Legitimising a ‘zombie idea’: childhood vaccines and autism – the complex tale of two judgments on vaccine injury in Italy

Abstract

The impact of ‘bad’ science on judicial decision-making is a thorny aspect of the relationship between science and law. This study employs doctrinal and empirical analysis to explore two Italian judgments that asserted a causal link between childhood vaccines and autism. Using a combination of actor–network theory and legal pragmatism, we uncovered a network of actors and institutions internal and external to the legal system enabling these impactful decisions that went on to contribute to a crisis in vaccination coverage in Italy. These include trial strategies, resources, communication practices between arms of government, awareness and responsiveness of institutional actors, and institutional mechanisms governing the integration of scientific expertise into the legal process. By forensically analysing how a ‘zombie idea’ received a patent of legitimacy in the Italian context, this study provides useful lessons for legal systems grappling with complex and contested public health matters.

Giving Bad Science the Stamp of Approval: Policy and Legal Consequences of a Vaccine Scare in Italy

“…When the case moved to a hearing, the government lawyers did not attend. The court-appointed expert supported the plaintiff’s claim, referring to Wakefield’s paper 2 years after its retraction [ 1 , 5 ].…”

“…There has never been suggestion of an autism link with this vaccine. Here, the State Attorney failed to back their defence with expert testimony, and the court-appointed expert found the vaccine to be the most probable cause of the child’s autism [ 1 ].…”

“…The Rimini and Milan court cases illustrate several problems within Italy’s legal and administrative systems that may pose similar risks elsewhere. These include ineffective communication between responsible ministers and their lawyers, a lack of resources and staffing, and insufficient awareness amongst government stakeholders of the sensitivity of public health issues [ 1 ].…”

Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates

“…A judge in the Trani region led an investigation into this spurious link, generating more bad publicity. 61 , 62 These challenges to vaccine confidence were exacerbated by the Fluad scare, in which deaths of elderly Italians were incorrectly linked to receipt of influenza vaccine. 63 Vaccination rates plummeted, especially the non-mandatory MMR (measles, mumps, and rubella) vaccine, which fell from 90% coverage in 2010 to 85% in 2015.…”

“…In 2016, the Emilia Romagna region introduced a new law for the four vaccines that were still ostensibly mandatory, denying unvaccinated children access to early (non-compulsory) education. 62 , 64 Regional officials were prompted by falling coverage rates, outbreaks of whooping cough resulting in infant death, a parent advocacy group called “Vaccination in the Nursery,” and supportive local public health bureaucrats (ITE-ER, Venturi, personal communication). Although the new mandate did not include pertussis (whooping cough), this antigen is combined with the mandatory antigens.…”