Italy’s ‘green pass’ boosts vaccine uptake while the right grumbles

ROME — Getting between Italians and their morning trip to the espresso bar is no joke. 

But Prime Minister Mario Draghi has done exactly that as he attempts to strong-arm undecided Italians into getting vaccinated — and keep ahead of a surge of COVID-19 cases resulting from summer holiday mixing and travel.

Starting Friday, Italians need a pass certifying immunity to sit down inside coffee bars and restaurants as well as access to venues such as cinemas, museums, pools and gyms. The requirement is waived for outdoor dining or buying a coffee at the counter. The “green pass” will also be required, from September on, to use long-distance transit and attend universities. When schools reopen, all teachers must have the pass or face suspension without pay.

For now, the nudge, or rather shove, seems to be having the desired effect, with regions posting a jump in vaccination appointments from 15 to 200 percent, according to Il Sole 24 Ore. Meanwhile, a survey by pollster Nando Pagnoncelli pointed to broad support, with only a quarter of respondents saying they are somewhat or very against the measure.

But those who are opposed are waging a noisy campaign, calling the rules unconstitutional, discriminatory and an assault on individual freedom. Protests were held in 12 Italian cities last weekend, with people bearing slogans such as “Born free and we’ll die free” and “Passport of slavery.” This movement is also gaining traction on the right, as multiple cities get ready for elections this fall.

The anti-green pass camp includes its share of conspiracy theorists and libertarians, but many are owners of bars and restaurants, who say the green pass is an extra burden on top of the strict guidelines already in place, like reduced capacity. Further restrictions would damage their relationship with regular customers, they say. And small local events such as village food festivals, known as sagre, are likely to be canceled because of logistical difficulties.

At the L’Angolo bar near Rome’s San Giovanni square, owner Sabrina Pieroni juggled customers and cappuccinos on Friday morning as one of her employees checked the green passes using the health ministry’s app.

“We are the sector that has suffered the most in the pandemic,” she said. “It’s a problem for us. Anything I have to check means losing time. It’s not pleasant to ask regular customers for their documents, like a policeman, and it definitely won’t be pleasant if I have to ask them to leave.”

“I didn’t choose that path in life,” she added.

Delta rising

Italy is facing the same challenge seen by governments around the world, as policymakers become creative in encouraging citizens to get vaccinated while the Delta variant surges. In this case, Italy has followed France’s lead, nudging the unsure by threatening their lifestyle rather than dangling U.S.-style incentives or cash payments.

Under the new rules, adults and teenagers will be required to prove immunity from COVID-19 by showing one of the following: A digital or paper document that indicates they have at least one dose of a recognized vaccine; documentation they had COVID-19 within the past six months; or a negative test result in the past 48 hours. Customers breaking the rules risk a fine, while businesses can be closed for up to 10 days.

Some businesses are determined to resist. In Borgetto, in Palermo, a sign outside a gym reads: “Here we do not ask for the green pass. You got it? Good. You don’t have it? It’s O.K. anyway.”

In the beach town of Alghero in Sardinia, a rebellious bar owner, Gianfranco Passero, hung out a star of David, with a message: “Since 1961, today, tomorrow, always, everyone can come in.”

The green pass is a deprivation of rights and a reminder of the segregation enforced by fascist Italy’s racial laws against Jews, he said.

“I am offering solidarity to those who freely and legitimately choose not to get vaccinated and not get the green pass,” he said. He already had fewer clients that day, chalking it up to the unwillingness of people “to get a test every 48 hours just to go to the bar.”

The challenge for Passero and other diehard opponents: The summer and travel season is kicking up case numbers just as vaccinations have slowed down — a pattern seen across Europe.

In Italy, 2.7 million people over 60 are still not fully vaccinated, according to the health think tank GIMBE. Weekly case totals have been rising since lockdown eased at the end of June, from 5,000 to 38,000, while the percentage of people testing positive has risen from 2 to 11 percent. The number of intensive care beds occupied by COVID-19 patients has also risen, with the seven-day rolling average jumping from 5 a day in early July to 21.

It doesn’t help that the southern regions of Italy — which are most popular with vacationers — are also the most diffident about vaccines. In Sicily, only 51 percent of the population is fully inoculated compared to 59 percent of those in Lombardy. Especially concerning is that 24 percent of Sicilians over 80 still haven’t completed the vaccine cycle.

Some vaccine skepticism stems from deep-seated distrust of government, the rural character of the region, and the fact that it wasn’t as hard-hit by COVID-19 as the north, say public health experts. Another reason is the scare prompted by the confused messaging around the Oxford/AstraZeneca vaccine.

But now, with its COVID-19 hospitalization rate the highest in the country, Sicily is at risk of returning to a partial lockdown. In response, its government has introduced a raft of incentives, including prioritization of residents of its smallest islands; “bring your nonni” events that let young people get jabbed if they bring an elderly person; and “aperivax” drinks evenings.

Jabs with a side of politics

Italy’s trust in vaccines was already relatively weak by European standards before the pandemic. A long-discredited paper linking the measles vaccine to autism was one factor, but even after it was debunked, rumors around immunization continued to spread, causing vaccination rates to fall so much that a measles outbreak erupted in 2017.

Another factor was that one of the parties in power, the anti-establishment 5Star Movement, long drew support from vaccine-hesitant groups, with one of its MPs, Sara Cunial, even comparing vaccinations to “a free genocide.” But the party has generally shifted to a more moderate stance, while Cunial has been suspended.

These days, most political opposition to the green pass is coming from the right. Giorgia Meloni, leader of the main opposition party, the extreme right Brothers of Italy, tweeted in July that it was “the final step towards the realization of an Orwellian society.”

Last week, the Brothers of Italy occupied parliament in protest, forcing the sitting to be suspended. A video of MP and former basketball player Federico Mollicone dodging stewards during the protest went viral.

“We are not anti-vaccination, but the green pass law is an indirect obligation that amounts to blackmail,” he said later. “If you are a family of four going for a pizza and you have to buy four tests, that’s €50 on top of your dinner. So you won’t go.”

Meloni’s competitor on the right, Matteo Salvini, has come under pressure after his League party was overtaken by Brothers of Italy in the polls — and has attempted to shout even louder.

Unlike the Brothers of Italy, however, the League is part of Draghi’s grand coalition. When he made the announcement in July, Draghi attempted to bring Salvini to heel, quipping: “The appeal not to get vaccinated is an appeal to die, basically.”

Polls suggest that a majority of Salvini and Meloni supporters actually back the green pass. For his part, Salvini has attempted to play up the business angle. He claimed victory Friday by boasting the League had prevented hotels from being affected by the rules, and that families wouldn’t see vacations ruined because they have the option to get tested instead of getting a vaccine.

Still, with local elections in October in major cities, including Rome and Milan, the two right-wing parties seem determined to court, or at least not alienate, the vaccine-skeptical vote.

While 11-13 percent of Italians are largely opposed to getting the vaccine, the figure is much higher among voters on the right, according to research by Demos. Its surveys show 20-23 percent of those voters opposed to compulsory vaccines.

Fabrizio Masia, director of polling agency Emg Acqua, claims this contingent of skeptics could represent as many six million votes in a likely electorate of around 30 million, “certainly not insignificant.” But how Italy’s parties try to exploit the issue may well depend on how divisive it is in the coming months — especially as the weather gets colder, social life moves indoors and conditions become more favorable for another wave.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.