, which has hemorrhaged support, has welcomed the vaccine and urged Italians to get it.
But some Italians seem less than convinced.
Claudia Alivernini, the first Italian nurse to receive the vaccine, said she was so inundated with hateful messages on Facebook that she deleted her account. Facebook, which was a preferred method for spreading anti-vaccine conspiracy theories, recently removed the page of the main anti-vaccine group in Rimini.
Rimini, a city on Italy’s east coast, is a hotbed of vaccine skepticism where judges have linked vaccines to autism and workers in nursing homes have refused to be vaccinated.
Maurizio Grossi, president of a doctors’ association in Rimini, warned that 30% of nursing home workers were initially unwilling to get vaccinated.
He said that while persuasion campaigns had decreased the number of skeptics, Five Star had in the past “exploited” anxieties for political gain, and then given members who were elected “a megaphone because they could talk as political representatives.” The mayor of nearby Bagno di Romagna wrote a letter to Prime Minister Giuseppe Conte warning that half the 36 orderlies working in his town’s nursing home had refused to be vaccinated.
The mayor, Marco Baccini, said that Five Star’s early mixed messages about vaccines contributed to confusion about their safety. But he said the country’s media was also to blame.
Italy’s virus-obsessed newspapers and television channels often fill space with minority and unproven scientific opinions, casting doubt on vaccine efficacy or suggesting that a shot might cause illness.
Critics say Italy also lacks a single, trusted institutional messenger within the government.
Burioni, the virus expert, said the true level of skepticism would reveal itself only at the end of the vaccination efforts.
He expressed confidence that people would get with the program once they saw their colleagues get vaccinated and not get sick. The challenge, he said, was what the government would do with the holdouts.
“We have to decide if it is acceptable that a medical doctor, nurse, health care worker can continue caring for patients without being protected, so with the danger of spreading the disease,” he said.
Sandra Zampa, the deputy health minister, with the Democratic Party that is now Five Star’s coalition partner, said it was “evident” that health care workers should be vaccinated as “a precondition” of their continued employment.
But Fabiana Dadone, a Five Star member who serves as minister of public administration, has opposed requiring vaccinations for public sector employees.
Forcing people to get inoculated, she said on Italian television, was “absurd.”