Italian medics may be permitted to ration life-saving care under new pandemic plan

This article is more than 1 month old

Health ministry under fire for draft document, the first update to the plan since 2006

Former Italian prime minister Matteo Renzi
Former prime minister Matteo Renzi said that if resources were scarce, Italy should draw on EU funds rather than ration care. Photograph: Fabio Frustaci/EPA

The Italian health ministry has been criticised after a draft of the country’s new pandemic plan revealed medics would be permitted to choose which patients receive life-saving care.

This is the first time Italy has updated its pandemic plan since 2006. The absence of an adequate plan is thought to have contributed to Italy’s coronavirus death toll of more than 79,000.

The draft copy of the pandemic plan for 2021-23, seen by the, stipulates that while health workers are obliged to provide the best and most appropriate care to patients, there are circumstances that may make it necessary to prioritise who to try to save.

Page 25 of the plan reads: “The imbalance between needs and available resources may make it necessary to adopt criteria for triage in access to therapies,” and therefore “scarce resources could be allocated in order to provide necessary preferential treatment to those patients who are most likely to benefit”.

Doctors in Lombardy, the region worst affected by the coronavirus, were forced to prioritise younger patients due to a severe lack of resources at the beginning of the pandemic.

Critics of the draft plan argue that Italy needs to be better prepared so that medics do not need to resort to triage.

Matteo Renzi, the former prime minister who leads Italia Viva, a small party in the ruling coalition, wrote on Twitter: “If resources are scarce, you must choose who to care for. I have a simpler idea. If resources are scarce, we can take from the ESM [European stability mechanism]. What’s not to understand?”

For months, the government has been at loggerheads over the ESM, the EU’s bailout fund, which could be used to help the country’s health system manage the coronavirus pandemic but which one of the coalition partners, the Five Star Movement, has objected to on the grounds that it infringes on Italy’s national sovereignty.

Ettore Rosato, an Italia Viva MP, wrote on Facebook that the possible triage policy was “a huge disgrace for the country”.

A health ministry source told the Italian newspaper Corriere della Sera that the “informal draft” was shared with stakeholders and intended to “collect information and changes”.

Coronavirus deaths in Italy

On page 19 of the plan, the ministry concedes that “the existing plan was edited in 2006 and has been valid until now”.

The outdated plan is a key element in the preliminary investigations being carried out by prosecutors in Bergamo – the Lombardy province hardest hit during the first wave of the pandemic – into possible criminal negligence by authorities. Prosecutors have already questioned the health minister, Roberto Speranza, and are seeking to question Giuseppe Ruocco, the health ministry’s director general of prevention, and his predecessor, Claudio D’Amario.

It was revealed that Italy’s pandemic plan dated back to 2006 in a report led by the World Health Organization (WHO) scientist Francesco Zambon into the country’s initial response to the coronavirus outbreak. It was published on the WHO website on 13 May but taken down the following day. Its removal allegedly came at the request of Ranieri Guerra, the WHO’s assistant director general for strategic initiatives.

Guerra was the director general for preventive health at the Italian health ministry between 2014 and late 2017, and was therefore responsible for updating the pandemic plan in accordance with new guidelines laid out by the WHO and the European Centre for Disease Prevention and Control.