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

As Italy opens up vaccinations to more age groups, many foreign residents say they're still unable to access the system due to bureaucratic barriers and rules which vary across the country. Clare Speak looks at their problems as well as the hurdles she herself had to get over to obtain a Covid-19 vaccine.

'It seems to depend on luck': Foreigners in Italy continue to report problems getting Covid vaccines
Photo: Marco Bertorello/AFP

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.

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

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.”

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

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.

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.

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.


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.

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.

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

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.

See here for details of which age groups are now eligible in your region and how to book.

Find regional registration websites and phone numbers here.

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.

Member comments

  1. Tuscany now requires a tessera sanitaria to book an appointment. I booked before that but now, when I search, it says it has no record of me. Why no tessera? Because I took out expensive health insurance for residency, but that does not count.

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Semen ‘a vehicle’ for monkeypox infection, say Italian health experts

Researchers in Italy who were first to identify the presence of monkeypox in semen are broadening their testing, saying early results suggest sperm can transmit infection.

Semen 'a vehicle' for monkeypox infection, say Italian health experts

A team at Rome’s Spallanzani Hospital, which specialises in infectious diseases, revealed in a study published on June 2nd that the virus DNA was detected in semen of three out of four men diagnosed with monkeypox.

They have since expanded their work, according to director Francesco Vaia, who said researchers have found the presence of monkeypox in the sperm of 14 infected men out of 16 studied.

READ ALSO: EXPLAINED: How is Italy dealing with rising monkeypox cases?

“This finding tells us that the presence of the virus in sperm is not a rare or random occurrence,” Vaia told AFP in an interview.

He added: “The infection can be transmitted during sexual intercourse by direct contact with skin lesions, but our study shows that semen can also be a vehicle for infection.”

Researchers at Spallanzani identified Italy’s first cases of monkeypox, found in two men who had recently returned from the Canary Islands.

The latest results reported by Vaia have not yet been published or subject to peer review.

Since early May, a surge of monkeypox cases has been detected outside of the West and Central African countries where the disease has long been endemic. Most of the new cases have been in Western Europe.

More than 3,400 confirmed cases and one death have now been reported to the World Health Organisation from more than 50 countries this year.

The vast majority of cases so far have been observed in men who have sex with men, of young age, chiefly in urban areas, in “clustered social and sexual networks”, according to the WHO.

It is investigating cases of semen testing positive for monkeypox, but has maintained the virus is primarily spread through close contact.

Meg Doherty, director of the WHO’s global HIV, hepatitis and sexually-transmitted infection programmes, said last week: “We are not calling this a sexually-transmitted infection.”

Could antivirals curb the spread of monkeypox?

Spallanzani researchers are now trying to ascertain how long the virus is present in sperm after the onset of symptoms.

In one patient, virus DNA was detected three weeks after symptoms first appeared, even after lesions had disappeared – a phenomenon Vaia said had been seen in the past in viral infections such as Zika.

That could indicate that the risk of transmission of monkeypox could be lowered by the use of condoms in the weeks after recovery, he said.

The Spallanzani team is also looking at vaginal secretions to study the presence of the virus.

A significant finding from the first study was that when the virus was cultured in the lab, it was “present in semen as a live, infectious virus efficient in reproducing itself”, Vaia told AFP.

Vaia cautioned that there remained many unanswered questions on monkeypox, including whether antiviral therapies could shorten the time in which people with the virus could infect others.

Another is whether the smallpox vaccine could protect people from the monkeypox virus.

“To study this we will analyse people who were vaccinated 40 years ago before human smallpox was declared to have disappeared,” Vaia said.