Italy’s vaccination campaign slows as ‘green pass effect’ fails to materialise

As Italy falls just short of its goal of vaccinating 80% of the population, the impending requirement for all workers to show a health certificate has yet to make a significant impact on the immunisation effort.

d of the Covid-19 on July 27, 2021 at the Piazza del Popolo in Rome.
Protestors demonstrate against Italy's green pass in Rome on July 27th, 2021. Photo: Andreas SOLARO/AFP

For a moment, it looked as though the Italian government would reach its goal of vaccinating 80% of Italy’s population against the coronavirus by the end of September.

On September 30th, the counter hovered at a tantalisingly close 78.5%.

A couple of weeks earlier, in a push to make it over the finish line, government ministers passed a decree making it obligatory for all workers to produce a health certificate or ‘green pass’ to enter the workplace from October 15th.

READ ALSO: Italy extends Covid ‘green pass’ requirement to all workplaces

It was hoped that the requirement to show a green pass – which proves that the holder has received at least one dose of the vaccine, has recovered from Covid in the past six months, or has recently tested negative for the virus – would nudge the vaccine-hesitant over the fence and provide a boost to the final stages of the campaign.

But with just one week to go before the rule comes into force, the government’s vaccination counter remains stubbornly stuck at 79.74%, indicating that the hoped-for ‘green pass effect’ hasn’t materialised on a national level.

A report published by the Gimbe foundation for evidence-based medicine on Thursday shows that the rate of new vaccines administered declined by 22.2% in the week between September 27th and October 3rd.

Overall, the rate of vaccine dose administration shows a steady weekly decline between August 30th and the start of October, bar a brief bump in the week of September 20th-26th.

Weekly vaccination doses between July 5th and October 3rd.
Weekly vaccination doses between July 5th and October 3rd. Source: Gimbe Foundation

One thing the green pass requirement does appear to have influenced, the report shows, is the public’s use of rapid antigen tests.

These increased by 57.7% in the month between August 6th (when a green pass requirement was first introduced for entry to leisure and sport facilities and indoor dining) and September 7th.

The seven-day moving average in rapid test use increased from 113,000 on August 6th to 178,000 on September 7th, and has since plateaued.

Rates of newly vaccinated people and of rapid tests between July 22nd and September 6th.
Rates of newly vaccinated people and of rapid tests between July 22nd and September 6th. Source: Gimbe Foundation

“The progressive expansion of the green pass has had a very clear effect in terms of population testing, contributing to reducing the circulation of the virus,” said the foundation’s president, Dr. Nino Cartabellotta.

“But up to now, it has not brought about a surge in the curve of newly vaccinated,”

“Considering that at least five million unvaccinated people are of working age, the litmus test to assess the effectiveness of the ‘gentle push’ will come around October 15th, when the mandatory green pass for public and private employees takes effect”.

EXPLAINED: How Italy will enforce the new ‘green pass’ rules in all workplaces

The sluggish vaccine uptake rate of recent weeks stands in stark contrast to that of late July, when prime minister Mario Draghi first announced the introduction of the green pass as a requirement for entering sports and leisure facilities.

Despite widespread protests, online vaccination booking portals struggled to cope with demand for appointments in the immediate aftermath, with at least half a million appointments made in the 24 hours following Draghi’s televised address.

But with the majority of the population now inoculated against the virus, those who remain unvaccinated are likely to be the most staunch holdouts, with the greatest level of resistance to the government’s efforts.

8.3 million eligible people in Italy currently remain unvaccinated, according to the foundation’s report.

It is not known what proportion of those people are unable to get vaccinated for medical reasons.

In introducing a health certificate requirement for employees, Italy has followed a similar path to France, where workers in public-facing roles have since August 9th been required to show a health certificate.

From mid-October these employees will no longer be able to access free tests, but must pay for ‘convenience tests’ at a rate of €29 for an antigen test or €49 for a PCR test.

Despite some initial resistance, France’s immunisation campaign has been broadly successful, with almost 90% of the eligible population now vaccinated.

