On Monday, the Italian Senate passed the relevant amendment that aims to end compulsory vaccinations of children attending kindergartens and primary schools. The proposal, however, will not take effect before the start of the new school year, as it is yet to pass through the lower house.
History of Italy's Vaccination Law
The move, promoted by the new Italian government, comes at a time when an outbreak of measles in Italy and on the Balkans has hit thousands of people. With 5,004 cases of measles registered in 2017, Italy accounted for 34 percent of the cases reported in the European Economic Area, according to the European Centre for Disease Prevention and Control (ECDC).
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The outbreak prompted the former Italian government to introduce 10 mandatory vaccinations instead of the previous four vaccinations, which did not include measles. Those not complying with the regulation are subject to fines under the existing legislation.
New Italian Interior Minister Matteo Salvini, however, claims that compulsory vaccination discourages school inclusion.
"The 10 compulsory vaccines (measles, chickenpox, mumps, rubella, tetanus, poliomyelitis …) are useless and in many cases dangerous, if not harmful. We are committed to allowing all children to go to school. The priority is that they don't get expelled from their class," he told reporters.
Health Minister Giulia Grillo confirmed that "the government wants to spur school inclusion and simplify rules for parents."
‘Herd Immunity' at Risk
Meanwhile, experts express concerns that the abolition of compulsory vaccination threatens to undermine not only the health of certain individuals but also "herd immunity," affecting the broader population.
"A vaccine has two levels of efficiency. First, it must protect the person by developing an immunity to the disease, but there is a second and even more important goal of vaccination campaigns; it is reaching the ‘herd immunity’ level, to protect a larger population; if 95 percent of the people in a given country have had the disease or are vaccinated, the disease — for example, measles, chickenpox, mumps, rubella or hepatitis – cannot develop, and simply disappears. When you are vaccinated, you will never get the disease anymore. Your body has developed the antibodies that attack that particular germ and kill it," Dr. Clement Brasseur, a vaccination specialist from National Children’s Organisation of Belgium (ONE), told Sputnik.
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According to the expert, Europe’s tradition of massively vaccinating children has been in place since the end of World War II and proved its effectiveness. Decisions to refuse vaccination, in contrast, result in the re-appearance and even outbreaks of diseases which have been previously eradicated.
"Lately, fringe groupings have refused to let their children be vaccinated. It was first an extreme protestant community in The Netherlands for example, whose members refuse transfusion or vaccination. Now the situation worsens. With the internet, people believe rumors and fake news that they read on the web. For example, there is a persistent rumor that vaccines can develop autism in children. This is totally untrue, but it still lingers among people who are afraid of having their children vaccinated. This has reduced the number of vaccinated individuals over time, which makes the situation prone to the re-appearance of epidemics or at least outbursts of diseases that had been eradicated," Brasseur pointed out.
Noting public ignorance about the issue and general distrust of scientists, Brasseur concluded that compulsory vaccination remains the best approach.
"There is a general lack of trust in scientists in Europe. People believe the most hair-raising ideas that they have read on the internet. That is why I believe the best approach remains the compulsory vaccination. Only that way, can you reach the desired levels of 95 percent for the most contagious diseases," he stressed.
Unfortunate Example of France
To prove the need for compulsory vaccination, one of the experts cited the example of France, where a rising number of unvaccinated people resulted in a measles outbreak.
"France is badly hit for the moment. The country has recorded more than 2,500 cases of measles in the year to May 2018, including three deaths and high rates of hospitalization (22%). The French outbreak has risen sharply in the second quarter of 2018. French authorities believe the outbreak may now have peaked but, due to high numbers of unvaccinated citizens, the risk of future epidemics remains. Most cases are children who are too young for a vaccine; they can only be protected by the ‘herd immunity’ which is very low in France; since only 88% of people are vaccinated for a recommended 95% of the population," Gary Finnegan from Vaccines Today, an online platform financed by the industry, told Sputnik.
According to Finnegan, vaccination rates in France are among the worst in Europe, while vaccine confidence of the citizens is the lowest in the world. A total of 41 percent of French respondents do not agree that vaccines are safe, the Vaccine Confidence Project said.
EU Concerned By Rising Vaccination Skepticism
To find out the EU position on compulsory vaccination, Sputnik asked Aikaterini Apostola, the spokesperson for the EU health and food safety commissioner, for a comment.
"Vaccination programmes are one of the greatest achievements of public health. They have contributed to the eradication of polio and smallpox in the EU and led to a significant decline in a number of other infectious diseases. However, as ‘herd immunity’ is dependent on a high rate of vaccination coverage, the Commission is concerned by the rise in vaccine skepticism. This skepticism has led to some parents refusing or delaying vaccines for their children," she told Sputnik.
Apostola noted that, even though vaccine coverage remains high in the union, the bloc should "keep a watchful eye and work together" to raise awareness of the importance of vaccination and consequences of failing to get vaccinated.
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Commenting on Italy, Apostola noted that "vaccination is the responsibility of member states," stressing that "the commission is committed to stepping up EU support for national efforts though." She went on to note that the European Commission’s approach is based on three main pillars – "tackling vaccine hesitancy and improving vaccination coverage; sustainable vaccination policies in the EU; and EU coordination and contribution to global health."
WHO: Vaccination Should Be Made Easier and More Convenient
To address growing vaccine hesitancy, the World Health Organisation (WHO) developed in 2013 a Tailoring Immunization Programme (TIP) – a structured research approach – to help health care professionals and doctors to identify populations susceptible to vaccine-preventable diseases, diagnose barriers and motivators to vaccination, and make recommendations to improve immunization coverage.
"Building trust and understanding [among] the community is essential to responding to vaccine hesitancy. Many people assume vaccine hesitancy is about people being unwilling to be vaccinated, but under the surface it is often simply about the convenience factor and how easy it is to get their children vaccinated," Katrine Bach Habersaat, a technical officer from the Vaccine-preventable Disease and Immunization Division in the WHO Regional Office for Europe, told Sputnik.
TIP studies are being conducted in Bosnia-Herzegovina at present, for example, to improve the levels of vaccination, which is a WHO strategic objective in its European Vaccine Action Plan 2015–2020 (EVAP).
Vaccination Fears Are Mostly Myths
Not all vaccination specialists promote compulsory vaccination though. On the Vaccines Today website, the industry is very careful not to antagonize people who believe that they are well-informed and who attribute malicious and deadly developments to vaccination campaigns. The industry prefers soft persuasion, having medical authorities answering all questions.
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The most commonly-suggested concern is that the measles, mumps and rubella vaccine (MMR) could be linked to autism, diabetes and multiple sclerosis. The vast majority of doctors and scientists nevertheless views the idea that vaccines cause autism as a damaging myth.
Indeed, recent outbreaks of measles – which has killed people in Europe – have highlighted the need to improve vaccination rates.
The infectious disease that causes the biggest burden on people in Europe is influenza. Not only is the flu common, it also has a high death rate – particularly among older people or those with other chronic conditions such as immunosuppression, liver disease, and neurological disease, as well as diabetes, heart failure or chronic lung diseases.
The European Centre for Disease Prevention and Control (ECDC) studied 31 infectious diseases, comparing their impact in terms of disability-adjust life years (DALYs) – a way of measuring the loss of a healthy year of life. Worst is the flu, the fact that will probably prompt some people to get vaccinated this fall.