SHARE
COPY LINK

VACCINE

OPINION: Bureaucratic barriers must not stop Italy vaccinating its foreign residents

Of all the reasons why Italy’s vaccination campaign is stalling, not having the right paperwork is one of the most frustrating, writes The Local’s Jessica Phelan.

OPINION: Bureaucratic barriers must not stop Italy vaccinating its foreign residents
Italian Red Cross volunteers at a pop-up vaccination centre in Rome. Photo: Tiziana Fabi/AFP

When fellow foreigners in Italy first began asking us whether they’d be able to get vaccinated against Covid-19, it used to be easy to reassure them.

Of course, we’d reply to the anxious emails: Italy says everyone who wants a vaccine should get one, wherever they’re from and whatever their immigration status.

The Italian government hasn’t gone back on that commendable principle, the same one that makes all essential healthcare available to everyone in Italy. 

But four months into the country’s vaccination programme, as more and more people become eligible – in theory – for a shot, international residents are discovering that having the right to care doesn’t always translate into getting it. 

TELL US: Have you had problems getting the Covid-19 vaccine in Italy?

Now the question we receive from readers isn’t whether they can get vaccinated, but how.

Many people hit a hurdle as soon as they go to book a jab: the websites that regional health services are using to manage appointments almost always ask for the number of a valid Italian health card, or tessera sanitaria, that shows you’re enrolled in the public health system. Even upon calling the booking helpline, we’ve heard from people who reach an automated message or are simply told no: no tessera sanitaria, no vaccine.

There are plenty of reasons why someone might not be able to produce a health card, not least the difficulty of obtaining documents in a year-long pandemic and a country where most administrative matters require at least one trip to an office.

But foreign residents are more likely to have trouble getting one. Italian nationals (and their immediate family members) are entitled to enrol in the national health service for free whatever their circumstances, while foreign nationals have to meet certain conditions or pay an annual fee somewhere between €400 and €3,000 – if they’re allowed to sign up at all.

READ ALSO: Who can register for national healthcare in Italy?

Customers at a pharmacy in Rome. Photo: Andreas Solaro/AFP

In many cases foreigners’ access to healthcare depends on where they live: since Italy’s national health service is in fact made up of 20 regional ones, all largely independent, you can be charged a different amount to enrol from region to region, while some say you’re not eligible if you have private insurance (Veneto) or do not allow other EU nationals to pay to opt in at all (Umbria).

For UK nationals, there’s the added confusion of a new immigration status and new documentation that has barely begun to be issued.

In fact, EU and non-EU residents alike who aren’t working or studying here – notably retirees in the age groups who should be getting vaccinated first – will have encountered a healthcare Catch-22 as soon as they arrived: to register as a legal resident, Italy requires foreign nationals to show they have access to healthcare. Yet to enrol for access to healthcare, you have to be a registered resident.

The solution that many people settle on is to take out a private insurance policy that will satisfy the bureaucrats at the local registry office. But that doesn’t do you much good when a pandemic hits and vaccines are only available via the public health system. 

It’s understandable, even admirable, that Italy insists on keeping Covid-19 vaccines a public service rather than a private one. It’s just as understandable that vaccinating some 53 million adults comes with immense logistical challenges. It’s not like the programme is going smoothly even for people with all the paperwork, after all.

READ ALSO:

The barriers that people without a health card are running into are almost certainly a simple oversight. One of the most striking emails The Local received about this matter was an exasperated message forwarded from a health service employee in Umbria: writing to a colleague on behalf of an international resident, he pointed out that his office had had several inquiries from foreigners who, despite living in Italy legally, find themselves unable to register with the Italian health service.

“I hope that the Region will soon give indications… They need to be included on the Covid vaccination lists and obviously not being registered with the national health service they will probably never be able to book,” he wrote. (Umbria is understood to be reviewing its policy on opting in to the health service; residents are advised to keep contacting their local health authority to express their interest.)

But even sympathetic officials are hamstrung by a rigid administrative process. The staff in charge of assigning appointments have to cross the Ts and dot the Is – and rightly so, given the outcry over i furbetti del vaccino, the ‘vaccine cheats’ who wangle their way to the front of the line.

A vaccination hub set up outside Rome’s Termini station. Photo: Andreas Solaro / AFP

Yet foreign residents aren’t trying to skip the queue. The people we’ve heard from are eligible for vaccination by age, and they’re not asking for anything that Italy hasn’t already promised: “all people will be vaccinated who are present on the Italian territory”, as the Italian medicines agency AIFA’s guidelines state.

Some official instructions from AIFA or other government bodies would go a long way. The British Embassy told The Local in March that further information on the process of booking a shot without a health card “is due to be made available”; to date, we’re still waiting.

It turns out that whether foreigners can get vaccinated in Italy and how they can get vaccinated are in fact the same question, and if the answer to the second is ‘we don’t know’, then the answer to the first is effectively ‘no’, or at least ‘not yet’.

