“Consider delaying the start of school in Sicily; Meloni should intervene to recommend vaccinations,” infectious disease specialist Bassetti says on the diphtheria case: “Ensure compliance with the rules” A delay in the start of the school year to ensure a safe school year. The proposal and reflection come after the death from diphtheria of…
“Consider delaying the start of school in Sicily; Meloni should intervene to recommend vaccinations,” infectious disease specialist Bassetti says on the diphtheria case: “Ensure compliance with the rules”
A delay in the start of the school year to ensure a safe school year. The proposal and reflection, following the death of a young girl from diphtheria in Palermo, comes from infectious disease specialist Matteo Bassetti, who has for years been at the forefront of efforts to raise awareness of the safety and necessity of vaccines. “I believe that, in light of the vaccination coverage situation in Sicily, it would be reasonable to consider a short delay in the start of classes, at least in primary schools, to allow health authorities to thoroughly verify the vaccination status of enrolled students and, where necessary, complete catch-up vaccination programs. This is not a position ‘against’ anyone, but a matter of public health and prevention,” explains the director of the Infectious Diseases Department at the Policlinico San Martino in Genoa. “It would be important to verify, person by person, that the required vaccines have actually been administered, rather than relying solely on aggregated data or self-certifications.”
In Bassetti’s view, the issue does not concern only individual students. “With the start of the new school year, it would be important to remember one simple thing: a school is also a health community, where thousands of children and young people share the same spaces every day.” Hence the idea that, before students enter the classroom, it is necessary to know precisely the vaccination status of those who make up that community. “Not to blame parents, but to ensure that the rules are applied and that no one is left unprotected simply because of bureaucratic inertia,” Bassetti stresses, calling for verification not to rely solely on self-certification.
The reasoning inevitably extends to the very role of vaccinations within the community. “Vaccinations recommended for children and adolescents serve to protect not only the individual child, but also the community, especially those who cannot be vaccinated for medical reasons. Diseases such as measles and diphtheria do not belong to the distant past: when vaccination coverage declines, the risk of outbreaks becomes real again.” Bassetti therefore calls for political responsibility as well: “I would like to hear a strong voice on this issue from the Prime Minister, the Minister of Education, and the Minister of Health, jointly recommending that Italians vaccinate their children.”
As is well known, during the COVID-19 pandemic, Prime Minister Giorgia Meloni stated and “asserted” that she would not have her daughter Ginevra vaccinated. This position was accompanied by calls from the scientific community for greater clarity. Unlike vaccines developed to prevent COVID-19, which were designed and made available within a year, vaccines against other diseases have been used for years and have helped contain or even eradicate severe and, in some cases, fatal diseases.
“We should focus our efforts on the hesitant; not all are anti-vaxxers”
But the problem of insufficient vaccination coverage cannot be addressed by treating all parents who have not vaccinated their children as belonging to the same category. Tito Barbagiovanni, regional secretary of the Italian Federation of Pediatricians, identifies a group of hesitant or simply inattentive families for whom, precisely when a risk is perceived as real, information can still make a difference. “Not all people who do not vaccinate their children are genuine anti-vaxxers,” Barbagiovanni explains. “There is a world between those who get vaccinated and those who will never get vaccinated. A large group that accounts for more than 5% of the total, out of the approximately 15% of unvaccinated children in Sicily.”
These are, he continues, “people who are busy with all sorts of other things and who may then be swayed by some denialist voices circulating in the environments they frequent.” For these parents, the Palermo tragedy may represent a turning point: “For these ‘distracted’ parents, the tragedy of the girl who died in Palermo was a wake-up call, so they are now rushing to get their children vaccinated as soon as possible, driven by fear.” This distinction is also important in terms of public health strategies. While some parents are radically opposed to vaccination, others can be reached through information, reminders, and simpler interventions: reminding them of a deadline, facilitating an appointment, checking whether a dose is missing, or explaining the risk.
“The hesitant and the distracted,” Barbagiovanni reiterates, “represent a significant proportion of the unvaccinated population toward whom we are directing our efforts to increase acceptance of immunization.” He adds: “The diehards are not very numerous, but they make a lot of noise because they are active on social media, always present, and use slogans. But there is also a group of people who are uncertain, and in cases of concrete danger such as this one, they rush to get vaccinated.”
For pediatricians, the goal is to reach precisely these people before another case occurs. “The Palermo case was terrible, but I believe we have a duty to harness this fear and direct it in the right direction to finally address the delay in vaccination coverage that genuinely exists in Sicily.” Barbagiovanni explicitly links this reflection to the child’s death: “Anna Rosa’s sacrifice must not be in vain; it must help save everyone else, not only from diphtheria, but also from measles and the other diseases that vaccines prevent.”
Monitoring, catching up, taking responsibility
The debate thus shifts from vaccination uptake alone to the health system’s ability to know who is vaccinated, who is not, and why. Barbagiovanni will also bring several operational proposals to the regional meeting with Sicily’s Health Councillor Marcello Caruso: including vaccination records on medical certificates for sports activities and requiring pediatricians to report repeated refusal after parents have been properly informed. “We want to contribute,” Barbagiovanni explains, “with some practical ideas to combat missed vaccinations and the serious consequences that can result from them.”
According to the pediatrician, including vaccination records on sports certificates would also serve a cultural purpose: “It would in some way reaffirm that when an unvaccinated person enters a community, they can put the health of others at risk. And therefore, whoever controls entry into a community—whether sporting or educational—must do so with a certain degree of care.” The other proposal concerns the role of pediatricians. “Another recommendation is to strengthen the role of pediatricians,” Barbagiovanni says, “who to date have not been systematically involved by the regional vaccination system, in order to increase our ability to address vaccine hesitancy.”
According to Barbagiovanni, the region already has the information needed to determine vaccination status: “In practice, the region already knows who is vaccinated and who is not; you just have to press a button and access the data.” The problem, therefore, would also be to turn administrative data into individual healthcare action, giving pediatricians a more active role in identifying unvaccinated children and engaging with their families.
“In practice, under my proposal, the pediatrician should officially issue an additional communication confirming that repeated and detailed information has been provided on the issue, but that the response was negative. This could help promote a more conscious assumption of responsibility for any refusal.”
School as the final link in a chain of prevention
The proposal to delay the start of classes therefore forms part of a broader approach: rather than waiting for an emergency to check vaccination coverage, use the data already available to intervene beforehand. The short delay proposed by Bassetti would serve precisely this purpose: turning a handful of days into an operational window for checks and catch-up vaccinations. The infectious disease specialist makes the principle explicit: “A vaccination appointment or a self-certification should not become a way of indefinitely postponing vaccination. We need precise, consistent, and timely checks, together with a system that facilitates catch-up vaccinations and provides families with accurate information.” And his conclusion points in the same direction: “Prevention works when it is concrete: vaccinate, verify, and intervene before a case becomes an epidemic. The health of children and the school community deserves seriousness, not shortcuts.”
Barbagiovanni also urges that the attention generated by the case not be allowed to fade: “The tragic case of the girl from Palermo is a wake-up call. We must not allow the attention—and the fear—it has generated to go to waste. It must become the driving force for bringing vaccination coverage in the region up to the appropriate levels.”
Meanwhile, the legal proceedings also remain ongoing. The autopsy of the girl, initially scheduled for Wednesday, has been postponed. Following the criminal complaint filed by the parents against the three hospitals that treated the child, the number of people under investigation could expand to include the doctors formally named in the complaint.
