Six years on, why lobbying success for COVID victims association in Italy over pandemic mismanagement matters

IN BRIEFClick here for the key takeaways In France notably, during the 1990s, association-led action in the context of the HIV pandemic resulted in the development of “health democracy”. Six years following the onset of COVID, anthropological research focusing on an association for victims’ families in Bergamo, Italy—where the pandemic began in Europe—show that legal action can have a significant impact. The redefinition of the crime of “culpable epidemic” by Italy’s Highest Court could inspire legislative changes elsewhere in Europe and worldwide. Close The World Health Organization (WHO) recommends involving populations in the response to epidemics, and even co-constructing responses with them. This approach is in line with “ health democracy” that is enshrined in French law and developed by a movement combining ethics, human rights, and public health. As a reminder, health democracy is an approach that aims to involve service users, professionals, and public decision-makers in the development and implementation of health policies in a spirit of dialogue and consultation. However, the importance attached to this concept varies from country to country, and its practical application is debated whenever a new outbreak occurs. This is currently the case with the Ebola outbreak in the Democratic Republic of the Congo. In the context of COVID, using the law to enforce health democracy In Italy, the association network was mobilised during the COVID pandemic for rescue and care interventions, but was not involved in public health decisions. In Bergamo, Sereni e sempre uniti (“Serene and Always United”) is an association that was founded by families of victims during the pandemic with the goal of mutual support and advocacy. From the perspective of the socio-anthropology of associations, this organization has adopted a unique positioning that holds major scientific interest. It differs from other associations representing healthcare professionals, families, or people living with HIV, in that it uses the law as a tool to enforce health democracy. Our research began in 2020. Initially centred on experiences with COVID and the social relationships between patients, families, and healthcare professionals and around Bergamo and in the Seriana Valley, it gradually shifted focus to the association’s rationales of action in response to the failure of public health systems in a province where 6,000 deaths were mourned. Ethnographic investigations (participant observation and traditional methods) have continued to the present day to ensure full documentation of the process. A case of flawed crisis management by the Italian authorities The first European country to be hit by an outbreak of the pandemic, Italy recorded its earliest cases in the highly industrialised Seriana Valley. While the Lombardy region boasts a renowned healthcare system, it is characterised by a progressive desertification of public health infrastructure, attributed to aggressive privatisation policies. This structural vulnerability, combined with political decisions made during the crisis, led within a few weeks of the first COVID wave to internationally broadcasted images of a convoy of military trucks evacuating coffins that could no longer be managed locally. A fierce controversy erupted over measures described as “makeshift” and systemic negligence in implementing protocols. Families denounced the circumstances surrounding the deaths of their loved ones: saturated facilities, overcrowded emergency departments with endless waiting lines, resource shortages preventing access to care, and corpses piled up in churches. Many people died at home from asphyxiation because medical oxygen was unavailable. An association’s legal battle Families then banded together to create the Noi Denunceremo movement (“We will Denounce”), which quickly evolved into the association Sereni e sempre uniti. The association develops support initiatives for its members and promotes the memory of those who died from COVID-19, efforts which have expanded into lobbying activities such as protests and public statements. Furthermore, with the support of a group of lawyers led by attorney Consuelo Locati, the association pursued legal action to obtain explanations regarding the relevance and legitimacy of the measures adopted during the pandemic. A total of 700 complaints became the subject of two judicial proceedings against the Italian Ministry of Health, the Presidency of the Council of Ministers, and the administrators of the Lombardy region. In April 2020, the Bergamo Public Prosecutor’s Office opened an investigation that would last three years and culminate in the indictment of the officials and politicians who managed the pandemic. These findings represent a significant milestone for Sereni’s legal action, as highlighted by Professor Andrea Crisanti in his 2022 report for the Bergamo Prosecutor’s Office (Crisanti A. 2022. Technical expert report by Professor Andrea Crisanti ordered by the Public Prosecutor’s Office at the Court of Bergamo. Report No. 15749/2020/21 No. 3). This legal battle, which aims to establish truth, justice, and recognition, attempts to end the impunity of health officials and, through this, to restore the dignity that victims have been denied until now. It also aims to ensure that, in the future, populations are less helpless against the authorities’ errors and, above all, more involved in the development and