Lorenzin on the diphtheria case in Palermo: “The little girl had already been out of school for eight months. My law did not protect her.”

Diphtheria has claimed a life in Italy once again, for the first time since 1996. In Palermo, an unvaccinated four-year-old girl died just over a week ago. The Italian National Institute of Health has confirmed the presence of the bacterium and the toxin responsible for respiratory diphtheria. The case has reignited the debate on compulsory vaccination and the 2017 law named after Beatrice Lorenzin. Almost ten years on, the former Health Minister and Democratic Party senator defends the framework of that legislation but admits that some aspects need to be amended. Although it is a harsh reality, she says the law has worked, but this has not been enough. It appears that, once it had been established that the requirements were not met, the child had already been excluded from nursery school as early as December 2025. “But the state education system cannot consider its task complete simply by excluding a child from school,” emphasises Lorenzin.

“The first thing I feel is immense pain, both as a mother and as a lawmaker.” Lorenzin begins here, even before addressing the political aspects. A little girl has died from a disease that vaccination can prevent, and “it is hard to accept that in 2026, in Italy, this could still happen”. When the decree – later converted into Law 119 – was introduced in 2017, the stated aim was “to reverse the decline in vaccination coverage and the resurgence of diseases that seemed to be under control”.

However, according to the former minister, the case in Palermo does not prove that the regulation has failed. On the contrary, it forces us to focus on a more specific point: the child was no longer admitted because she had not been vaccinated. The requirement for the 0–6 age group had been applied. “Now we need to understand whether all the mechanisms provided for by the law have been applied. The question,” continues Lorenzin, “then becomes: what happens when the system identifies an unvaccinated child? The school correctly prevents them from attending, but does the non-compliance continue?”

This is where the issue of vaccine bookings comes in, often used as a smokescreen, as a pretext to actually avoid vaccinating children. In 2017, the legislator introduced a provision in Article 3-bis to prevent families who had asked the local health authority (ASL) to vaccinate their child and were awaiting an appointment from being penalised. The rationale “was certainly not to allow people to book an appointment, fail to turn up and then rebook in order to circumvent the obligation”, explains the former minister. “If, in practice, this is how the system has come to function – that is, as a loophole to postpone the vaccine indefinitely – then that loophole must be closed.” Lorenzin therefore proposes “linking the request to a confirmed appointment and a set deadline, recording any failure to attend and triggering the prescribed procedures. A request for vaccination must be the first step towards vaccination, not a loophole to avoid it.” 

The other issue concerns schooling. The Lorenzin Act established a distinction: for children aged between zero and six, vaccination is a prerequisite for access to educational services and nursery school, whilst for those aged between six and sixteen, failure to vaccinate results only in a one-off financial penalty for parents. It was a conscious choice, explains Lorenzin. “From the age of six onwards, however, the constitutional right and duty to education comes into play: we did not consider it fair for a child to lose the right to attend school because of a choice made by their parents. We sought solutions that would strike a balance between two constitutionally guaranteed rights: the right to health and the right to education.”

At the 2017 Council of Ministers meeting, there was also discussion about whether to introduce an automatic link between failure to vaccinate and the loss of parental authority. However, it was decided not to do so: “We felt it was fairer to leave the issue of parental authority out of it. Restricting parental authority must remain an exceptional measure, assessed by the courts on a case-by-case basis. It is a different matter if the courts assess that repeated behaviour on the part of the parents causes serious and concrete harm to the children’s health”.

But who was supposed to check that the vaccinations had actually taken place, and what went wrong in the healthcare system? The tragedy in Palermo also raises the question of oversight. “We cannot simply say that the school failed to check,” Lorenzin adds. Instead, we need to “know exactly what happened: when the non-compliance was identified, what communications took place between the school, the family and the local health authority, how many requests or bookings were made, how many were disregarded, and what measures were taken afterwards”.

For Lorenzin, however, there is an even more important issue. Exclusion from school cannot be the end point of public intervention, just as it is not ‘the aim of the law’, which is instead to ensure that the child is ‘vaccinated and protected’. “This is why I consider the extraordinary checks launched today in Sicily to be necessary, but we must also recognise that monitoring, active outreach, following up with those who are non-compliant and providing information must be standard practices within the public health system.”

Almost ten years on, the former minister goes on to say, she would revise certain measures, but not the structure of the law itself; indeed, she stands by the results achieved. First and foremost, the “rapid recovery of vaccination coverage, which had been declining. In fact, there was an exponential increase in vaccinations”. The former minister then adds that certain measures should be updated in the light of experience, for example the exchange of data between the vaccination register, local health authorities (ASP) and the school system, as well as stricter regulations regarding the link between appointment booking and actual vaccination.

“The case in Palermo shows, however,” concludes Lorenzin, “that being excluded from school obviously does not mean being protected from the disease. And that is why I expect the government to take strong action as well. Faced with the death of a little girl from diphtheria and areas where it is clear that vaccination coverage is insufficient, there can be no institutional silence.”

The lesson that the former minister offers to lawmakers is therefore less ideological than the debate on vaccines often suggests. “What is certain is that without a united institutional commitment, strong political will and the involvement of all stakeholders, legislation alone is not enough to counter the wave of systematic, daily anti-scientific disinformation that has been rife for years.”