READ ALSO: 

And that outcome is worse for everyone. Researchers at the Italian National Institute of Health studied the differences between Covid-19 cases in Italians and foreign nationals in Italy in the first five months of the pandemic: they found that, compared to Italian cases, non-Italian cases were diagnosed later, were more likely to result in admission to hospital and intensive care, and in cases involving people from countries low on the Human Development Index, had a higher risk of death.

The study, published in the European Journal of Public Health, highlighted “informal barriers” such as language, bureaucracy, or legal, cultural and social factors, as well as economic pressures to keep working, as some of the possible reasons why foreigners don’t always seek or receive healthcare as soon as they need it. Delaying a diagnosis increases the chances that the disease worsens and gives it more opportunities to spread.

“Removing healthcare access barriers and reinforcing communication are, therefore, essential to control SARS-CoV-2 transmission, preserve health services and improve the health outcomes of all people living in the same country, regardless of nationality,” the researchers wrote.

Italy must apply to Covid-19 vaccinations the lesson it has learned from Covid-19 tests: the more people who can get one, and easily, the safer we all are.

Find information about how to register for vaccination in your region of Italy here

Member comments

  1. Thank you for putting this into words. It is incredibly frustrating that we are within a week of being eligible and are prevented from booking. We are legal foreign residents, 2 years now, and we bought private health insurance the first year because of the catch-22 you mentioned for gaining residency. There was NO good reason to enroll in the SSN, and it is not against any rules for us to NOT enroll in the SSN. We’re comfortable with private insurance and the thinking was that it would actually help us when we travel back to the USA to visit family (emergency coverage in the most expensive country in the world for healthcare). We love that the Italians have the intent of vaccinating everyone, but it’s just such an awful, ridiculous obstacle to throw in the path to vaccination. Is there any good argument for it, from their perspective? Is it just to be able to track everyone who’s getting it?

    1. We’re in the same boat, have been residents since 2017. We have all the required docs (even new driving licences!) yet, alas, not the elusive tessera sanataria. Thanks to our health insurance, we weren’t fussed until the tessera suddenly became a pre-requisite for booking a jab.
      But judging by Andrew’s experience above, not even that is guaranteed! Thinking of flying to either Dubai or Belgrade, choosing whichever vaccine we want, pay-up, get the certificate and move on. So much for “sanitá per tutti”.

      1. We’re still hoping things change here as Italy is about 6 weeks behind the US maybe there’s still hope for us? I’m also planning to contact my private insurance and ask them to help us. It seems it would be in their best financial interest to make sure their clients are vaccinated. Surely, that’s more cost effective than hospitalization. I contacted them a few months ago and they had no information but maybe now they’re more informed. Frustrating…

        1. Kenda, I’d love to know if you make any progress. Thanks for writing, everyone, and for this continued reporting, Jessica Phelan. Is there anything we can do as a group that would make us more effective?

          1. I will! Don’t give up. I’m now writing to someone different every day – finding email addresses online. Good question about doing something as a group.

  2. Actually, despite having both a tessera sanitaria and a codice fiscale … the online system won’t let me book a jab. It states there’s something wrong with my application…! Sigh! It looks like emails and/or phone calls for me…

  3. So frustrating…. having been assured that I would be eligible for a jab without a tessera sanataria it is clearly a no–go. I have private medical cover, but the answer was to signup for a tessera sanataria as well, being assured that as soon as I got the paperwork that I would be able book a jab. Not so. I now have the paperwork, but the paperwork does not provide the necessary tessera sanataria number – for that I must wait for the actual card to arrive in the post; days waiting have now turned into weeks.

  4. I am a resident in Molise. I am a Italian national and did my military service. I pay taxes on my properties but I have a private health insurance and do not possess an Italian health card. I have been told when I called the regional health authorities that no card no vaccine.

    I could become a walking COVID time bomb.

    There seems to be no solution until the vaccine is made available to buy.

  5. Kenda, and anyone else interested — would you contact me at [email protected]? I’m writing to someone different everyday too, and have been doing so for the last month. Have also traipsed to several ASL offices. Have talked to a lawyer. Maybe we can consolidate our efforts and represent ourselves as a group. Thanks. Karen Bermann

Log in here to leave a comment.
Become a Member to leave a comment.

TOURISM

OPINION: Why Italy should let the rich pay for ‘private moments’ at tourist hotspots

Instead of criticizing actor Jason Momoa over his VIP visit to the Sistine Chapel, Italy should encourage wealthy visitors to pay large sums for such experiences, says Silvia Marchetti.

OPINION: Why Italy should let the rich pay for ‘private moments’ at tourist hotspots

Signing a generous cheque in order to enjoy a private, exclusive moment – without crowds – at the Colosseum, the Pantheon, or sitting on the Spanish Steps should not be seen as scandalous nor outrageous.

