UPDATE: Do you need a health card to get vaccinated in Italy?

As Italy rolls out its Covid-19 vaccination campaign to more and more categories, foreign residents who aren't enrolled in the national healthcare system are wondering how and when they'll get their turn.

UPDATE: Do you need a health card to get vaccinated in Italy?
Arriving to be vaccinated at a clinic aboard a vaporetto in Venice. Photo: Andrea Pattaro/AFP

How does someone who doesn’t have an Italian healthcare card get vaccinated against Covid-19? 

The Local has been receiving versions of this question ever since Italy began its vaccination campaign at the end of December, and it’s only becoming more urgent as the programme opens up to more and more sections of the population.

Health officials have repeatedly stressed that Covid-19 vaccines should be offered to everyone in Italy, including foreign nationals. “All people residing or permanently present on the Italian territory, with or without a residence permit or identity documents” are entitled to vaccination here, states the Italian Medicines Agency (AIFA) in its official vaccination FAQs.

The country has a principle of making essential healthcare available to everyone, regardless of nationality or immigration status. That includes vaccinations against potentially severe infectious diseases, such as Covid-19.

So we know that foreigners should be eligible to get vaccinated in Italy. But in practice, it’s a bit more complicated.


Italy’s vaccination programme is being administered by the national public healthcare service, the Servizio Sanitario Nazionale (SSN), or rather, by the various separate regional health services (Servizi Sanitari Regionali, SSR) that make it up. Covid-19 vaccines are not available privately.  

AIFA previously stated that to get vaccinated you would need to show “a valid identity document and health card (tessera sanitaria)”: the health card that shows you’re enrolled in your region’s public health system.

As of late April, it has deleted this guidance from its FAQs, without replacing it with updated advice.

But most people will find that it remains the case when they try to register for a jab. Almost every regional health service has an online platform where residents can book an appointment, if they’re in one of the categories currently being vaccinated. Most of these require you to fill in the number of a tessera sanitaria.


If you are signed up to the SSN but your health card is out of date, the good news is that it need not stop you from booking your shot. The Italian authorities have extended expired documents several times over the past year as the pandemic makes it harder to renew paperwork, and AIFA specifies in its FAQs that “holders of an expired health card” are entitled to get vaccinated in Italy.

If this is your situation, try calling your regional health service’s vaccination hotline and registering over the phone. You may be able to identify yourself using your codice fiscale (fiscal code) instead of your tessera sanitaria. Take your expired card to your appointment with you regardless.


If you do not have a health card because you are not enrolled in the SSN, things get trickier. 

Italy’s Covid-19 emergency commission has told health services to make exceptions for a few specific categories of people who are not enrolled in the public system, namely Italian citizens who usually live abroad and are only in Italy temporarily; foreign diplomats; and current or retired employees of the EU or other international organizations, as well as their dependent family members. 

READ ALSO: Italy says diplomats and Italians who live abroad can get vaccinated without a health card

Since the commission gave its instructions in late April, a few local health authorities have begun offering alternative means to register for vaccination without a tessera sanitaria – including Liguria, which since early May has directed people who fall into one of these categories to email or call its vaccine help services.  

As well as the categories specified by the commission, Liguria also says it will offer appointments to people with either an STP code (Straniero Temporaneamente Presente – temporarily present foreigner) or an ENI code (Europeo Non Iscritto – non-registered European citizen). Both the ENI code – for EU nationals – and the STP code – for non-EU nationals – are only for foreigners in Italy who cannot afford the cost of medical care.

In the part of the region that borders France, a well-established route for migrants without documents trying to cross the border, health services say they will also vaccinate foreign nationals who are in Italy temporarily and don’t have either of these codes. 

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

Photo: Alberto PIZZOLI / AFP

However, no other regions have yet made the same provisions. And in any case, they do not apply to foreign nationals who live in Italy permanently.

The Local has heard from several readers who say they were told flat-out by their local health authorities that they would not be able to register for vaccination without first signing up for national healthcare, which some residents might not do for a variety of reasons – including regional rules that prevent certain foreign nationals opting in to the public system if they’re not working in Italy.

At least one of those barriers came down this week: according to citizens’ rights group Beyond Brexit, Umbria, the region that most tightly restricted foreigners’ access to public healthcare, recently agreed to allow British residents who settled in the region before the UK’s transition out of the EU to opt in to the regional health service even if they don’t work. 

That means UK nationals who moved to Umbria before the end of 2020 now have more options to enrol in the public health service, get a tessera sanitaria and book their vaccination via the usual route. 

