‘Be tenacious as hell’: How people in Italy have managed to get vaccinated without a health card

While Italy is delivering more shots per day than ever, the Health Ministry still hasn’t given any official guidance on how people who aren’t enrolled in the public health system should register for a Covid-19 vaccine. 

In the absence of national instructions, getting vaccinated without a tessera sanitaria – the Italian public healthcare card – can come down to your region, your local vaccination centre, your doctor, a lot of persistence or just sheer luck.

READ ALSO: ‘It seems to depend on luck’: Foreigners in Italy continue to report problems getting Covid vaccines

Since The Local reported on the difficulties our readers were facing back in April, we’re happy to say that several of the people we spoke to then have since managed to get their shots.

“I cannot tell you what a weight off my shoulders this has been,” says Kenda, an American resident in Liguria who had her first dose in late May. 

She and her husband Scott, both retirees, found themselves locked out of the region’s vaccine booking system because they took out private insurance instead of enrolling in Italy’s public health service. After emailing, calling and visiting their local health authority (Azienda Sanitaria Locale or ASL) in person multiple times, they eventually heard back from one of the directors, a doctor, who helped book appointments on their behalf. 

Kenda’s recommendation to others in a similar situation is to “be tenacious as hell”. 

“The advice I have is for folks to get online to their region’s ASL, find their district, collect the email addresses of the directors and write compelling emails to all of them (in a single email) imploring their help. And then keep writing,” she says. 

While she still isn’t sure what exactly the key was in her case, “if you throw enough darts at jello, something will stick”.

Red Cross volunteers check documents at a vaccination centre at Rome's Termini train station. Photo by Andreas SOLARO / AFP

We’ve heard the same thing from others who’ve found themselves arguing for their right to be vaccinated in Italy.

“Make the appointment via telephone. Be prepared to call 1,000 times before getting through even to a menu which will take you to a real person. Often a recording says, ‘Due to call traffic we can't talk to you now’ and hangs up. Persist,” advises Karen, an Austrian-American dual citizen who booked her vaccination in Rome using only her codice fiscale, or tax ID code.

“I think the only advice you can give people without a tessera is to just call the local vaccine hotline and hope for the best,” agrees Max, an American also in Rome who booked the same way.

While his own experience making an appointment via the Lazio region’s helpline was smooth, he advises others to be prepared to insist if necessary. (Ask someone else to call on your behalf if you need some help explaining your situation: find phone numbers for every region here.) 

“Tell them your permesso di soggiorno is in attesa, the questura is closed, whatever, and as a result you can’t get a health card. Then give them your codice fiscale. If they say no, try again the next day. If they give you an appointment but insist you’ll need the tessera when you show up, go anyway,” Max says.

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

Not everyone has faced a battle, however. Megan lives in Florence and booked an appointment via Tuscany’s online vaccine portal without once being asked to show a tessera sanitaria, which she doesn’t have.

“All they asked from me online was my codice fiscale. I am a Canadian married to a British citizen who has Italian residency, but none of this came up at any time. I have had my first vaccine and have an appointment for my second, with no questions asked,” she told The Local.

Tuscany is one of a few Italian regions whose vaccine booking websites do not ask for the number of a valid Italian health card, and several readers have told us the region is vaccinating people with minimal fuss about paperwork. 

Umbria, too, requires only a codice fiscale to book online. “It was very straightforward,” says Pam, a British-Australian resident who had been struggling to enrol in the region’s public health system but was eventually able to get vaccinated without doing so.

“All I needed was my codice fiscale. When they sent the forms that I needed to fill out there was a place for the tessera but it said ‘if available’ so that was obviously not an issue. [And] when I actually went for the jab there was no question of needing the tessera.”

EXPLAINED: How can you book a Covid vaccination appointment in Italy?

Umbria recently changed its regional rules to allow EU citizens who don’t work in Italy, including Brits who settled here before the Brexit deadline, to opt into the public health system in exchange for an annual fee. Since having her first shot, Pam has enrolled until the end of 2021 and is awaiting her tessera sanitaria.

“Once I receive the card, I intend to contact my GP to see if I can arrange to have my second jab at the surgery as I am in the age category for that,” she adds.

