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Italy’s health minister fires country’s top health board

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5158 (Published 05 December 2018) Cite this as: BMJ 2018;363:k5158
  1. Owen Dyer
  1. Montreal

Italy’s health minister, Giulia Grillo, has fired all 30 independent members of the country’s Superior Health Board, a body set up to advise the government on all aspects of public health, explaining that she wished to send a “signal of discontinuity.”

Although incoming governments have occasionally changed a few staff on the council, such wholesale dismissal is unprecedented. The current board was appointed last year and was supposed to remain in place until 2020. It was unchanged from the previous three year term, which began in 2014.

“I decided to give a signal of discontinuity with respect to the past by renewing the composition of the 30 members,” wrote the health minister, a member of the ruling coalition’s Five Star Movement, on her Facebook page. “We are the #governmentofchange and, as I have already done for other appointments to ministry committees, I have chosen to open the doors to other deserving personalities. It is time to give space to the new.”

Twenty six seats on the council are reserved for employees of government ministries, and those members keep their places. But those dismissed include some of the biggest names in Italian medicine, including the geneticists Bruno Dallapiccola and Giuseppe Novelli, the gynaecologist Giovanni Scambia, and the oncologist Napoleone Ferrara.

The dismissed president of the council, Roberta Siliquini, said that members learnt that their services were no longer needed from a brief letter that arrived on the same day as the public announcement on Facebook.

“I would like to thank extraordinary colleagues and excellent scientists who for four years have worked hard, with rigour and competence, and free of charge for the country,” said Siliquini, a specialist in public health and infectious diseases. “I see no scientific reason for the decision.”

She said that Grillo had never consulted the council, which has historically tackled issues as diverse as hospital design and marijuana legalisation. “It would have been a courtesy to meet us at least once since taking office—that is six months ago—but we have never seen the minister,” she told the newspaper La Repubblica.

The dismissals come amid concern that the new government is suppressing scientific opinion that is not in line with its priorities and using the resulting vacancies to reward supporters. Last month most of the committee that picks the heads of public research institutes resigned, after the government unexpectedly fired the head of the Italian Space Agency.

The Five Star Movement, which governs Italy in a coalition with the far right League party led by Matteo Salvini, as well as Silvio Berlusconi’s Forza Italia and four smaller parties, has a history of taking populist positions on health issues, including vaccine scepticism.

In 2015 the party proposed a law against vaccinations, citing “the link between vaccinations and specific illnesses such as leukaemia, poisoning, inflammation, immunodepression, inheritable genetic mutations, cancer, autism, and allergies.”

In the last election the party’s leader, Luigi di Maio, campaigned on a platform of reducing the number of childhood vaccinations. The founder of the Five Star Movement, the comedian Beppe Grillo, frequently comments on health matters through his popular blog and has written that many vaccines are as dangerous as the diseases they target.

In 2013 the Five Star Movement’s first major public campaign condemned the medical establishment for preventing parents from accessing a controversial stem cell therapy called Stamina, which was claimed to cure degenerative diseases. The treatment was later shown to be a scam, and the psychologist offering it, Davide Vannoni, was convicted of conspiracy and fraud.

Giuseppe Conte, the lawyer who represented the families seeking access to Stamina, is now prime minister of Italy.

Last year the health minister of the previous government, Beatrice Lorenzin, a physician and leader of a small left wing party, imposed mandatory school reporting of childhood vaccinations. The rule came in response to a measles outbreak of 4885 cases in Italy in 2017.

The new health minister, Giulia Grillo, reversed that rule in June, saying that parents could “self report” vaccination instead of providing a doctor’s note. She then changed course as measles surged again last month, enforcing the vaccine obligation and calling for 800 000 more children to be immunised.

Grillo, who is not related to the movement’s founder, Beppe Grillo, is herself a physician and has said that she supports vaccination but believes that it needs to be better explained to the public.

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