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By Ciara Nugent and Jamie Ducharme
August 8, 2018

Italy’s parliament shocked the scientific community on Tuesday by voting to lift a legal requirement that parents vaccinate their children before sending them to pre-school. The move, driven by Italy’s new populist coalition government, has been widely criticized by doctors, who say vaccinations are essential to avoiding outbreaks of serious diseases like measles.

Here’s what to know about the Italian government’s decision:

What did the Italian government do with vaccines?

Italian lawmakers in the upper house of parliament voted 148 to 110 to amend a law that required children under the age of 6 to undergo 10 routine vaccinations before enrolling in nurseries and pre-school.

The law was introduced last year under the Democratic Party government during an outbreak of measles that saw the number of cases in Italy hit 5,004 in 2017 – up from 870 the year before. That gave Italy the second highest number of measles cases in Europe, after Romania. In response, lawmakers made it mandatory last July to vaccinate for measles, mumps, rubella, chicken pox and meningitis – all of which were previously only recommended.

Why the U-turn on vaccines in Italy?

Rightwing party the League and the leftwing populist Five Star Movement were both staunchly against the law that required vaccinations when it was introduced and campaigned on scrapping it ahead of elections in March.

The anti-vax vote is significant in Italy, with widespread distrust of vaccinations dating back to a later debunked and retracted 1998 study that claimed to show a link between the measles, mumps and rubella (MMR) vaccine and autism. As late as 2012, a court in Italy ruled that a child’s autism had been caused by the MMR vaccine, fueling the anti-vaccination movement. That ruling was overturned in 2015, but its effect seems to linger: A 2017 study of Italian internet habits between 2010 and 2015 found a connection between search and social media activity around the MMR vaccine and lower vaccination rates.

After the Five Star Movement and the League formed a coalition government in May, Interior Minister Matteo Salvini said that the 10 mandatory vaccines were “useless and in many cases dangerous, if not harmful.”

Health Minister Giulia Grillo says requiring 10 vaccines threatens “school inclusion” and that the government want to “simplify rules for parents.”

Why are vaccines important for public health?

Vaccines create immunity by introducing a weakened version of a disease into the body, prompting the immune system to respond with germ-fighting antibodies. These antibodies stay in the body, ready to respond to active versions of the disease and stave off future infections.

Widespread vaccination creates an effect called “herd immunity.” If most people in a population are protected from a disease, the thinking goes, it will not spread as extensively from person to person, reducing the entire community’s likelihood of getting sick.

The World Health Organization (WHO) says 93% to 95% of a population must be vaccinated to produce herd immunity against diseases such as measles. Italy’s pediatric measles vaccination rate has traditionally lagged far behind that goal, hovering around 85% for the first dose and 83% for the second dose as of 2015, according to WHO data. By 2017, the year the mandatory vaccine law took effect, that number was up to 92% for the first dose and 86% for the second dose.

What was the response to the vote?

Opposition politicians were quick to condemn the move. Stefano Bonaccini, a Democratic Party member and governor of wealthy northern region Emilia Romagna, said the move was a “surrender to the no-vaccination lobby” that “sends us right back to the Middle Ages.”

Antonio Saitta, a health coordinator for Italy’s federation of regions, told local media the amendment was “a step backwards.” “Vaccines are not a bureaucratic imposition but the best method of prevention,” he said.

What’s next for vaccines in Italy?

The amendment still needs to be approved by the lower house, which can’t happen until after Italy’s parliamentary recess. That means it won’t come into force before the new school year.

If the amendment does pass, it will suspend the vaccine requirements for one year, during which time the government plans to introduce more permanent legislation to give Italians freedom of choice on vaccines.

Write to Ciara Nugent at ciara.nugent@time.com and Jamie Ducharme at jamie.ducharme@time.com.

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