When we first reported the problems Italy’s foreign residents were having with signing up for the Covid vaccine in April, we didn’t expect we’d still be writing about the very same issue two months later.
After all, many countries reported some initial problems in the early days of their vaccine rollouts, before soon getting them ironed out.
But we’re now six months in to the vaccination campaign and, rather than being an initial oversight that could quickly be resolved, the issue Italy’s foreign residents are facing is becoming more pressing with every passing week.
With vaccine appointments now opening up to more age groups, we’re receiving emails and messages daily from readers around the country who say they can’t sign up despite being eligible.
Sometimes this is simply because they haven’t been given the right information. Several people wrote in to say they’d only booked after finding the signup page through one of our recent articles, such as this one.
But in too many cases, the problem is that people are being prevented from booking their injection, because they don’t have a certain document and can’t get one.
The tessera sanitaria is the card which shows you’re registered with Italy’s national health service (Servizio Sanitario Nazionale, SSN) and many of Italy’s foreign residents simply aren’t, for various legitimate reasons.
For example, it’s not possible to sign up for this until you’ve applied for your residency permit (permesso di soggiorno), meaning that for your first year in Italy you’ll need to pay for private health insurance.
Even many of those who are registered and do have a tessera sanitaria have been unable to book an appointment, for example because the card has expired or because they’ve recently moved to another region and need to re-register.
While that may sound simple enough, registering for a health card in Italy requires paperwork which is not always easy to get hold of, and often a wait of several months for the card to arrive.
It also costs at least €387 per year to register. Which doesn’t sit well alongside the Italian government’s promise to offer the vaccine for free to all, especially for people who are signing up for national health insurance just to get vaccinated.
At The Local, we’re hearing from many readers who are doing exactly that – even though they already have the private insurance they were told they needed when they arrived.
“I have had private health insurance ever since I came to Milan in October 2019. Now, due to the vaccination situation, I feel like I have no option but to apply for the tessera sanitaria,” said Sakshi Taparia, a 23-year-old non-European citizen who came to Milan in 2019. “It just upsets me that as an international student, along with a number of other expenses, I will now have to pay additionally for this.“
“From the articles I read on The Local, it looks like people have managed to get vaccinated without the tessera sanitaria but at this point it just seems like it all depends on your luck.”
“It has been extremely difficult for me to figure out how to book an appointment for myself to get vaccinated without the tessera sanitaria. With a fiscal code, resident permit and health insurance, they are refusing to allow me to book an appointment.”
I myself have also experienced some of these difficulties reported by readers.
I only realised my health card was apparently not valid when the online vaccination appointment booking system refused to accept it.
When my age group (under-35s) became eligible for vaccination in my region (Puglia), I was waiting to book the moment appointments opened up. That didn’t work out – after three hours in an online queue, the system rejected my tessera sanitaria number and wouldn’t let me proceed without it.
I then tried a pharmacy, called the booking helpline, sent half a dozen emails and visited two ASL offices (azienda sanitaria locale, or local health service) on my quest to find out how I could book the appointment I was eligible for.
Everyone I spoke to gave a different explanation as to why my tessera sanitaria was not being accepted. But no one could tell me how I could get vaccinated without it.
The answer to that question, at least, was uniform: “You need to be registered with an ASL in this region or you can’t get vaccinated.”
That’s not supposed to be the case. In theory, everyone in Italy should be able to access the vaccine, regardless of what sort of paperwork they can provide.
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.
But in practice not all local authorities are making provisions for people who don’t have the same paperwork as Italian citizens.
This one especially resonates: “It is as though the people who set up the system here thought that the single biggest risk during this global public health emergency was that someone MIGHT get the vaccine irregularly.” pic.twitter.com/v8rAaHnFgj
— Jessica Phelan (@JessicaLPhelan) June 7, 2021
Under Italy’s highly decentralised health service, some things (such as the booking process and priority groups) depend on regional authorities, and other things (such as the exact process for applying for a health card) depend on individual ASL offices.
These major differences in regional healthcare provision and organisation mean people with exactly the same set of circumstances can have a very different experience, and be given different information, depending on which part of the country they happen to live in – and even who they speak to. It’s the Italian version of what we’d call a postcode lottery in the UK.