Italy has never provided free testing, though the government has introduced similar caps on the cost (however the exact price varies between region) and recently extended the validity of green passes generated from a negative PCR test result from 48 hours to 72.

READ ALSO: 72 or 48 hours? How Italy has updated the rules on testing to obtain the Covid green pass

The Italian government however has not ruled out the possibility of introducing a vaccination mandate for all if its targets are not reached.

Ministers previously stated that any new rules would be evaluated partly based on the vaccination rate achieved by September 30th, as this would make clear the extent of vaccine hesitancy in the country.

At a press conference in September, Health Minister Roberto Speranza said the Italian government would proceed “without fear” with plans to introduce a mandate if it were deemed necessary “in the defence of the right to health and the need to avoid new deprivations of freedom”.

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Italian government begins talks on Covid ‘super green pass’

Italy is set to tighten the rules on its health certificate scheme from December as Covid-19 contagion and hospitalisation rates continue to rise.

Employees in Italy must show Covid health passes to access workplaces.
Employees in Italy must show Covid health passes to access workplaces - but are the rules about to get stricter? Photo: Marco Bertorello/AFP

Note: This article is no longer being updated. Please find the latest news here.

Italian Prime Minister Mario Draghi will hold a meeting with regional leaders on Monday evening, beginning several days of talks on a new government decree which is expected to be announced by Friday, reports national broadcaster Rai.

As the health situation has worsened across Italy in recent weeks – particularly in the north-eastern regions of Friuli Venezia Giulia, Veneto and the autonomous province of Bolzano – leaders of local governments are increasingly pushing for new measures, mainly in the form of further restrictions on the unvaccinated under a so-called “super green pass” scheme.

KEY POINTS: Italy’s new plans to contain the Covid fourth wave

Italy began rolling out its health certificate or ‘green pass’ for domestic use in August, initially making it a requirement at many leisure and cultural venues such as cinemas and indoor restaurants, before extending its use to workplaces and some forms of public transport. 

The certificate shows that the bearer has been vaccinated against Covid-19, has recovered from the disease within the last six months, or has tested negative in the last few days.

Instead, the proposed ‘super green pass’ would only be issued to those who are vaccinated or recovered, with passes issued based on testing in future only valid for entry to workplaces.

Photo: Andreas Solaro/AFP

While no concrete decisions have yet been made, sources within the health ministry have indicated that it is considering the measure for any region declared a higher-risk ‘orange’ zone.

“Closures and restrictions must not be paid for by the vaccinated,” said Health Undersecretary Andrea Costa, adding that the ‘super green pass’ plan would “guarantee the unvaccinated access to workplaces and basic needs, but certain activities such as going to a restaurant, cinema or theatre should be reserved for the vaccinated if the situation worsens.”

“It is clear that we must bring in new initiatives,” he said in an interview with Sky TG24 on Sunday.

EXPLAINED: Will Italy bring in a Covid lockdown for the unvaccinated?

At the moment all of Italy remains in the lowest-risk ‘white’ zone, with few health measures in place.

However several regions are now nearing the thresholds at which they would be moved into the ‘yellow’ zone next week, and – if the situation continues to worsen – then risk being placed under orange zone restrictions two weeks later.

Costa said a planned third dose obligation for health workers “is already foreseen and I think it will be approved this week.”

Health Minister Roberto Speranza put forward proposals last week to make third doses obligatory for the healthcare staff already subject to a vaccine requirement, and also to cut the validity of Italy’s Covid-19 health certificate – the so-called green pass – from 12 to nine months for people who are vaccinated, including with a third dose.

READ ALSO: Italy to start Covid boosters for over-40s on Monday as infection rate rises

The changes have not yet been formally approved, but are expected to come in from December 1st under the planned new decree set to be signed into law by the end of the week.

Other measures the government is reportedly considering include cutting the validity of green passes based on PCR test results from 72 to 48 hours, and those from the results of rapid testing will be reduced from 48 to 24 hours.

There have also been calls from health experts and regional leaders to stop issuing green passes based on rapid test results altogether, as these are less reliable than the results of a PCR test.