The latest homework assignment in Italy involves rolling up your sleeve and getting a vaccine.
Under the country’s new Lorenzin law, students under the age of 6 who show up to school without proof that they’ve been vaccinated will be sent home, according to the BBC. For students between the ages of 6 and 16, failing to provide proper vaccine documents will result in their parents receiving a $560 fine.
The new law is the latest step in the country’s campaign to contain an outbreak of measles that forced the government to declare a state of emergency last November. Between February 2017 and January 2018, more than 5,000 cases of measles were reported in the country. Although cases of measles seemed to be declining toward the end of last year as public health campaigns escalated, they more than doubled in January compared to the month before.
The Lorenzin law seeks to further bolster vaccination rates.
"Generally, having a law without enforcement doesn’t work — you really have to enforce it to have an impact,” Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins School of Public Health, told Global Citizen.
Salmon described how past measles outbreaks in the United States have been contained through campaigns that hinged on laws excluding unvaccinated children from schools. While more than 500 people were dying of measles in the US throughout the 1960s, the number of deaths dropped to 89 in 1970 and continued to fall, nearly vanishing by the turn of the century, because of coordinated public health campaigns.
In recent years, Italy’s vaccination rates dropped to around 80% of the population, allowing measles, a disease that was once thought to be eradicated in much of the world, to surge back. Since the onset of the latest outbreak, the country has been able to boost rates to 95%, achieving the World Health Organization’s recommended level.
When a population achieves a 95% vaccination rate, it reaches what is known as “community immunity.”
“Certain people can’t be vaccinated because of medical reasons or they’re too young,” Salmon said. "The idea behind community immunity is that if you have a high enough proportion of people vaccinated or immune, it prevents the introduction of the disease in the population.”
The Italian government is already warning families about the new law. In Bologna, for example, more than 300 families received a letter stipulating the new school requirements, which went into effect on Monday. In areas with high vaccination rates, the window for complying will be more flexible, according to the BBC.
Italy’s measles outbreak was largely driven by the growing number of parents opting out of vaccination requirements either because of medical, religious, or philosophical reasons.
Misinformation spread by the “anti-vaxxer” movement was a big factor in this decline, according to the BBC, but Salmon said that the emphasis on this movement in Italy, and elsewhere, is misguided.
“There are not a lot of people who are ideologically opposed to vaccines; there are a lot of parents who have concerns, and making laws more strict isn’t going to address those concerns,” he said. “We need to listen to the parents, we need to understand them, we need to address their concerns.
“If a parent walks into a facility and says 'I read on the internet that there’s formaldehyde in vaccines and it scares me,' the doctor needs the training, patience, and reimbursement to deal with that concern,” he added. "Doctors are the most credible source for parents, but they’re often not equipped with the tools and training to have these conversations."
Rather than demonize parents who have concerns or may be misinformed, Salmon said that countries need to do a better job investing in educational campaigns and reimbursing doctors for dispelling myths and reassuring people.
“Public health officials and parents share a desire to protect children and we have to build on that desire,” he said.