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

Covid-19 vaccinations are now open to most adults and teenagers in Italy, but some residents are still struggling to get an appointment if they’re not signed up for public healthcare. The Local spoke to people who successfully navigated the bureaucratic hurdles and got their shots without an Italian health card.

‘Be tenacious as hell’: How people in Italy have managed to get vaccinated without a health card
Getting vaccinated at Castello di Rivoli museum near Turin. Photo: Marco BERTORELLO / AFP

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.”


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.

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.

Member comments

    1. You seem to be confusing tenacity with aggression. Two very different behaviors: one using communication skills with great determination and the other acting on anger with hostility.

  1. I’m not confusing anything: there is a very thin line between tenacity and aggression in many places in Sicily today.

  2. Tuscany ignored my online application which didn’t ask for heath card. I got an appointment through an Italian friend which did not ask for a health card to book but then said that I needed to bring the card with me to the appointment. The same web site is NOW asking for the tessara. Seems they are discriminating and going backwards, at the same time.

    For a health card you need to prove income and wait a long time. We are 6 months waiting for our driving licences already. Money in the bank doesn’t count and you cannot make the maximum contribution without proof of income. Crazy, even by Italian standards.

    1. This seems like a classic shakedown scam, “Your money or your life.” There are five million foreign residents in Italy, many of whom are extra-comunitari. Perhaps a million of them have private’s health insurance, are insured either by the international companies they work for, pension plans, or privately. Thus they are being forced to join Italy’s Sanitaria, or not be vaccinated. Particularly now with the mandates, this forces people who do not otherwise need to join the Sanitaria to pay into it in order to get vaccinated. At an average of 400 E each for students, it would minimally make 400 million for Italy’s Sanitaria. The minimum income required for a Permesso di Soggiorno is something like 35 K per couple, and the tax for the Sanitaria is something like 7% on the first 22k, and 4 % on anything else up to a little over 100 K. So at say a minimum of 2,000 euros for each couple, that would be a minimum of billion euros of profit at the minimum income, and up to 3 billion at the maximum income. for the Italian Sanitaria on this scam. Can one think that the Italian government has merely forgotten such a large category of its residents, or are the foreign residents being illegally made into a valuable resource?

  3. I’ve tried different channels and also hit a wall for months – ever since they announced availability for my age bracket. I’ve even tried contacting the Red Cross. No luck anywhere. I have expensive private health insurance as mandated by the government until my new permesso arrives and can buy into the public system. I have a codice fiscale. I’m following bureaucratic procedures and working with a lawyer. This has been a very discouraging experience, and it does absolutely feel like discrimination. To the writers of the Local, please keep covering this topic. This isn’t right, and we need information on how to get vaccinated to protect ourselves and others.

  4. Hi everyone, some good news from me in Florence. I’m an American without a tessera but with a codice fiscale. I had success getting an appointment by calling this number: 055 545454 and then pressing 2. The first three times I called the wait time to speak with someone was over an hour in which case the call disconnects. The fourth time I was put on hold and was caller number 56 (hahaha) but it actually went very quickly. I think I waited 20-30 minutes. The gal was very nice, I told her I had no tessera and it wasn’t a problem. If you have ever contacted an ASL before, they are able to see your info immediately by providing your name. She looked up my address and got me a vax appointment close to my house. She told me to bring my old tessera to the appointment but I said I never had one, she laughed, and my codice should be enough. We’ll see when I go on the 3rd. I’ll leave an updated comment after !

    1. Ok it was a nightmare and apparently the woman made me an appointment for a tessera, not for a vaccine, so you can imagine the chaos that ensued when I arrived. Ive called many numbers since and everyone insists you need a tessera even when you mention the law. Got unlucky with who responded I guess. This place at times is difficult to say the least.

      I’m leaving for the states next week and will just do it there.

  5. My partner and I live in Tuscany and we have also sent many emails and made many phone calls, because we do not have a tessera sanitaria but a private health insurance. We were advised to get vaccinated in another region, or to get the vaccination in the Netherlands. But we thought this was such a strange advice, surely it should be possible to get the vaccination in Tuscany?

    We got vaccinated last Monday in Arezzo (Tuscany), after having sent a rather desperate mail to the mayor’s office of Arezzo a week before. After that it was arranged in no time, we just had to give our telephone number and our codice fiscale. We are very grateful to the municipality of Arezzo for helping us so well and quickly!

        1. Hi,

          We’re so glad to hear that the link was useful and you were able to book your appointment.
          Thanks for reading The Local!

          Best wishes,

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Covid face mask rule on flights in Europe set to be eased

The mandatory EU-wide mask requirement for air travel is set to be dropped from Monday, May 16th, but airlines may still require passengers to wear masks on some or all flights

Covid face mask rule on flights in Europe set to be eased

Europe-wide facemask rules on flights are set to be ditched as early as next week in light of new recommendations from health and air safety experts.

The European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) dropped recommendations for mandatory mask-wearing in airports and during flights in updated Covid-19 safety measures for travel issued on Wednesday, May 11th.

The new rules are expected to be rolled out from Monday, May 16th, but airlines may still continue to require the wearing of masks on some or all of flights. And the updated health safety measures still say that wearing a face mask remains one of the best ways to protect against the transmission of the virus.

The joint EASA/ECDC statement reminded travellers that masks may still be required on flights to destinations in certain countries that still require the wearing of masks on public transport and in transport hubs.

It also recommends that vulnerable passengers should continue to wear a face mask regardless of the rules, ideally an FFP2/N95/KN95 type mask which offers a higher level of protection than a standard surgical mask.

“From next week, face masks will no longer need to be mandatory in air travel in all cases, broadly aligning with the changing requirements of national authorities across Europe for public transport,” EASA executive director Patrick Ky said in the statement. 

“For passengers and air crews, this is a big step forward in the normalisation of air travel. Passengers should however behave responsibly and respect the choices of others around them. And a passenger who is coughing and sneezing should strongly consider wearing a face mask, for the reassurance of those seated nearby.”  

ECDC director Andrea Ammon added: “The development and continuous updates to the Aviation Health Safety Protocol in light of the ongoing Covid-19 pandemic have given travellers and aviation personnel better knowledge of the risks of transmission of SARS-CoV-2 and its variants. 

“While risks do remain, we have seen that non-pharmaceutical interventions and vaccines have allowed our lives to begin to return to normal. 

“While mandatory mask-wearing in all situations is no longer recommended, it is important to be mindful that together with physical distancing and good hand hygiene it is one of the best methods of reducing transmission. 

“The rules and requirements of departure and destination states should be respected and applied consistently, and travel operators should take care to inform passengers of any required measures in a timely manner.”