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Ivan Catalano had been sheltering in place at his house in Lombardy, Italy’s coronavirus epicenter since early March, when the Italian government imposed some of the strictest social distancing measures in Europe. Like the rest of the population, Catalano can only leave the house for urgent matters like getting food, essential work, or health reasons. Every time he goes out, he has to carry a self-declaration form to justify why he is not at home. Violating the measures could cost him more than $3,200 in fines.
Yet, unlike millions of people in Italy and across the globe, Catalano is not looking forward to the release of a COVID-19 vaccine. A former member of Parliament from the anti-establishment Five Star Movement and a current member of Movimento 3V: Vaccini Vogliamo Verità (“We want the truth about vaccines”), a single-issue party opposing mandatory vaccination, Catalano has been a representative of Italy’s anti-vaccine movement for years. The coronavirus pandemic has not shaken his beliefs: “I’m not scared, and the people I’m in contact with aren’t either.”
Italy currently has the second-highest number of reported COVID-19 deaths. It is also a country with a vocal and influential movement opposing mandatory vaccinations. At the end of February, when the threat of the virus was already looming over Lombardy, former Prime Minister Matteo Renzi joked that “Nowadays you can’t find an anti-vaxxer in Italy, not even if you pay for it.” As weeks went by and the numbers of sick people and dead grew by the hour, many believed that the lines of coffins and solitary burials provide skeptics with the brutal reality of what a world without vaccinations would look like and could ultimately mark the end of the anti-vaccine movement in the country. But it’s more complicated than that.
The Italian anti-vaccine movement has grown in recent years, gaining a bigger platform thanks to the Five Star Movement, an idiosyncratic party that is currently part of the coalition governing the country, which has, in the past, stoked fears about vaccine safety. More recently, together with the far-right Lega party, the Five Star Movement opposed a mandatory vaccination law that raised the number of compulsory vaccines for children from four to 10 in 2017. The law was approved following a surge in measles cases from 843 to more than 5,000 in 2017. Despite the vaccination efforts, last year the Italian Institute of Health, reported that Italy is among the 10 European countries where measles is still endemic due to low vaccine rates.
At the latest regional elections in January, only a few weeks before the COVID-19 outbreak, Movimento 3V recorded a surprising result in Emilia Romagna, a region in northern Italy, gaining almost 11,000 votes. It was not enough to reach the 3 percent threshold to get into the regional council, but it underlined how rooted vaccine mistrust is in the country. Emilia Romagna would soon be among the regions hit hardest by the coronavirus.
Catalano was a Movimento 3V candidate in Emilia Romagna in those elections and although the pandemic has since brought social and economic disruption in his country and across the world, he believes that this health crisis could actually strengthen his movement. “I am even more convinced about my choice,” he said.
This is not surprising to Sara Gorman, a New York–based public health expert and co-author of the book, Denying to the Grave: Why We Ignore the Facts That Will Save Us. She says that at a time of crisis like this, we should expect anti-vaccine groups to become even more entrenched in their beliefs. “These are really group phenomena where people join groups of people that are like-minded and hold the same belief,” Gorman says. “In a stressful situation, you’re going to lean on that identity more.”
Gorman also notes that there’s a very strong correlation between anti-vaccine beliefs and overall distrust in the establishment and the government. In Italy, like in the United States, policymakers made a number of mistakes in tackling the crisis. For groups that are already distrustful of the government, mistakes like this could reinforce their lack of trust at a time when the government is asking or compelling individuals to curtail their personal liberties. “This is the sort of thing that anti-vaxxers don’t like,” Gorman says.
Yet, the anti-vaccine movement is extremely diverse and includes people with different levels of skepticism. It is estimated that less than 1 percent of parents in Italy refuse vaccinations for their children altogether, while 15 percent are in the so-called hesitant category: parents who are not entirely opposed but have concerns about possible side effects and would like more freedom of choice regarding the pace of vaccination and the types of vaccines.
According to Antonio Clavenna, head of the pharmacoepidemiology unit at the Mario Negri Institute in Milan, hesitant parents are the ones whose worries can be resolved more easily through communication and empathy. Still, he doesn’t think the coronavirus will be a game changer for them. “COVID-19 presents an emotional charge and risk of serious symptoms and death that are not perceived as strongly in other diseases,” explains Clavenna. “The emotional impact of COVID-19 is not necessarily going to lead people to accept any kind of vaccinations.”
One of the cornerstones of the anti-vaccine movement is the assumption that potential negative consequences of vaccinations could be greater than the risks of diseases they prevent. Mario Small, a professor of sociology at Harvard, also believes that one of the reasons why COVID-19 is unlikely to shake this conviction is the perception of the magnitude of the coronavirus, which cannot be compared to other diseases. “You can’t ignore the coffins and the deaths,” Small says, but it is likely that the anti-vaccine movement will approach this disease as different. “Part of the mentality for which you’ve made such strong commitment would be to find reasons why your beliefs are still consistent with reality.”
Giovanni—he has asked Slate to use only his first name—is a father of two in his mid-30s from the Emilia Romagna region. He is a strong opponent of mandatory vaccination, and his two small children were excluded from preschool when he and his partner refused to vaccinate them. He says he might be open to a coronavirus vaccine for himself when one become available. “There are different types of vaccines and different types of diseases. We don’t know enough about COVID-19 yet, but if one day a vaccine became mandatory I might do it to be able to work and travel. It’s soon to say.” What he is sure about is that the coronavirus has not made him change his mind about other vaccines. Giovanni also says that he is afraid this public health crisis will lead to a tightening of vaccination policies.
The World Health Organization reported that 70 COVID-19 vaccines are being developed at the moment and three are being tested in human trials. Last week, WHO Director-General Tedros Adhanom Ghebreyesus said that he would soon announce an initiative for the accelerated development of vaccines. This accelerated approval process could be used as an argument by anti-vaccine leaders if the vaccination were made compulsory.
“These groups are skeptics about the safety of vaccines that were approved decades ago, let alone of a vaccine whose trials have only lasted a few months,” says Mattia Casula, a researcher in public policies at Cà Foscari University in Venice, who has studied the political impact of the anti-vaccine movement in Italy.
The uncertainty around the virus is also among the reasons why this public health emergency has not become a come-to-Jesus moment for vaccine skeptics. “Different experts have different opinions,” said Giovanni, the vaccine skeptic father, explaining why he is struggling to trust medical experts during this crisis.
According to Catalano, these concerns are widespread among vaccine skeptics. Catalano pointed out that “we don’t know how it’s going to work, how long its coverage will last, and whether it will be made mandatory.”
He adds: “This emergency has drawn even more attention around mandatory vaccination. Now I’m even more convinced about freedom of choice when it comes to vaccination, even if it is a vaccine against coronavirus.”