implementation of epidemic preparedness and response measures a demand fully aligned with health democracy. For six years, along with its lawyers the Sereni association carried out preliminary documentation work based on collecting, organising, and then filing thousands of pages of documents with the courts – an essential step in the judicial decisions that have marked this campaign. Protest led by the Sereni association in front of Bergamo City Hall to demand a governmental commission of inquiry. Italy, July 31, 2021. Chiara Alfieri, Author provided (no reuse) A landscape-changing victory A decisive step in the legal battle was reached on April 10, 2025, when the Italian Supreme Court of Cassation broadened the legal definition of the crime of “culpable epidemic” to include “omission, negligence, inaction, and silence in the context of a duty to inform.” This ruling could lead to the reopening of criminal proceedings previously dismissed against high-ranking officials from political and health institutions at the time of the events. It could also inspire legislative changes in other countries. This event offers even greater hope as it builds on two other previous successes. In 2024, the European Court of Human Rights (ECHR) agreed to hear the case Sereni submitted, which revealed human rights violations in the management of the pandemic – a rare feat, as only 5% of complaints submitted to this court are accepted. The association is currently awaiting further developments. Then, on March 24, 2026, the families within the association were officially recognised as victims by the Rome Criminal Court. During this preliminary hearing involving Ministry of Health officials, it was formally established that Italy’s national pandemic plan, which should have been updated, “was not updated, in part due to a lack of resources.” . This opened a breach in the wall of omerta and immunity that had protected the authorities for six years regarding the failures in crisis management. These three events show that the association has achieved significant successes due to four main elements: the expertise of dedicated lawyers who were themselves personally affected by the loss of loved ones; the considerable effort put into documenting and preparing legal cases; the perseverance that allowed them to overcome institutional timelines; and the support of hundreds of families. One ethnographic vignette illustrates this vividly. On March 24, 2026, inside the vast courtroom of Rome’s Criminal Court, filled with law enforcement officers, around one hundred members of Sereni had travelled more than 600 kilometres to stand alongside their lawyers during the hearing. A wall of solidarity and support, a deeply emotional presence, ensuring that the voice of the citizens is heard and carries weight when it comes to the health of all. In Italy and beyond, Sereni’s perseverance bolsters associations’ power to challenge authorities Within a hostile national context in which neither politics nor the health officials responsible for managing the crisis were able to shed light on the reasons for the disaster, this association found in the justice system a means to push forward its grievances, and those of the victims’ families. The stakes do not only concern the affected families. For populations, in Italy and beyond, Sereni’s exemplary associative perseverance further solidifies the power of associations against authorities and paves the way to a form of health democracy. Monitoring the proceedings initiated six years ago will require several more months or years of anthropological documentation. Today, the ethnographic inquiry among the families of the deceased and members of the association shows that its activist work has helped restore meaning to the hardships they endured, enabling them to overcome situations of grief described as traumatic, impossible, or absent, for deaths experienced as unjust. More steps to take and a final chapter to write Citizen mobilisation has also helped legally redefine the notion of “culpable epidemic, » significantly expanding its scope. As a result, “omission, negligence, inaction, and silence in the context of an obligation to inform” have become subject to imprisonment in Italy. In light of the positions held by global health institutions, the scope of this legal reclassification deserves to be further expanded to include epidemic preparedness, or even community participation in the development of strategies. Will this legal concept have an incentive effect? A call went out for further research to determine whether this specific Italian legal singularity — the “crime of culpable epidemic through omission, negligence, or inaction” — now empowers populations to exert tangible power over the government in defining and implementing health policies. The recognition of this legal concept in other countries could help hold States accountable for the preparedness of their healthcare systems, an essential element for gaining public trust and ensuring an effective response to epidemics. The COMESCOV project, titled “Containment and Health Measures to limit COVID-19 transmission: Social Experiences in France, Italy, and the USA in the time of a pandemic” (ANR-20COVI-0083-01), is supported by the French National Research Agency (ANR), which funds project-based research in France. The ANR’s mission is to support and promote the development of basic and applied research across all disciplines, and to strengthen the dialogue between science and society. For more information, visit the ANR website..