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science. Nearly 480,000 people now follow
him on Facebook—an impressive number in
a country of 60 million. A web page he and
colleagues established to provide general
health information gets more than 100,
visitors per month.
Burioni, with his shock of graying hair,
peaked eyebrows, and ironic smile, appears
often on TV and at public events. His four
recent science books for popular audiences
have become best sellers. The Italian edi-
tion of Forbes magazine named him one of
Italy’s top five internet game changers, and
a former health minister nominated him for
Italy’s gold medal in public health.
Internet prominence brings trolls, and
Burioni has been forced to worry about
security. Some respected health research-
ers and journalists have also been critical,
saying his blunt, even abrasive manner
inflames an already polarized conflict. But
many public health experts credit him with
changing Italy’s debate about vaccination
and elevating the profile of science there.
“I think he’s had a major impact on the
public’s understanding on the topic of vac-
cinations and science in general,” says Pier
Luigi Lopalco, who studies epidemiology
and public health at the University of Pisa.
“He’s re-established the right of scientists to
speak directly to the people without having
a DJ or actor intervene.”
BURIONI MIGHT seem an unlikely media per-
sonality. He followed a rigorous academic
track: a medical degree in Rome; a Ph.D.
in microbiology in Geneva, and several
years of postdoctoral research at the U.S.
Centers for Disease Control and Preven-
tion, the University of Pennsylvania, the
University of California, San Diego, and
the Scripps Research Institute. As a profes-
sor in Milan, he develops monoclonal anti-
body therapies for herpes, hepatitis C, and
other viral diseases—work that has led to
30 international patents.
He made his first foray into social media
in 2015, when a friend who had created a
Facebook group for mothers asked him to
write an explainer about vaccines. Burioni,
already irked by Italy’s growing antivaccine
movement, agreed. “I felt it was my duty to
do something as a doctor and a professor
and as a father of an 8-year-old daughter.” He
worried that the push to resist vaccinations
could put her and her classmates at risk.
He posted a five-point rebuttal of popular
vaccine misconceptions and conspiracy the-
ories—including the notion that drug compa-
nies promote vaccination in order to increase
profits. “Pharmaceutical houses earn much
more from disease cures than from vaccines,”
he declared. “So if you don’t vaccinate your
children, the pharmaceutical multinationals
will be sincerely grateful to you.”
That post and others hit a nerve. Within
weeks his social media followers grew from
about 100 to six digits. A voice like Burioni’s—
that of an expert who sees no reason to
mince words or suffer fools—was evidently
what many Italians were looking for.
As in many Western nations, concern
about vaccines had surged in Italy in the late1990s after U.K. doctor Andrew Wakefield
published his now notorious study in The
Lancet linking autism to the measles,
mumps, and rubella (MMR) vaccine. The
study was later shown to be fraudulent, and
Wakefield lost his medical license. But that
didn’t stop him from continuing to prosely-
tize against vaccines or prevent vaccine op-
ponents from embracing his study.
The Italian government insisted vaccines
were safe, but a series of medical scandals
had damaged its credibility. The most re-
cent involved an experimental treatment
called Stamina therapy, developed by an
entrepreneur who claimed to be able to re-
generate nerves from stem cells and cure
conditions such as Parkinson’s disease and
muscular dystrophy. The inventor, Davide
Vannoni, received huge fees from desper-
ate patients, despite having produced no
clinical studies or peer-reviewed papers.
Scientist denounced the treatment, and the
Italian Medicines Agency ruled it unsafe.
But the Italian Senate, bowing to public
opinion, permitted doctors and hospitals to
administer it and funded a nearly $4 mil-
lion clinical trial that was never completed.
Stamina therapy was finally outlawed
in 2014, and Vannoni received a 22-month
suspended sentence for fraud. (He died in
December 2019.) Later, it was revealed that
Italy’s current prime minister, attorney
Giuseppe Conte, won a court case in 2013
that allowed Stamina therapy to be given
to a girl suffering from an incurable neuro-
logical condition. The child later died.
Courts in Italy have compounded the
problem. Local judges often lack scientific
expertise and are allowed pick their own
consultants on technical matters. In one
egregious case in 2012, a judge in Rimini
relied on Wakefield’s discredited research
to award the family of an autistic boy morethan $200,000 from the government, on the
grounds that the measles vaccine distrib-
uted by the national health service caused
his condition. News of the decision spread
on the internet like a contagion, igniting
false beliefs and conspiracy theories. “The
year 2012 was identified as the breaking
point in the public’s confidence in vaccina-
tion in Italy,” researchers at the University
of Pisa wrote in a study of the web’s effect
on vaccinations. An appeals court reversed
that judge’s decision in 2015, but the dam-
age was done.
Antivaccination sentiment infected not
only the courts, but also entertainment and
politics. In the late 1990s, for example, a
comedian named Beppe Grillo had become
famous in Italy for denouncing vaccination.
Ten years ago, he co-founded the Five Star
Movement, a libertarian political party that
became a dominant member of Italy’s ruling
coalition and embraced antiscience positions.
Vaccination rates, which had been climb-
ing since the 1990s, started to slide. Uptake
of the MMR vaccine declined from a peak
of nearly 94% in 2010 to just over 85% in
2015—one of the lowest rates in Europe,
and well below the 95% needed for herd
immunity. Almost in lockstep, the nation’s
measles rate climbed to the second highest
in Europe, after Romania’s.THAT WAS THE SITUATION Burioni waded
into when he made his appearance on Ital-
ian TV. He’d never been on TV before, and
when the network called he assumed he’d
be speaking to other medical experts. He
was shocked to find that he’d be sharing the
broadcast with two people who knew noth-
ing about vaccines. Hence his curt reply,
and the public’s enthusiastic response.
As he saw it, a door had opened and he
had to walk through it. The public seemed
hungry for straight talk from an expert,
and he obliged. “I realized that the lan-
guage of social media needs to be differ-
ent than the language used in conferences,
with colleagues or even with patients,” he
says, “so I tried to use not a single diffi-
cult word.” He turned instead to concrete,
nonmedical metaphors in his Facebook
and Twitter postings. “Does an aircraft en-
gineer take a vote among the passengers
as to how many wheels to put on an air-
plane?” he asked. “No—the engineer is the
expert, he’s trained for this job, and it’s his
job to decide.”
When one of the largest publishers in It-
aly asked him to write a book on vaccines,
Burioni cranked it out in 4 months. A night
owl, he wrote after his wife and daughter
went to bed. “I never realized that I was good
at writing,” he says. “Here I was at 54 years
old; how would you say it—a late bloomer?”Roberto Burioni had never appeared on TV before
a 2016 appearance catapulted him to fame.
“He’s the one scientist
who stood up and
said, ‘This is bullshit.’”
Guido Silvestri, Emory University3 JANUARY 2020 • VOL 367 ISSUE 6473 17
Published by AAAS