The Ministry of Health issued guidelines for the monkeypox vaccination strategy on 5 August. In this document, we read that, considering “the current epidemic scenario” and the “limited availability of doses”, the vaccine will initially be reserved for some “first high-risk categories”, including “Gay, transgender, bisexual and other men who have sex with men (MSM)” who carry out a non-monogamous sexual activity, or are in one of the following conditions: “I) recent history (last 3 months) with multiple sexual partners; and / or ii) participation in group sex events; and / or iii) participation in sexual encounters in local / club / cruising / saunas; and / or iv) recent sexually transmitted infection (at least one episode in the past year); and / or v) habit of the practice of associating sexual acts with the consumption of chemical drugs (Chemsex)”.
To get vaccinated, you must send an email to the Spallanzani Institute indicating your willingness to receive the vaccine and your belonging to a risk category mentioned above. Risks to privacy and the protection of personal data are just around the corner. The stigma towards LGBTQIA + people is still very present in our country and could easily add to the stigma towards people who have greater sexual freedom and the stigma towards the “greaser”, which we have learned to observe in recent years. pandemic.
Just a few years ago, a survey showed that the stigma against sexual freedom is still very present in our country: only 25% of respondents considered sex as a free act, regardless of stable romantic relationships. The sad story of AIDS at the end of the last century has taught us how much the “sex shaming”And homophobia can dangerously join forces in stigmatizing gay people, especially if they live a casual sex life.
Monkeypox seems to revive the nightmare of the “gay disease”, in a world that has learned to deal with anti-pandemic programs and emergency vaccination plans, but also in a world where we are our personal data and where our digital traces are a bargaining chip and a source of profiling, discrimination and personalized advertising in the digital market. The question therefore seems obvious: is it necessary, safe and far-sighted (even before legal) to limit access to the vaccine to a specific category, especially if so vulnerable to discrimination and stigma (“gay, transgender, bisexual and other men who have sexual with men “who have a free and non-monogamous sex life)? And is it wise to reduce everything to an e-mail booking in which you self-declare yourself a member of one of those risk categories?
From an epidemiological point of view, it may be justified to limit vaccination to specific vulnerable categories, due to the limited availability of doses and the need to rapidly reduce the spread, acting directly on groups that statistically are the most affected by the epidemic. However, it must be asked whether the modalities of the vaccination campaign can amplify the existing stigma towards those social categories – even considering that monkeypox is not a sexually transmitted disease – and whether such modalities are respectful of the laws on privacy and protection. some data.
The European Data Protection Regulation (“GDPR”) considers sensitive data (“special categories of data”) – among others – all data concerning sexual orientation, sexual life and health status. The processing of such data can only be done in one of the few and specific cases provided for by law (including public health and the prevention of epidemics), adopting specific additional security measures, which are parameterized to the risks assessed in practice, and in compliance with the principles of necessity and proportionality.
In this case, being a vaccinable subject for monkeypox in Italy seems to be a “triple” sensitive datum, because it is a datum that reveals at the same time, with a good approximation, both sexual orientation or sexual identity (gay, bisexual, transgender), both sexual life (having free sex, in clubs, chemsex, etc.), and the risks on the health of the subject vaccinated or to be vaccinated.
Legal commentators have long wondered about “quasi-sensitive” data, that is, data which, while not strictly relating to the state of health or sexual orientation, etc., can indirectly lead to the disclosure of sensitive information, if anything through other statistical or personal data. Just a week ago, the Court of Justice of the European Union issued a ruling in which it stated that the information they can even if only indirectly leading to the disclosure of data on the subject’s sexual orientation and sexual life are to be considered sensitive data.
In this case, in reality, we would be in the opposite extreme: we are dealing with “super-sensitive” data, that is, data that alone can directly reveal at least three sensitive aspects of the subject in question. Based on the risk level approach, it is necessary to ask whether this “triple” sensitivity of the data in question actually leads to a “triple” risk for the fundamental rights of the subject in the event that these data are collected and processed. The risks are, in fact, multiple and complex: just think of the risk of discrimination and stigmatization in the event that the vaccine booking email – a normal email, without special anonymization measures – is the victim of a data breach (data breach) and these “super-sensitive” data are disseminated. Not to mention the cascading effects: negative effects on the workplace (up to the dismissal of the “gay libertine”); price discrimination by services of e-commerce o insurance (eg, life insurance that can raise prices for those at risk); negative effects in the family (think of people who have not declared their sexual orientation or their sex life to family members); up to the psychological consequences derived on the subject (including the risk of suicide).
This wide range of risks makes us understand that, even if on a political-health level it is justified to reserve vaccination for gay, bisexual and transgender subjects who have an active and free sex life, the “proportionality” of the methods of the current vaccination campaign it is at least doubtful. And the problems are not reduced only to the level of privacy legislation, but also extend to the wider political-social impact that derives from putting pen to paper the existence of an “epidemic of gay libertines”.
What alternatives would the Ministry have for respecting the principle of proportionality? Probably “recommend” the vaccine to those categories most at risk, but refer the decision to a vaccinator who, after a physical meeting and a questionnaire (similar to the one you fill out for blood donation), can indicate if the patient needs vaccine or is not at risk. All this would lead to a reduction of stigmatizing automatism (if you are a “gay male libertine” then you are a monkeypox infector), but also to greater legal and technical protection of the super-sensitive data of the subjects. There is no gay disease. Unlike people, diseases don’t discriminate.