Children in Italy have been told not to turn up to school unless they can prove that they have received mandatory immunizations.
Parents in Italy had until 10th March to show appropriate certification, but as the 10th fell on a weekend, the (already extended) deadline was extended once again, to Monday 11th.
The deadline follows months of national debate over Italy’s approach to addressing plummeting vaccination rates, which have dropped below the World Health Organization’s target of 95%.
Children under the age of six years-old can now be refused entry from school. While unvaccinated children between 6-16 years old can’t be banned from attending school, their parents may be fined up to €500 (£425; $560) if this occurs.
According to the BBC, Health Minister Giulia Grillo told a local newspaper that the rules were now simple:
“No vaccine, no school.”
The move reflects worrying trends, whereby vaccine coverage is on the decline, and the spread of misinformation, and vaccine-preventable diseases,1 are on the rise.
The law has been dubbed the “Lorenzin Law,” named after the health minister from the previous government, who championed compulsory vaccinations.
What is vaccine hesitancy and why does it exist?The World Health Organisation has identified “vaccine hesitancy” as a complex global problem that requires ongoing monitoring, and defines it as below:2
“Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.”
Why is vaccine hesitancy a problem?While vaccination programs are one of the greatest achievements of public health, and have greatly contributed to the decline in mortality and morbidity of various infectious diseases2-4 their success relies on high vaccination coverage rates. When vaccination coverage is low, not only are fewer individuals directly protected from vaccine-preventable diseases, but the indirect protection for the overall community is greatly reduced.
Watch this video to learn about herd immunity
Recently, the head of NHS England has warned that “vaccination deniers” are gaining traction on social media as part of a “fake news” movement. When speaking to the BBC, Simons Stevens said:
"Frankly it's as irresponsible to tell parents that their children shouldn't be vaccinated as it is to say don't bother - to your kids on their way to primary school - to look both ways when they cross the road. As a health service we've really got to help support parents on this."
Tips for responding to anti-vaccine argumentsAs recognized by Dubé et al. (2013),3 vaccine hesitancy is an individual behaviour influenced by a range of factors, such as knowledge or past experiences, but it is also the result of broader influences such as communication and media, and trust in public health policies and health professionals.
The World Health Organization has released a 52-page document titled: How to respond to vocal vaccine deniers in public. The guidance document is primarily intended for spokespersons of health authorities who want to prepare themselves for a public event with a vocal vaccine denier.
The document highlights five common characteristics of science denialism (championing conspiracy theories, using fake experts as authorities, cherry-picking isolated papers that challenge scientific consensus, having impossible expectations of treatments, the use of false logic) and highlights the five topics of vaccine denial, so the technique used by the vaccine denier can be unmasked.
5 topics of vaccine denial:
- Threat of disease: Arguing that vaccine preventable diseases are eradicated or harmless
- Trust: Questioning the trustworthiness of health authorities.
- Alternatives: Arguing that there are safer and/or more effective prevention methods than vaccination
- Effectiveness: Questioning the effectiveness of vaccines as a prevention method
- Safety: Questioning that vaccines entail more benefits than risks and raising general safety issues.
Some Do’s and Don’ts:
- Do stay calm and rational
- Do respond with correct evidence-based information instead of repeating any anti-vaccine argument
- Don’t raise questions about the personal motivation of vocal vaccine deniers
- Do underline scientific consensus with regard to vaccine safety and efficacy
- Don’t use humor – it can be taken the wrong way
- Do emphasize the social benefits of vaccines and make sure your audience understand the importance of herd immunity
1. Thornton, T. (2019) Measles cases in Europe tripled from 2017 to 2018 BMJ 364:l634
3. Dubé, E., et al. (2013). Vaccine hesitancy: an overview. Human Vaccines & Immunotherapetics 9: 1763-1773
4. Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900-1999. MMWR Morb Mortal Wkly Rep 1999; 48:241-3; PMID:10220250.