Names, anti-vaxxers, strategies, Trumpism's return. And Schillaci? Healthcare is a black hole of melonism.

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Amid strategic promotions, new institutional figures, and influential appointments, the role of the Minister of Health appears increasingly marginalized. In recent months, the ministry, led by Orazio Schillaci, has been undergoing an internal restructuring that risks further diminishing its authority. Two figures stand out: Marcello Gemmato , current Undersecretary of Health, and Maria Rosaria Campitiello, head of the Department of Prevention . The most recent and significant element of this process is the Presidential Decree, recently approved by the Council of Ministers, updating the organizational regulations for the offices that work directly with the Minister of Health . The decree officially introduces the position of Deputy Minister of Health, alongside that of Undersecretaries. This role, with specific delegated functions, could be filled by Gemmato himself, despite his denials to the press. This move would formalize and strengthen his influence within the ministry, in a context where tensions between technology and politics are increasingly evident.

Should Gemmato be promoted to deputy minister, the role of undersecretary of Health could go to Andrea Costa, a member of the Noi Moderati coalition. Costa, currently one of Minister Schillaci's experts, previously served as undersecretary of Health in the Draghi government when Roberto Speranza was in charge. But let's return to one of the key figures in this story. Marcello Gemmato, a pharmacist and member of parliament for the Brothers of Italy party, was appointed undersecretary in November 2022. In recent months, there has been widespread talk of his promotion to deputy minister, which has since been put on hold, officially due to "further consideration" by Palazzo Chigi. But the delay is said to be due to resistance from Minister Schillaci, who, according to some sources, dislikes Gemmato's excessive activism. It's no coincidence that the appointment was not formally announced during a Council of Ministers meeting in which Giorgia Meloni, leader of the Brothers of Italy party and considered politically very close to Gemmato, was absent.

The Apulian MP, however, continues to raise eyebrows in the scientific and political world. During the pandemic, Gemmato was at the center of heated controversy for statements on vaccines deemed unacceptable by much of the medical and scientific community . In November 2022, a guest on the program "Re Start" on Rai 2, he declared: "Would it have been worse without vaccines? You say so," prompting an immediate reaction from politicians and scientists, who called for his resignation. Minister Schillaci himself was forced to distance himself , emphasizing that the government's position was consistent with that of previous administrations on prevention. Gemmato also criticized mandatory vaccination for healthcare workers and the green pass, calling them lacking scientific basis. This position ended up lending credence, even within the ministry, to a populist vision of healthcare, one that prioritizes consensus rather than science.

This shift was further highlighted by Italy's decision, just a few days ago, to reject all the 2024 amendments to the WHO's International Health Regulations. The Ministry of Health, in an official statement signed by Schillaci himself, declared its rejection of the new mechanisms for coordinating and responding to health emergencies, citing the protection of national sovereignty . This stance has raised alarm among experts and marks a clear break with Italy's international commitment to global prevention, echoing the views of the movements most critical of supranational institutions and the WHO itself. Following Italy's abstention from the global agreement on pandemics, also promoted by the WHO, Italy's repositioning toward Washington appears to be increasingly entrenched, particularly in the conspiracy theories surrounding healthcare exploited by Donald Trump's MAGA movement.

Meanwhile, Maria Rosaria Campitiello has consolidated her position as head of the Department of Prevention, Research, and Health Emergencies . Her meteoric rise, supported by the Brothers of Italy party, has also raised concerns due to her personal ties to Edmondo Cirielli, Deputy Foreign Minister. Her appointment is widely seen as part of a much broader political plan to divide healthcare power. The combination of Gemmato's new deputy ministerial position and Campitiello's growing influence risks radically altering the internal balance of power within the ministry. In this dynamic, Minister Schillaci, a technical figure represented by the center-right, appears increasingly isolated. The real risk is that the Ministry of Health will be led by two de facto "shadow ministers," without a unified leadership.

Further complicating the situation are accusations of conflict of interest: Gemmato owns 10 percent of Therapia Srl, a company that manages private clinics in Bitonto, and advertises shorter waiting times than the National Health Service (NHS) . The opposition accuses him of being in conflict of interest, despite having no management roles or perceived profits. However, doubts remain about the appropriateness of maintaining interests in the private sector while holding a prominent public office in the same sector. Campitiello is also not immune to controversy. The General States of Prevention, organized in Naples on his initiative, cost approximately one million euros, including a four-star hotel and a gala evening. All services were awarded without a competitive tender to Kidea Srl, a company selected directly by the manager. The event's location—Naples—has been interpreted by many as a way to support Cirielli's candidacy for president of the Campania region. President Vincenzo De Luca called the event "a shameful publicity stunt by the Brothers of Italy," denouncing the political misuse of public funds.

The emerging scenario sees Schillaci forced to navigate two powerful poles. Paradoxically, even Gemmato's detractors are those who would welcome his appointment as deputy minister: a way to rebalance Campitiello's growing influence. While Gemmato has a solid political foothold, Campitiello remains a technician, albeit a highly protected one. Schillaci could accept Gemmato's promotion on the condition that his responsibilities remain unchanged, thus maintaining a modicum of control over the ministerial structure.

Meanwhile, another crucial issue remains unresolved: control of Agenas. After more than seven months of stalemate in the Conference of the Regions between the center-right and center-left, the possibility of appointing a commissioner to manage the Agency is gaining momentum. The frontrunner for a possible regency is Americo Cicchetti, a former expert at the Ministry of Health. However, appointing a commissioner would require legislative intervention, which the Quirinale would only accept if it were truly impossible to reach a political agreement. If this option were to materialize, the Brothers of Italy party would find itself managing the entire national healthcare system. This political dominance would be virtually absolute, but threatened by internal divisions within the party, which risk rendering governance ineffective. The Ministry of Health, in this context, appears to be a prime example of a strategic sector paralyzed by power games, personal tensions, and factional clashes. This would have direct repercussions on an increasingly strained National Health Service.

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