Such developments are signs that, as more doses arrive, some health authorities are starting to make it easier for people to get vaccinated – including being flexible about paperwork.

In Veneto, the online booking system will accept not just a number from an Italian health card, but any European Health Insurance Card (EHIC) issued in the EU, Iceland, Liechtenstein, Norway, Switzerland or the UK. One reader also reported that their EHIC number worked in Lombardy.

Other regions have created alternative channels for people outside the public health system to book, including Liguria and Piedmont, where local health authorities have set up email addresses for people to request an appointment. (Check your ASL’s website to see what options are available near you.)

In Piedmont, Chris was able to register for vaccination by email back in April – though after more than a month without hearing anything, it took a friend of a friend who works at the ASL to establish that an SMS notifying him of his appointment had never arrived and he had missed his scheduled slot.

The contact was able to make him a new appointment, and Chris is now halfway vaccinated. "I guess the moral of the story is it helps to have friends," he says.

A vaccination centre at the Castello di Rivoli art museum in Piedmont. Photo by Marco BERTORELLO / AFP

But progress remains piecemeal across Italy. In Sicily, Irish-born Palermo resident Joanne faced long delays enrolling in the health system and found herself unable to book using the regional website. 

Eventually her husband contacted the nearest vaccination hub directly, who assured that anyone in the region had the right to a vaccine and directed them to a separate booking website where it was possible to register without a tessera sanitaria. (The same website, which is specifically for the Fiera del Mediterraneo convention centre in Palermo, even allows people to reserve without a codice fiscale.)

“But when we got to the centre straight away I was asked for my card at reception, then the medic asked for it and my husband asked would I be able to get it if I didn’t have the card, and he looked sceptical and said they need it for the system,” Joanne told The Local.

Luckily her tessera sanitaria had finally arrived two days earlier so she was able to show it. “I can’t help but wonder if you turned up without it, maybe there would be a wink and a nod and you’d get it?” she says. “Pure speculation and I’m glad in the end I didn’t have to test that.”

READ ALSO:

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Her story illustrates one of the major frustrations for people outside Italy’s public health system: without an official procedure in place, operators on the ground are uncertain whether they can or should be flexible, and may prove reluctant to admit anyone for vaccination without first ticking all the boxes.

The Local has asked the Italian Health Ministry and Covid-19 Emergency Commission how they plan to address the issue, but we are still waiting for an answer. A Health Ministry spokesperson recently told the New York Times that “as soon as Italy received enough vaccines, it would give a shot to everyone who wants one”, without giving any details.

This is too vague. You need 1) official, nationwide guidance on booking without a tessera sanitaria or codice fiscale, and 2) to brief the operators responsible for registering people for appointments, who are effectively gatekeepers, that they can and should be accommodating. pic.twitter.com/EYBmkd8eqn

— Jessica Phelan (@JessicaLPhelan) June 7, 2021

In the meantime, persistence might be your best chance.

If you find yourself denied a vaccination appointment you can try referring officials to the guidance from Italy’s medicines agency AIFA, which says that vaccination is open to “All persons residing or otherwise present on the Italian territory, with or without a residence permit or identity documents, including holders of the STP (Stranieri Temporaneamente Presenti) or ENI (European Non Iscritto) code, holders of the numerical tax code Codice Fiscale or those without one, holders of an expired health card and those who fall into the categories periodically updated by the Vaccination Plan”. (Have the page ready on your smartphone: find the link in Italian here.)

You can also cite Ordinance 3/2021 from Italy’s Covid-19 Emergency Commission, which states: “each Region or Autonomous Province should proceed to vaccinate not only its resident population but also people domiciled on regional territory for reasons of work or family necessity, or any other justified and proven reason that requires their continuous presence in the Region or Autonomous Province.”

While some readers have told us they managed to get a dose by turning up directly at a vaccination centre and arguing their case, there’s no guarantee that this approach will work – and you could face a long wait and added exposure for nothing.

If possible, try to contact the centre by phone or email first. You can also investigate whether any vaccination hubs are offering leftover doses without appointments: try asking your doctor, if you have one, a local pharmacist or the regional information line.

Find more advice on getting an appointment without a health card here.