Italy’s uphill battle to force health workers to get vaccinated

ROME — When 79-year-old emphysema patient Giulio Maciò died of COVID-19 in a ward supposedly isolated from the virus, it sounded the alarm on a problem looming over the vaccination drive in Italy.

An investigation into his death on March 11 revealed a cluster of 19 cases among patients and staff members at the San Martino hospital in Genoa — including a nurse who had recently refused to get the vaccine.

The incident, followed by several similar mini-outbreaks in Italian hospitals and care homes, has highlighted a concerning trend of health care workers rejecting the vaccine, striking a nerve in a country with the most COVID-19 deaths in the European Union.

The Rome government decided to take a tough stance on Wednesday, approving emergency legislation to make coronavirus vaccines mandatory for all health care workers, including pharmacy staff. Those who refuse can be transferred to another job without risk of spreading infections, or suspended without pay for up to a year.

The government said the rules were intended to “protect both medical staff and those who are in environments that may be more exposed to the risk of infection.”

But Rome faces fierce resistance to its decree from the country’s deeply rooted anti-vaccine movement, which has been fostered in part by populist political forces. They include the 5Star Movement, which entered government in 2018 peddling vaccine skepticism, although it has now distanced itself from that position.

Public trust in the vaccine has also taken a hit after the country temporarily decided to suspend the use of the Oxford/AstraZeneca jab after several deaths. Willingness to get a shot dropped by 5 percentage points in a week to 52 percent, according to a poll by Nando Pagnoncelli in March.

The problem isn’t new. A 2016 study found that while just 0.7 percent of Italian parents are anti-vaccine, less than the 2 percent average in the EU, 15.6 percent are vaccine-hesitant.

Between 2013 and 2016, the number of children getting the vaccine against measles, mumps and rubella fell below recommended levels ensuring herd immunity and Italy experienced a serious measles outbreak in 2017.

But now, as the pandemic wears on and the new variants take their toll, convincing people to accept vaccines has become urgent.

In Lombardy, the northern Italian region worst hit by COVID-19, between 6 percent to 10 percent of health operators have not joined the vaccination rollout. In Puglia in the south, the regional authority estimates that number at 10-15 percent.

Many vaccine skeptics still embrace a now widely discredited 1998 paper in The Lancet medical journal that linked vaccines to autism, which has persisted in Italy despite its debunking. As recently as 2012, an Italian court relied on the study in mandating compensation from the state to the family of an autistic child, although that ruling was later overturned.

Roberto Burioni, a virologist at San Raffaele University in Milan and prominent pro-vaccination campaigner, blamed the spread of disinformation on social media. “The [Lancet] hoax made it worse, unfortunately,” Burioni told POLITICO. “Efforts by government institutions and pharmaceutical companies to counter fake news are very weak. If you lose trust, you can’t get it back overnight.”

Among those who have lost trust is Elena Vio, a 54-year-old nurse in Treviso, Veneto, who believes her now 14-year-old daughter suffered permanent problems after contracting encephalitis due to a post-vaccine reaction.

Vio is one of the dozens of health care workers in her health district now refusing the COVID-19 vaccine. In an open letter sent in March on behalf of 62 colleagues, Vio explained her reservations that the vaccine had been created in haste; that the long-term effects of the vaccine were unclear; that responsibility for compensation in case of an adverse reaction was not clear; and that it could be possible to transmit the infection after vaccination.

A complaint was filed to prosecutors in February after another group of 10 health care experts in South Tyrol in northeast Italy published a video on social media warning against vaccines and promoting alternative therapies such as Vitamin C and D, and zinc. It also called for “thinking positive thoughts” and “having faith in your power to self-heal.”

One of the doctors, Roberto Cappelletti, insisted to POLITICO that his views were deeply rooted in science. “These are experimental vaccines,” he said. “We do not know much about the long-term effects — if it could cause auto-immune diseases or degenerative diseases with a serious impact on health.”

It will take 10-15 years to be certain, he said, adding: “In the meantime, the risk is too high.”

Filippo Anelli, president of the Order of Doctors, Surgeons and Orthodontists (FNOMCeO), which backs the new decree, said vaccines have saved millions of lives and that doctors must be driven by scientific evidence. Medics who refuse the vaccine “are not doctors — it’s like an engineer who doesn’t believe in maths,” Anelli said.

Still, the region of Puglia has shown encouraging signs after passing a local law two months ago obligating health workers to get the jab, according to Fabiano Amati, a politician with the center-left Democratic Party who introduced the legislation.

“It has had a notable persuasive effect,” Amati said. “The first letters threatening sanctions have gone out, and now there is a race to get vaccinated.”

Violators there face being transferred to a different role as well as disciplinary proceedings and a €5,000 fine. Amati said merely transferring people was not enough, because “it could be considered a reward and have a boomerang effect.”

Not just Italy

Across Europe, health care workers share the same anxieties about vaccines. A 2019 study found the main barriers to getting vaccinations were concerns about side effects, underestimation of personal risk, and a belief that it is better to boost natural immunity by contracting the disease. Also in play are concerns about secret financial interests.

Nurses were more than seven times more likely than doctors to not believe in vaccination, with health care workers from Italy and Slovenia least likely among the European countries surveyed to believe in them.

Governments that are wrestling with the idea of making jabs obligatory include France. In a last-ditch effort to use persuasion rather than force, Health Minister Olivier Véran wrote to health care workers in March urging them to get vaccinated “quickly” to protect “our collective security and the capacity of our health system.”

The U.K. is preparing to make the vaccine mandatory for care home workers by the summer. Prime Minister Boris Johnson is expected to make a statement around April 5 and launch a consultation on how to make jabs a condition of employment, with a change in the law likely by mid-June.

Back in Italy, critics of the new legislation have questioned the legality of forcing only some categories of workers to get a vaccine, as well as raising issues of privacy and the constitutional right to refuse medical treatment.

The practicalities of transferring medics to other posts could be onerous, according to Anelli from the doctors’ organization: “It depends on the numbers. If it is one, two, three, they could be relocated to a workplace with no contact with fragile people. If it becomes 20 or 30 at one hospital, you have a crisis.”

But with little sign of the virus retreating in Italy and declining trust in the vaccines, the government has opted to act decisively.

For Burioni, the virologist, there is no room for flexibility, as even one unvaccinated person can cause a fatal outbreak.

“It is a matter of principle. A doctor who doesn’t believe in science is not a doctor,” Burioni said. “You cannot drive a school bus if you don’t believe in brakes. Just one anti-vax doctor is too many.”

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.