Vaccine Skepticism Helped Put Them in Power. Can They Inoculate Italy?

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 beating back a pandemic that has killed nearly two 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 percent of Italians have said they would get an available vaccine, according to figures by Ipsos, a polling firm, in France only 40 percent 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 percent 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.

Since entering power, Five Star has tried to back away from some of its worst anti-vaccine propaganda. But Roberto Burioni, a prominent virologist 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 Mr. Burioni, who spent years publicly criticizing Five Star for its excoriation of doctors as a self-interested elite and 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 and the Milan hospital treating many coronavirus patients is named for him.

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Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

In 1973, when cholera broke out in Naples, the authorities vaccinated about a million people in one week.

But between 2010 and 2015, vaccination rates for the measles-mumps-rubella shot fell from nearly 94 percent to 85 percent, 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, the 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, allergies and 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 joined 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.

After a coalition of Five Star and the League fell apart in 2019, vaccine doubters either left or were forced out.

One expelled member, Sara Cunial, lamented on the floor of Parliament last month: “Dear citizens, if you are vaccinated and damaged the state will leave you completely alone.” Others kept mum or changed their tune.

Among them is Mr. Bonafede, the justice minister. “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,” he said 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, the president of a doctors’ association in Rimini, warned that 30 percent 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 — who was handpicked for the job by Five Star — warning that half of the 36 orderlies working 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 the safety of inoculations. 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.

That might be most needed in Italy’s poorer and less developed south, the historical base of the Five Star Movement, where the vaccine program is already lagging behind the north in part because of lackluster organization.

Mr. Burioni, the virologist, 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.”

Emma Bubola contributed reporting.

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