Imagine taking in the view of the Trevi Fountain at sunset, by yourself in a deserted Rome, after having splashed out ten or hundreds of thousands of euros, just to see the sun go down and relax for an hour.

READ ALSO: ‘I love Italy’: Jason Momoa apologises over Sistine Chapel photos

The big fuss over American actor Jason Momoa taking pictures of the Sistine Chapel recently during his Roman stay while shooting his next movie has raised eyebrows worldwide and caused much ado about nothing. It even made global headlines.

The main complaint was that the actor had been granted the privilege of taking photos. in spite of the ‘no-photo’ ban, which many said apparently applied only to ‘ordinary people’.

Personally, I don’t see what the big deal is about Momoa’s not-so intimate moment in the Sistine Chapel.

We Italians tend to look down on tourists who are constantly grabbing their camera to take pictures. We consider our artistic heritage untouchable, or in a way, non-reproducible through photography. 

But Momoa was not committing a crime. 

He later apologized, and explained that he had paid for an exclusive “private moment” by giving the Vatican Museums a large donation.

I think this is something positive: a ‘mechanism’ that could be exploited to raise cash for city coffers and urban projects – instead of raising local taxes that weigh on Italian families.

Rome, and all other Italian cities, should rent out such locations for events – even for just one night, or one hour – in exchange for a high fee.

The rich and famous would be more than happy to pay for such an opportunity to enjoy Italy’s grandeur. As would ordinary people who may decide they can afford it for a special occasion.

These are solo, one-in-a-lifetime experiences in top sites, and must be adequately paid for. 

Rome’s Colosseum in February 2021. Lower visitor numbers amid the Covid-19 pandemic meant Italian residents were able to see the country’s major attractions without the crowds. Photo by Vincenzo PINTO / AFP

Italy is packed with historical, artistic and archeological gems that the entire world envies, people flock here just for a selfie in front of the Looming Tower of Pisa.

So why not make a leap forward and raise the bar for ‘private moments’; something Momoa, despite the unknown sum of money he paid, did not even actually get.

I’m not suggesting Italian cities lease monuments for weeks or months, for they belong to all humanity and everyone has a right to enjoy them. But allowing exclusive, short private experiences at Pompeii, or Verona’s arena, or just time to stare at Botticelli’s The Birth of Venus or Michelangelo’s The Last Judgement, should be seen as a source of extra revenue, not a taboo.

Italy should economically exploit its infinite artistic treasures as a powerful money maker, unleashing the full potential of it. 

If offered the chance, I think Elon Musk would not mind paying hundreds of thousands of euros, or even millions, for a private corporate cocktail party at the Colosseum.

OPINION: Italy must update its image if it wants a new kind of tourism

Of course, you’d need rules: a strict contract with specific clauses in case of damage or guest misbehavior; a detailed price list; and surveillance to safeguard the site during the private event. And extremely high fines if any clause is breached.

It’s a matter of looking at a city from a business and marketing perspective, not just a touristic one.

Today you can already take a private tour of the Vatican Museums for a higher ticket price, but it’s mostly for groups of 10 people, and there’s always a guide with you. You’re never really ‘still’ in your favorite room, so forget having a completely ‘private moment’.  

Taking photos inside the Vatican’s Sistine Chapel is usually forbidden, except for members of the media with special permission and, apparently, celebrities. Photo by Andreas SOLARO / AFP

One model city to take as reference is Florence, which in the past few years has done a good job of promoting the city brand.

The mayor’s office has set up a special committee that rents out Renaissance piazzas for private wedding celebrations and birthday parties, as well as several key historical spots like the Giardino delle Rose, and Palazzo Vecchio, the historical headquarters of the town hall.

There is an online menu with all the locations available for weddings and other private events, depending on the number of guests and type of celebration. 

Those interested should contact the town hall’s special ‘wedding task force’ if they want to book frescoed rooms in ancient palazzos or other buildings owned by local authorities. Last time I enquired, some elegant rooms are available to hire for as little as €5,000.

Would you pay big money to have major attractions, such as Rome’s Colosseum, all to yourself? Photo by Filippo MONTEFORTE / AFP

Venice, too, has attempted to raise cash by renting the façades of public buildings overlooking the Canal Grande to global fashion brands for advertisements, but the move raised eyebrows among locals. 

Even in Florence, residents weren’t so pleased to see huge, lavish billionaire Indian weddings celebrated in front of their palazzi, blocking access to their homes.

Italians need to reset their mentality. If anyone is willing to pay big money to enjoy the solo thrill of a site or location, we should be more than happy to allow it. 

As a result, we might end up paying lower city taxes for waste removal, water and other services. Every day, for free, we share the Trevi Fountain and Piazza Navona with masses of noisy, coin-throwing, gelato-slurping tourists; why not occasionally accept a generous donation from a VIP or philanthropist eager to pay for a moment alone in the company of Bramante and Brunelleschi? 

We would only be helping our cities to maintain their artistic heritage, which fills us with pride.

SHOW COMMENTS