The Directorate of Health and Hygiene: a conversation with the outgoing and incoming Directors

In the spirit of continuity

Pope Leo XIV has appointed Luigi Carbone, M.D. as the new Director of the Health and Hygiene department of Vatican City State, effective on August 1. He succeeds Professor Andrea Arcangeli, who has reached retirement age. This transition of department heads represents continuity at the helm of a Directorate that is a fundamental service for Vatican City.

Professor Arcangeli and Dr. Carbone have worked together for almost a year and a half, the former being Director and the latter Deputy Director of the Vatican Directorate of Health and Hygiene. Professionally, they met 25 years ago at the medical center of the Policlinico Gemelli in Rome. In this interview with www.vaticanstate.va, the two physicians talk about their experience in the Vatican. In particular, Professor Arcangeli takes stock of these past five years at the helm of the Directorate and in conclusion, Dr. Carbone announces some new projects he foresees for the Vatican health care system of the near future.

Professor Arcangeli, can you take stock of these past years as Director?

They have been five very intense and demanding years. They were a real challenge because up until I became Director I was accustomed to carrying out my work as a physician in a public hospital setting in Rome, although  I was already a consultant at the Vatican department of Health and Hygiene as a specialist in intensive care since the Jubilee year 2000. I was called at that time to manage medical emergencies and, in that context, a group of intensive care specialists was formed of which I later became coordinator. In fact, when Pope St. John Paul II began to have health problems, the director at the time, Dr. Renato Buzzonetti, wanted a group of experienced resuscitators to protect the Pope's health. From there I continued my journey to eventually being appointed Deputy Director on April 1, 2019, under Professor Alfredo Pontecorvi, M.D. ; then upon his retirement, I took over his role as Director of Health and Hygiene on August 1, 2020.

A period that was not always easy?

For me, as with most practicing physicians in 2020, the challenge came about with the sudden outbreak of the Covid pandemic. We got right into the thick of it - we all remember its critical level in the winter of 2020. Covid had spread mostly in northern Italy while central Italy had not been particularly affected. It was presumed the pandemic was retreating but I immediately found myself immersed in its new problems. I remember that people had relaxed a bit during the summer, they had gone to the beach and they were coming back to the city with Covid symptoms. So I found myself facing a new wave of emergency cases. When autumn came about, Rome was also hit hard by the pandemic wave and an extraordinary effort was needed. I remember arriving at 8 in the morning and leaving at 9 in the evening. There were problems of all kinds. We had to manage the positive cases, decide whether to direct them towards hospitalization, deal with the shortage of swabs. In the beginning, it was not easy to find the swabs. The collaboration of the Bambino Gesù pediatric hospital was requested and subsequently of the Policlinico Gemelli. In a short time, however, our laboratory became autonomous, facilitating the tracking and management of cases. It was a set of problems that put a strain on the system, which nevertheless held up effectively. In the Vatican we had many infected patients, but thankfully no victims: a significant result, which I think should be underlined.

Any other critical moment?

In 2021, we faced a new, decisive challenge: the organization of the anti-Covid vaccination campaign within the Vatican City State. It was a complex experience, but also successful. With the help of our Vatican Pharmacy, we were able to obtain the vaccines directly from the Pfizer parent company, being among the first in Europe to receive them.

While the first steps were being taken in Italy, the Vatican had already started its vaccination program.

With the full collaboration of the entire staff of the Health and Hygiene department, we set up an effective and well-coordinated vaccination program.

The location for its administration was in the atrium of the Paul VI Hall, a large enough space particularly suited from a logistical point of view, which allowed for the orderly and efficient management of all vaccination operations.

During this period, the healthcare and administrative staff mobilized and operated with great commitment and a spirit of service. I also asked for support from our retired medical professionals who responded with enthusiasm and generosity. Among them, I would also like to mention my wife, former head nurse at Gemelli, who offered her competent skills to the project. There was no lack of voluntary participation of colleagues from other Directorates of the Governorate as well. All this has contributed significantly to the success of the entire vaccination campaign.

From a structural point of view, what changes were most significant?

The structure in its general layout is essentially the one I found when I took office. Personally, I have tried to make it as efficient and functional as possible. After the Covid period, we gradually returned to the routine of providing regular health care services. In recent years, thanks to the generous support of the Governorate, many of our healthcare facilities have been renewed, for example in radiology and the ultrasound scanners used in the radiology, cardiology, obstetrics and angiology fields. Today we have latest generation, state-of-the-art biomedical equipment, which has significantly improved the quality of medical care.

We have also expanded into new areas such as physical therapy, inaugurated shortly before the Covid emergency and but could begin its activity only at the end of the pandemic.

This is a service that was not previously present and which has met with a high level of satisfaction from patients.

The psychology and psychotherapy service is also now offered and well received in helping patients and their families.

