ROM – Giulio Macciò tested negative for the coronavirus and spent weeks receiving treatment for emphysema – and a nurse who refused to be vaccinated – in a locked hospital under the care of doctors and pulmonologists. He died unexpectedly on March 11th. A post-mortem swab found he had contracted the virus, as did 14 other patients and the unvaccinated nurse who had spent her shifts in its midst.
“It makes no sense for a person whose job it is to cure the sick to give them Covid and kill them,” said Massimiliano Macciò, the son of Mr Macciò, who made a complaint against the San Martino Hospital in the northern Italian city Genoa submitted. He believes the nurse, one of an estimated 400 who refused to be vaccinated against Covid-19 in the hospital, infected his father, who died unvaccinated at the age of 79.
As vaccination adoption accelerates, businesses everywhere are grappling with whether or not they can require their employees to be vaccinated, raising sensitive ethical, constitutional and privacy issues in Europe and the US. However, this dilemma becomes even more urgent when the person is your health worker.
In Italy, the original Western Front in the war on Covid, a rash of outbreaks in hospitals where medical workers have chosen not to be vaccinated, has raised fears that their attitudes pose a threat to public health. It has also sparked a strong response from an Italian government struggling to get vaccinations on track.
On Wednesday, Prime Minister Mario Draghi tested the legal limits of his government’s ability to address the problem by issuing a decree mandating vaccination of workers in health care facilities. It also allowed hospital employers, healthcare workers who refuse to suspend without pay.
Some legal analysts have stated that requiring health workers to be vaccinated with Covid-19 could violate Italian data protection laws and that dismissal or enforcement of unpaid leave based on a specific article protecting people who refuse health treatments could be unconstitutional.
However, recent court rulings have interpreted the law differently and Mr Draghi has made it clear that for a country that has suffered more than 100,000 Covid deaths, the security breach cannot be tolerated.
“It is absolutely not okay for unvaccinated workers to be in contact with the sick,” he said at a press conference last week as he announced his government’s intention to “intervene” if he was told by unvaccinated health workers was asked.
During much of the pandemic, nurses and doctors stood as national heroes, sacrificing their waking hours, their safety, and sometimes their lives to protect their compatriots. It shocked Italians that in some large hospitals, up to 15 percent of medical professionals, who were given preference over the elderly when vaccination was introduced, avoided vaccination.
“It’s really humiliating for the medical and health staff class to have to force people to vaccinate themselves,” said Roberto Burioni, a virologist at San Raffaele University in Milan.
He added that while it was extremely difficult to lay off workers in Italy, he hoped the decree would hurt the salaries of all vaccine skeptics, especially given the huge amount of data showing that the effectiveness of vaccines is worth the risk. He also feared that the high number of health professionals who refused to be vaccinated had worrisome consequences.
“Unfortunately, there is a large proportion of doctors who are profoundly ignorant,” said Burioni, who suggested that “the selection process to get people to graduate and then the medical license is not effective enough”.
While Italy’s populists, including the Five Star Movement and the League parties, have exploited vaccine skepticism for political gain in recent years, the country is not even considered the most vaccine skeptical in Europe, a dubious distinction normally accorded to France. Italy also got off to a quick start on vaccinations earlier in the year, precisely because the previous government gave priority to health professionals.
Updated
April 1, 2021, 11:02 p.m. ET
In January, Health Minister Roberto Speranza said on TV that Italy, like its European partners, believed that it was better to persuade people to vaccinate than to ask for it. “Those who have had to deal with the virus, our healthcare workers, are even more aware than the others,” he said. “I think readiness will be enough.”
But the Anti-Vax health workers hit a deep nerve.
In a nursing home outside Rome, almost all healthcare workers chose not to be vaccinated, and a group of three workers and 27 of the 36 elderly guests formed. Roberto Agresti, the owner of the house, feared the worst for her. “If we had a law that forced everyone to vaccinate, the virus would be over without us even realizing it,” he said.
In the southern city of Brindisi, the local health authority has initiated disciplinary proceedings against 12 health workers who have specifically refused to be vaccinated. It also examines why about 140 healthcare workers, including doctors, nurses, pediatricians and specialists, have refused to accept the Pfizer vaccine.
“We don’t want to punish the workers – we need them,” said Giuseppe Pasqualone, who heads the local health department. “But the risk of infection is not only very high for them, but also for fragile patients.”
Officials at the San Martino Hospital, where Mr Macciò died, said it was not clear whether the unvaccinated nurse was the source of the cluster, but they admitted it was a problem.
Salvatore Giuffrida, the director of Europe’s fourth largest hospital, said he was in favor of mandatory vaccination as it would also ensure the health of medical workers and strengthen lines of defense if a brutal third wave spreads across northern Italy.
“We can’t afford not to have her at work,” he said. “The goal is not to lose soldiers during a war in a nation that complains that they have no health care workers.”
He estimated that 15 percent of his caregivers, about 400 nurses, were not vaccinated. Just removing these nurses from the wards or, as some have suggested, redirecting them to control panels would be “a cure worse than the disease,” he said, because it would result in a 250 bed reduction.
He and other directors said Italy’s strict data protection laws were preventing hospitals from knowing which doctors and nurses weren’t vaccinated.
Paolo Petralia, the general manager of Lavagna Hospital in Chiavari, the site of another outbreak this month, said 90 percent of his doctors had been vaccinated, along with about 80 percent of the nurses and helpers.
“You are protected by data protection laws,” he said, citing a statement recently made by the Italian Data Protection Agency that the vaccination status of health workers should be unknown. “But that right lasts until it doesn’t interfere with another person’s right,” Petralia said.
Some Italian dishes have agreed. In 2017, Italy mandated some vaccinations for children, including measles, and banned the unvaccinated from school – a decision backed by the Italian Constitutional Court because it also protected public health. In the northern city of Belluno, a court ruled in mid-March that a nursing home employing several health care workers who did not get vaccinated could force them to take paid leave.
Mr Macciò, whose father had died in Genoa, said it was pointless for the people in charge of caring for his father to harm him. He said he complained to the doctors who told him their hands were tied because the nurses were protected by privacy regulations.
But amid Italy’s frustration and the new decree, something seems to be changing. Mr Macciò said the police asked for his help in identifying the nurses he saw when he went to pick up his father’s belongings.
“I hope that something good will come of it,” he said of his father’s death. “These people should change jobs.”
Emma Bubola contributed to the coverage.