And it’s easy to think the problems must be confined to less wealthy and famously disorganised southern regions, like mine, which often have poorly-funded services due to the enormous inequalities in healthcare provision seen under Italy’s regional system.
But things aren’t that clear-cut. In recent weeks we’ve had emails and messages from readers everywhere from Lombardy to Sicily who’ve encountered issue after issue with the booking process.
I am an Italian citizen living abroad and legally entitled to a vaccine in Italy. I spent hours round the houses and no one knows or is willing to help
— Paola Fiocchi Van den Brande🌸 (@PassepartoutHom) June 7, 2021
It baffles me everyday. I’ve tried so hard. My last reply was “Il codice fiscale inserito non rientra al momento nelle categorie previste dal piano di vaccinazione. Non possiamo richiamarti per fis” In MI everyone is eligible – bar me and under 12’s apparently.
— Sascha. (@sipsasch) June 7, 2021
In Tuscany it seems to be a little better, but the system won’t accept foreign phone numbers – a bit of an oversight in a region that has such a strong regional appeal.
— Adriana Urbano (@G_AdrianaUrbano) June 7, 2021
Italian authorities have not yet announced a standard procedure for those who are not enrolled in the public health service. Nor have they issued any nationwide guidance to the regions on how to deal with such cases.
In the meantime however, at least some regional authorities do appear to be catching on to the problem.
Several regional booking websites, such as Tuscany’s, no longer require a tessera sanitaria number – just a codice fiscale (tax code) and basic personal details such as a name and phone number.
Because of this, we’ve heard some recent success stories from people who’ve been able to book vaccination appointments quickly without needing a health card.
- How can you book a Covid vaccination appointment in Italy?
- Who can register for national healthcare in Italy?
- The essential Italian vocab for getting tested or vaccinated for Covid-19
Reader Megan Byrne in Florence was one of them: “Thanks to your useful information, I used this website to book an appointment without the tessera sanitaria. 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 said. “Was I just lucky?”
It does feel increasingly as though whether or not you can get vaccinated in Italy or not is down to sheer good fortune.
In my own case, I managed to get vaccinated purely due to luck and persistence, and without booking.
A few days after being told I couldn’t book an appointment, I was able to get an unused dose after walking in to the city’s vaccination hub and pleading my case – after a staff member at the ASL suggested that I try doing so, and told me what time to go and which doctor to ask for.
I only got this information by repeatedly calling the ASL office and being very insistent – and I only got the vaccine in the end because the people I spoke to were fortunately very kind, helpful, and in a good mood that day.
However, I did need to show my health card – the very same one that the booking system rejected.
Italy in a tweet. You never see the light at the end of the tunnel; and then suddenly you do, but only after losing all hope. https://t.co/9hLlqG3NJk
— Alessio Colonnelli (@co1onne11i) June 7, 2021
While things worked out for me, this isn’t much help to others who are not able to access the system and it was far from guaranteed to work.
I found this a pretty daunting thing to have to do alone in a foreign country and in a foreign language, and I wouldn’t expect everyone to do the same. Nor do I recommend turning up at your local vaccination centre without an appointment unless you know that they’re giving unused doses out to those who want them.
But if you’re at the point where you’re considering trying to sign up for Italy’s public health system – a time-consuming and expensive process – it is worth first investigating whether vaccine hubs in your area are allowing people to stand by for unused doses that may otherwise go to waste.
Your doctor, local pharmacy, or region’s vaccination information line (numero verde) should be able to tell you, or if that doesn’t work you could ask the volunteers outside the vaccination centre itself.
You may be able to book by calling the regional information line – some readers say they got an appointment using only their codice fiscale after explaining the problem over the phone. You can ask someone else to call on your behalf if you’re worried about answering rapid-fire questions in Italian.
While things are more difficult than they should be, all hope is not lost. The best advice we have for now is to stay informed, know your rights, and be persistent.
The Local is continuing to follow this issue and has contacted the Italian health ministry and Covid-19 emergency commission. We will post any updates on how readers may be able to get vaccinated without a health card as soon as we get them.
Find all of our reporting on Italy’s vaccination campaign here.