Finally, in these five years, a certain generational renewal has taken place within the medical team, with the hiring of new specialists, confirming the desire to invest in professional skills and scientific advancements.

How did you organize yourselves for the Jubilee?

We spent last year preparing for the Jubilee and now we are implementing what was planned. Precisely in view of the Holy Year, there were acquisitions of new equipment, in particular, two latest-generation ambulances, which were the subject of a private donation made possible by the Presidency of the Governorate. At the same time, interventions have been carried out to adapt the first aid rooms both within the Vatican State and in the papal basilicas so as to guarantee high standards of medical emergency assistance and first aid to the enormous influx of pilgrims.

Particular attention has been dedicated to providing health care services within the Vatican Museums complex, especially during the summer months when the demand for first response emergency aid increases significantly.

In addition, an emergency service has been organized within St. Peter's Basilica, with the presence of a physician, a nurse and a first responder to support pilgrims who require urgent care and assistance.

I remember that in the Jubilee of 2000 I was called as a resuscitation physician, to provide health support during the Jubilee events. That became my initial experience of medical service to the Vatican - an intense and personally significant experience alongside Pope St. John Paul II, which I consider one of the highest moments of my life and career,  having the privilege of being part of the team that took care of him both during his hospitalizations at the Gemelli hospital and later, in his private apartment in the Apostolic Palace.

Are you at the direct service of the Pope?

Ultimately, there were critical moments with Pope Francis' illness, first during his hospitalization at the Gemelli, then at his residence at Casa Santa Marta and, finally, in the last days leading to his passing. We had organized a very focused structure with everybody’s collaboration.

Subsequently, Dr. Carbone and I, with the assistance of two nurses, were called to work during the Conclave, ensuring medical support to the Cardinals if needed, within a context of maximum confidentiality and historical relevance. Today, we are at the service of Pope Leo XIV.

In collaboration with the Health Assistance Fund (FAS), there is no doubt that the Directorate plays a role of primary importance within the Governorate, to guarantee the protection of the health of all residents, workers and pensioners of the Vatican City State and the Holy See.

Is there a changeover now?

Yes, as happened in my case when I was appointed Deputy Director in 2019, before taking over the department a year later. Now the same transition continues: Dr. Luigi Carbone, current Deputy Director, will take over as Director.

During the Christmas Mass of 2024, I had hoped that he would agree to take over after my retirement. Besides being my right hand man in the last year and a half, our collaboration is long standing. We had been working together for many years at the medical center of the Policlinico Gemelli. I entered as a staff physician in the Intensive Care unit in 1981, while Dr. Carbone started as a specialist in 2001 and became a staff physician in the emergency room in 2004.

Working together, in particular during the management of Covid and in the subsequent vaccination campaign when he was the attending physician, I have always been able to count on his competence and highly professional support. I am therefore very pleased that he is my successor because I consider him to be a well prepared, highly skilled and balanced professional, perfectly fitted to fill this role.

Doctor Carbone, what is your experience so far in this Directorate?

I have collaborated with Professor Arcangeli  this last year and a half as his Deputy Director and the outcome is certainly positive. This period allowed me to learn not only the medical organizational part but also its administrative side. It was a very instructive experience which allowed me to understand things from different angles. A physician is used to observing and deducing from a medical perspective, while the experience as deputy director requires one to actually  manage the administrative structure with the added experience gained as a practicing physician. It's a beautiful thing - what I feel is a great sense of gratitude for the responsibility entrusted to me and at the same time, it is a challenge, because what is asked of us is a service that requires immediate responses and we have to be ready to provide them with competence.

Prospects for the near future?

We are still in the midst of the Jubilee. Its planning started some time ago. There may be something to review, but I don't expect major changes. The primary task of the Directorate is the management of health and hygiene within the Vatican State. From the latest guidelines given by the chief Government Bodies, importance is being given to the safety of workers. We are already implementing that service, together with a focus on public hygiene as indicated in the HACCP protocol. We must resume some practices that were suspended during the Covid period, continuing to respond to the health needs of the Holy Father, Vatican residents and those who are even temporarily within the Vatican State territory. These are the challenges to be addressed and improved upon with the commitment of all persons involved, also because the Directorate is made up of many professional figures who are called upon every day to offer their skills in various fields. This is one of the greatest objectives: to share in the same goals and make projects operational for today’s needs. It is clear that this requires great teamwork. The people who work at the Health and Hygiene Directorate have those necessary human and professional characteristics, ready to respond to these needs and achieve these objectives.

I address both of you: what does it mean to be appointed by the Pope?

Receiving a papal appointment is, above all, a great honor. One perceives the weight of the task that the Holy Father conferred on us in this position of great importance with humbleness. Together we share a deep sense of gratitude. The awareness of being called to carry out such a significant task directly by the Pope is a call to serve, to respect and to recognize the great responsibility worthy of the trust placed in us all by the Holy Father.