When his daughter Angela was gravely ill, Nicola Pomaro made her a solemn promise: If she recovered, he would do all he could to help her live life to the full.
Angela was just 3 years old when she was diagnosed with aplastic anemia, a rare blood disorder that meant her body could not produce enough red blood cells. It left her needing a bone marrow transplant.
But when Angela got better and developed a love of dance Pomaro, from Padua in northeastern Italy, was faced with a dilemma: How to find a ballet school where she would be safe from disease in a country which had one of the highest rates of measles in the world in 2017, according to the World Health Organization.
Like thousands of other transplant recipients in Italy, Angela, has little or no immunity. Going about her daily life can be a gamble.
Public places like trains, airplanes, shopping malls and cinemas are all out of bounds for the 7-year-old.
Northeastern Italy has been a hotbed of the anti-vaccine movement since a judge in Rimini ruled in 2012 that the combined measles, mumps and rubella vaccine, known as MMR, caused autism.
Claims of a link between MMR and autism — first suggested by disgraced former doctor Andrew Wakefield in a since-retracted 1998 study — have been widely discredited.
The Rimini judge’s ruling was overturned three years later, but by then it had encouraged the spread of anti-vaccine theories in Italy and around the world.
Safe, but secluded
For Angela, the risk in her region was so great that she lived in virtual seclusion for two years, unable to attend school and seeing just one vaccinated playmate and her former kindergarten teacher.
Even her elder brother Pietro, now 18, had to be sent away to stay with his grandparents every time he had the slightest cold.
Two years ago, Angela’s life began to change, after Italy’s previous government made vaccinations mandatory by excluding non-immunized children from schools. Since then, the incidence of measles has halved and vaccination coverage among the whole population has improved to 92%.
It has not yet reached the 95% needed to ensure “herd immunity” required to protect people with impaired immune systems, like Angela.
But now, with populist parties the League and the Five Star Movement — both of which have embraced anti-vaccine sentiment — in power, the brief freedom Angela has gained is under threat once more.
“Being sociable, Angela really suffered being isolated from her friends for so long,” says Pomaro, 53.
“She began to fall behind in terms of her development and schooling and so eventually, as a family, we were advised to start taking some risks for her benefit, ” he says. “It would be a great shame to go back and erase the small gains that have been made.”
Just a year after its introduction, Italy’s mandatory vaccination program has already been watered down, allowing parents of children Angela’s age to pay a fine, or to self-certify that their offspring have been immunized, even if they have not.
Matteo Salvini, Italy’s deputy prime minister and the head of the League party, has hinted he may reverse the policy altogether, in order to prioritize school attendance instead.
To preempt such a move, Pomaro and his wife Federica enrolled Angela in a school that mostly serves the children of migrants. The population is much maligned by Salvini, but they are statistically more likely to take up their shots.
High-income, low trust
Though vulnerable to anti-establishment rhetoric thanks to years of dysfunctional government, Italy is not alone in finding a growing number of its citizens questioning crucial public health initiatives.
A survey by UK medical charity the Wellcome Trust found that inhabitants of high-income countries have the lowest confidence that vaccines are safe, with 20% of Europeans reporting that they were unsure about their risks, compared to their benefits.
One of those is Loris Mazzorato, 55. Like Pomaro, he too is a father of young children — his daughter Anita, 8, is just a year older than Angela. The families live a half-hour’s drive from each other, but on the subject of vaccines, they are worlds apart.
A former League party mayor of the town of Resana, Mazzorato once used his public office to lobby parents not to immunize their children when he registered their births, sending their certificates back accompanied by 25 pages of anti-vaccine propaganda.
Armed with little more than a high school diploma — and no scientific background — Mazzorato has emerged as one of the most vocal proponents of an anti-vaccine movement that now encompasses an estimated 1% of Italy’s population.
He travels the country giving speeches, with placards strapped to his children’s stroller. He has even draped banners proclaiming his anti-vaccine message from the balcony of his home.
‘It’s like being in a war’
For Mazzorato, it is as much about protecting his children’s bodies from the harmful substances he believes are inside the vaccines as it is fighting for his rights as a parent against what he views as an encroaching government.
“It’s like being in a war. Either you shoot first or you get shot,” he says. “It’s about freedom of choice. Each parent should have the right to choose what is right for their child and what is wrong.
“Besides,” he adds, “getting sick makes you stronger, and we live in a developed country where these risks aren’t there anymore.”
Measles can be a dangerous illness, leading to serious complications and hospitalization. One to three out of 1,000 people with measles will die, even with high quality health care, according to the US Centers for Disease Control and Prevention.
As his second daughter, Illaria, 2, prepares to enter nursery school without vaccinations in the fall, he says he will home school her if she is excluded.
When asked about the risk his family’s decisions pose for those in Angela’s situation, Mazzorato, who does not believe in herd immunity, is unapologetic, asking why he should inject his children with what he sees as “potentially harmful substances.”
For all Mazzorato’s heartfelt beliefs, the numbers tell a different story: Italy has seen almost 900 cases of measles so far this year. In 2018, there were more than 2,600, according to the World Health Organization.
The WHO has labeled resistance to vaccines one of the biggest risks to global public health in 2019.
For another father at the forefront of the struggle, speaking out against the threat of deadly disease has resulted in the threat of death — for him and for his daughter, Caterina, 8.
As a professor of microbiology at Milan’s Vita-Salute San Raffaele University, Roberto Burioni, 56, says he also became “mobilized” when Caterina reached school age.
“I realised how much disinformation there was out there and felt really, as a father, as a doctor, I had to do something about it,” he says.
Burioni says the decision by populist politicians to fan the flames of anti-vaccination sentiment is “really unfortunate.”
“Health, treatments or preventions should not be something which is left or right,” he says. “If you find a cure for a disease it is for everybody. And I think it is very bad that somebody is taking political stances on these issues where the safety of the whole community is at stake.”
Burioni wrote a book, called “Deadly Lies,” and has campaigned heavily for mandatory vaccinations, amassing almost a half-million followers on Facebook. But his work has also attracted negative attention; he was sent pictures of guns and bullets with his wife and daughter’s name on them via Twitter.
“It has been really unpleasant,” he says. “All I am trying to do is to tell people, as a scientist, that two plus two equals four.
“We have a really dramatic situation in Italy. In a country like this, how many cases should there be? Zero, because people should be vaccinated, it’s as simple as that.”
Freedom from disease
Angela’s father has managed to recreate that perfect world free from disease for his daughter, for now at least.
After months of searching, he has found a dance teacher willing to create a special class just for her, filled with other children who have all been vaccinated.
So what is Pomaro’s message for parents with doubts about the safety of vaccines?
“Think about children like Angela, ” he says. “They have been through so much and survived, only to suffer once more for the sake of superstition.
“I wish I could vaccinate her … but I can’t.”