READ ALSO: How British citizens in Italy are overcoming bureaucratic Brexit problems

The Local has also heard from a handful of readers who were able to get vaccinated without an Italian health card, including an Austrian national who was (eventually) able to book an appointment in Rome by phone with only a codice fiscale, a British second-home owner who got his shot in Sicily when the island offered AstraZeneca to everyone over 60 without appointments one weekend, and a British teacher in Florence who qualified for vaccination through his job.

But a few success stories aside, Italian authorities have not yet agreed on a standard procedure for those who are not enrolled in the public health service. Until they do, some foreign residents who might otherwise be eligible are likely to face delays in getting vaccinated.

The Local put this question to the British Embassy in Rome back in March, who told us: “Further information is due to be made available on the process for those who live in Italy but who do not hold an Italian healthcare card to book a vaccine so please continue to consult the relevant Italian government websites”, including AIFA’s guidelines, regional health authorities’ websites, and the Ministry of Health’s vaccination site

We have since contacted the Italian Health Ministry and the Covid-19 Emergency Commission to ask how they plan to address this issue.

READ ALSO: ‘It felt like a betrayal’: Foreign residents in Italy report problems getting vaccinated

We will publish any new information as we get it.

In the meantime, the best advice we can give is to contact your local ASL or call your regional vaccination hotline, rather than trying to register online, and to look into whether you are eligible to enrol in Italy’s public health system (find a guide here). 

If you have a regular doctor in Italy, you should also consult them about your options.

Even without enrolling in the Italian health system, ultimately you should be able to get vaccinated at one of the walk-in clinics Italy has promised to set up around the country by the time doses are more widely available. For now, however, vaccination in Italy remains by appointment only.

Have you been able to get vaccinated without an Italian health card? The Local would like to hear from you. Email us with your story.

Member comments

  1. I have investigated deeply and am sorry to say that everywhere I have investigated — ASL, my local hospital, and a vaccination center — I have been informed in no uncertain term that I will not get vaccinated without a tessera sanitaria (without participating in the national health care system.) This is not a British problem; I’m an Austrian citizen residing in Rome. I am in the process of getting the documentation which will lead to an application for a tessera sanitaria, but this will take a long long time. (Austria does not have an exchange agreement with Italy, and anyway, its national health care service only applies to Austrian residents, so that doesn’t help either.) If anyone wants to talk about this, or has other info, I’d love to hear from you: [email protected], Karen Bermann, … Thanks and best wishes!

  2. I can only imagine, it’s hard enough for the Italians, without the proper paperwork i would think they would go into meltdown as Karen says impossible.

  3. Have also been told that we can’t get a tessera sanitaria (hence no vaccine) despite being resident since 2017 (Umbria) and paying Italian taxes. “Sanità per tutti”? I don’t think so. Incredibly frustrating, almost as chaotic as the situation in France. We were told that this ‘wrinkle’ had been solved in Tuscany, would love to know if this is true. So the options are 1) go to the UK but first you have to get a swab result in English, Spanish or French….oh yeah, like the U.K. border police are all trilingual now. LMAO. But first you have to be re-assigned to a GP Surgery with your NHS number (assuming you still have it). Get your (first) jab and then get another swab test before coming back for 5-days quarantine. Not forgetting you’ll have to do this twice. 2) Fly to Serbia where – allegedly – they are offering a choice of vaccines for a price. Not sure if the vaccine certificate will be entirely legible and readily accepted by border police around the world. I mean, Serbian ain’t exactly Spanish or French is it? 3) Wait for the vaccine centres to open up, some time in 2035.

  4. I live in Piemonte, without the health card. I called the regional Covid hotline and referred to what I had read in The Local. «You should not believe what you read in the news» was their answer.

  5. Why don’t Italy just open a vaccination center for a fee? I am interested in getting vaccinated because I am 56 and I have co-morbidities, such as Coronary Disease, Diabetes and Hypertension, putting in the line of vulnerable population. I am not concerned about me dying or getting sick. I don’t want to be the reason why other people might get sick.

  6. I was successfully vaccinated yesterday without a tessera sanitaria.

    It was easy to book an appointment on-line several weeks ago just using my Codice Fiscale. I had no problems being accepted by staff at the vaccination clinic. They did ask for the tessera sanitaria, but were advised that I did not have it yet.

    I do think I was more readily accepted because of having my Codice Fiscale and Permesso, along with being older and having health conditions that made vaccination advisable. I also took an Italian friend with me to facilitate better dialogue in the event there were any wrinkles, but there were none.

    I might suggest reviewing the drop down menu of available vaccination clinic locations on the website and choosing one that is not in a city center. I think staff in the clinics in outlying areas might be more accommodating. Just a thought…..

