The Washington PostDemocracy Dies in Darkness

Vaccine mandates are spreading. Italy shows what to expect.

Security personnel of the Circumvesuviana railway check the green passes of employees, conductors and controllers at the beginning of a work shift in Naples on Oct. 15. (Ciro Fusco/EPA-EFE/Shutterstock)

ROME — Italy last month took a groundbreaking step for a Western democracy: Requiring the nation’s workers — public and private — to get government-issued health passes. The move amounted to a grand experiment to persuade the unvaccinated, who could keep receiving a paycheck only by getting inoculated or undergoing regular testing.

Four weeks later, with many countries now considering mandates of their own, Italy is showing what might be feasible in the deep stages of a vaccination campaign.

The emerging lesson seems to be that a forceful policy can indeed reap a payoff — at least, a modest one. Many minds won’t change, but some might. For the price of some resistance, a country can vaccinate a sliver of its population that otherwise would have stayed out of reach.

In the two months since the measure was announced, vaccination coverage has ticked up by 4.4 percentage points — not a dramatic increase, but more than any other Western European Union member, according to Our World in Data. During that same span, the E.U.’s vaccination coverage has risen three points.

Some might argue that such a modest gain isn’t worth the social price. In Rome, police on one occasion used tear gas and water cannons to constrain protesters.

But health professionals and government officials say even a few percentage points can be crucial. Around 78 percent of Italians have received at least one vaccine dose — the fourth-highest rate among the 27 nations of the E.U. And as Europe confronts another wave, countries with vaccination rates in the upper 70s are faring far better than those in the 60s. Analysts say the country is well-positioned for the winter, and there is little indication that its hospitals will be overwhelmed.

“The pandemic is striking relatively softly here,” said immunologist Sergio Abrignani, who serves on a scientific committee advising the government. “I am convinced we are doing the right thing.”

But while some people can be persuaded by policy — Italy estimates 560,000 people have gotten vaccinated in response to the workplace Green Pass requirement — it’s also true that hundreds of thousands are locked in deep resistance. Over the last four weeks, the number of daily swab tests performed in Italy has shot up some 60 percent. Unvaccinated workers are spending up to 200 euros per month on tests just to continue earning a paycheck.

“If anything I am now even more dead-set against vaccination,” said Arturo Pitardi, 24, a porter at an office building in the northern city of Padua. He said the need to re-up his Green Pass through testing keeps him in a “constant state of anxiety.” One time, he could find availability only at 4 a.m.

“Many people I know caved in after just a week and got vaccinated,” Pitardi said.

Europe has caught up to the U.S. on coronavirus vaccinations — and is deploying near-mandates to get further

The gains have been most significant among the young. In mid-September, 21 percent of Italians in their 20s were unvaccinated. That number has fallen to 12 percent, according to Gimbe, a research foundation in Bologna that tracks the pandemic. Among those in their 30s, the proportion of unvaccinated has dipped from 25 percent to 16 percent.

Pierpaolo Sileri, Italy’s deputy health minister, said the Green Pass is paying dividends even among those who have chosen to remain unvaccinated, because the required testing is detecting infections that might have otherwise gone unnoticed.

“The chains of infection are much more contained,” he told The Washington Post. “That is why the virus is much more under control.”

Sileri said the ultimate goal is to vaccinate 90 percent of the eligible population.

“It’s a target that can be reached even though for the time being it’s a difficult one,” he said.

While many Western countries have considered mandates or near-mandates politically untenable, some are revisiting the discussion as their vaccination progress has slowed or stalled. In Europe, France was the trendsetter: President Emmanuel Macron announced in July that everyone would be required to show a health pass — a proof of vaccination, recovery from covid-19 or a recent negative test — to sit at cafes, eat at restaurants, board long-distance trains and access many other venues.

That move prompted “an enormous surge in people who decided to get vaccinated,” said Françoise Salvadori, an immunology researcher and author.

Italy soon followed, with a similar Green Pass rule for leisure activities. While it didn’t see the same initial bump as France, its progress has been steady. Both countries have outpaced the E.U. in vaccination coverage since midsummer.

France’s health pass is not currently required in most workplaces, but it is mandatory for some occupations — restaurant servers, for example. In some cases, even a negative test is no longer sufficient. Vaccination is now mandatory for nurses, firefighters and certain other professionals.

More recently, France has shifted strategy, focusing not on convincing holdouts, but rather on emphasizing booster shots for people who have already been vaccinated. Beginning in mid-December, France will require anyone over 65 to have a booster shot if they want to keep their health pass, Macron said.

In the United States, the Biden administration has tried to require workers at private companies with more than 100 employees to be fully vaccinated or undergo weekly testing, but the move has been temporarily blocked by a court ruling.

In Europe, Austria recently barred unvaccinated people who haven’t recovered from infections from restaurants, bars and other public spaces. Latvia, facing a coronavirus surge that sent the country back into lockdown, has followed Italy in creating broad vaccination rules for its workforce — and seen its vaccination rate boom. Over the last seven weeks, the proportion of people with at least one dose has risen by a third, from a lowly 45 percent to 60 percent.

“We have had this heavy-handed approach of broad vaccination mandates,” Latvia’s health minister, Daniels Pavluts, told The Post. He said the mandate came “belatedly,” after having been discussed by parliament in the summer but not approved.

He said the rules were one of the factors influencing people. The other is the sheer horror of a wave that overwhelmed hospitals.

“Basically, we are having our worst time now,” Pavluts said.

Read more:

Italy makes health pass mandatory for many leisure activities, in bid to pressure the unvaccinated

Mario Draghi, hosting the G-20, has put Italy in enviable shape

Portugal has nearly run out of people to vaccinate. What comes next?

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