Italian MMR Autism Decision Overturned

This article reviews a recent ruling from an Italian Court of Appeals that overturns a widely ridiculed decision by a Provincial Court in 2012 that claimed that the MMR vaccine (for measlesmumps and rubella) causes autism. Apparently, that court rejected all other science, and only accepted the fraudulent work of MrAndy Wakefield to validate the claims about the vaccine and autism. The Italian MMR autism decision has started to return as a zombie trope. Probably as a result of the kerfuffle about the anti-vaccine propaganda movie, Vaxxed. 

In June 2012, a provincial court in Rimini, Italy granted compensation to the family of a child named Valentino Bocca. The family alleged that the MMR vaccine Valentino received as part of his childhood immunizations caused his autism, and the court compensated them on that theory. The lower court’s decision was never on very firm grounds: it depended in part on testimony of an expert witness who relied, in turn, on Andrew Wakefield’s debunked study. Unfortunately, this Italian MMR autism decision has been used by anti-vaccine activists as part of their claims that vaccines cause autism.

The Italian MMR autism court decision

On February 13, 2015,  a Court of Appeals in Bologna overturned the decision–a decision that apparently led to a decline in MMR immunization rates in Romagna, an historical district of Italy.

The Court of Appeal accepted the appeal filed by the Ministry of Health (ministero della Sanità). The expert appointed by the court of appeal highlighted that there is no scientific evidence supporting an MMR autism link. The expert highlighted that the lower court expert was wrong to rely on the study by Andrew Wakefield, a study debunked and rejected by the scientific community.

The expert also highlighted that while there is some temporal link between Valentino’s MMR vaccine and autism, in the sense that the diagnosis of autism followed the vaccine, the temporal connection was not strong and does not itself support a causal connection.

The expert, Dr. Lodi, stated that “In the medical history of the child there is not an objective temporal correlation between the gradual emergence of autistic disorders and the MMR vaccine, there is only the fact that the two events occur one before the other, but as shown, this is not sufficient to relate the two events .”

The Bocca’s lawyer, Luca Ventaloro, claimed that he will appeal to the Supreme Court of Cassation (Corte Suprema di Cassazione), the highest court in Italy. He based his intention to appeal on a claim that the expert ignored the latest studies, and highlighted that he is in touch with Andrew Wakefield. There are three problems with that claim:

  1. As far as I know, there are no credible studies, recent or otherwise, that actually support a link between vaccines and autism. There are some fatally flawed published studies, for example, Dr. Hooker’s retracted study, or Dr. Theresa Deisher’s problematic work (also discussed here, here, and here).
  2. There are several recent large scale reviews that highlight the lack of such a link (also discussed here and here).
  3. Andrew Wakefield is not a reliable source on anything related to vaccines, given his history. He has a history of serious ethical violations, of research fraud, of misrepresenting evidence in his self-justificatory book (pdf), Callous Disregard, and in his complaint to the Office of Research Integrity in the CDC, in connection with the so-called #CDCwhistleblower manufactroversy.

In short, the lawyer’s claims have no basis.

Furthermore, appeals to the Court of Cassation cannot be taken on matters of fact, only on matters of law. The claim of ignoring studies seems like a matter of fact–that is, the court got its fact wrong. This should not, on its face, be good grounds for appeal.

While Ventaloro, attorney for the plaintiffs, said he’s optimistic, I expect – and hope – that his optimism, based on such an unfounded set of facts and weak legal basis is misplaced, and that the Court of Cassation will do the right thing, follow the science and uphold the Court of Appeal’s decision. Science shows there is no link between vaccines and autism. On scientific questions, courts should follow the science.



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Dorit Rubinstein Reiss
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.