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Passports: What are the post-Brexit rules for dual-nationals travelling in Europe?

People who have more than one citizenship often hold multiple passports, so what does this mean for crossing borders? Here's what you should know.

Passports: What are the post-Brexit rules for dual-nationals travelling in Europe?

For many readers of The Local, gaining citizenship of the country where they live helps them to feel more settled – but there are also travel benefits, including avoiding the long ‘non EU’ queue when coming back into the Schengen zone.

But this week the problems associated with travelling while holding dual citizenship came to light, leaving many people wondering what they should know when they are entering different countries.

Put simply – which passport should you use? And do you have to carry both with you?

Financial Times journalist Chris Giles tweeted that the UK Border Force “detained” his dual-national daughter while she was travelling from France into the UK with her German passport – and not her British one. 

He went on to say that UK border guards released his daughter. According to Giles, the border staff said she should have had both passports with her “and asked why she was travelling on her German one”.

The rules on dual-nationality have not changed, but now that the UK is not in the EU, there are strict rules on non-Brits who enter the country (and vice-versa) which has made it trickier for travel.

For instance, UK nationals receive a stamp in their passport when entering Schengen member states because they are only allowed to stay up to 90 days within an 180 period (unless they have a visa or residency card).

READ ALSO: Brexit: EU asks border police not to stamp passports of British residents 

People coming from the EU to the UK can generally visit as a tourist for up to six months without a visa – but are not allowed to carry out any work while there.

So which passport should you show?

The first thing to be aware of is there are no specific rules on travelling with more than one passport. 

Travellers can choose to use whichever passport they prefer when going to a country. 

But one thing to note is that it’s worth using the passport that is best suited to your destination when travelling there. Each country has its own set of immigration and visa rules that you’ll need to research closely.

It could be that one passport is better suited for your trip – and you may be able to avoid visa requirements.  

READ ALSO: How powerful is the German passport?

In the case of the UK, many people are still getting to grips with the different rules that apply because it’s not in the EU anymore.

A question submitted to the Secretary of State for the Home Department in September 2021 provided some insight into this issue. 

The question from Labour’s Paul Blomfield asked what steps the UK government “is taking to enable dual UK and EU citizens to travel to the UK on an EU member state passport without having to further prove their UK citizenship?”

The Conservatives Kevin Foster said: “Border Force Officers examine all arriving passengers to establish whether they are British citizens, whether they require leave to enter or if they are exempt from immigration control.

“Where the passenger claims to be British, but does not hold any evidence of British citizenship, the officer will conduct all relevant checks to satisfy themselves the passenger is British.

Border control at Hamburg airport.

Border control at Hamburg airport. Photo: picture alliance/dpa | Christian Charisius

“When dual nationals who are eligible to use e-gates travel to the UK, they will enter via the e-gates without being examined by an immigration officer.

“We recommend all dual nationals, including EU citizens, travel on their British passport or with evidence or their British citizenship to minimise any potential delay at the border or when commencing their journey.”

The Local contacted the UK Home Office to ask if there was any official advice. 

A spokesman said: “An individual can present whichever passport they desire to enter the UK, however they will be subject to the entry requirements associated with the nationality of the passport they present.”

They said anyone who is looking for more information should check out guidance on entering the UK and on dual nationality.

In short, if you present a German passport on entry to the UK you will be treated the same as any other German citizen – which can include being quizzed about your reasons for visiting the UK – as border guards have no way of knowing that you are a dual-national. 

Do I have to carry both passports?

There’s no rule requiring you to have both passports, but you won’t get the benefits of a British passport (entry into the UK without questions) if you don’t show it.

Likewise if you are a French-British dual national and you enter France on your UK passport, you will need to use the non-EU queue and may have your passport stamped.

Should I think about anything else?

An important thing to remember is that if you apply for a visa and register your passport details, the same passport has to be used to enter the country. 

It could also make sense to travel with both passports, just in case. 

However, note that some countries – like the US – require that US nationals use a US passport to enter and leave the States even if they are dual nationals. 

In general, it’s best to use the same passport you entered a country with to depart.

The rules and systems are different depending on the country. But many countries require people to show their passport when leaving – and they will either stamp or scan the passport – this is how authorities know that a foreign visitor hasn’t overstayed their time in the country. 

So if your passport is checked as you leave the UK, you should show the one you arrived with, just to ensure there is a record of you arriving and leaving.

However as you enter France/Germany/other EU destination, you can show your EU passport in order to maximise the travel benefits of freedom of movement.