ROME — Every week for the past three months, a 63-year-old homeless immigrant from Croatia has walked to a medical clinic by Rome’s Termini train station, hoping for news about getting a coronavirus vaccination. And every time, doctors tell him that despite his multiple heart attacks and a raft of underlying health conditions, they are not able to book him for a shot.
“My heart is so weak that if I get Covid it will take me away for sure,” said the man, who asked to be identified only by his first name, Vlado, for fear of repercussions. “I am scared.”
While the Italian government has said that people have a right to get vaccinated no matter their legal status, in practice, many undocumented migrants and homeless people have been overlooked — a risk not only for them, doctors say, but for the whole country.
The official explanation in many cases is bureaucracy. Most Italian regions require a social security number to book an appointment on their online platforms, but only three of 20 regions in the country accept the temporary numbers given to hundreds of thousands of migrants.
And in a nation where immigration is a hot-button issue, some have also been asking whether Italians should remain the priority, at least until more shots are available.
“The system forgot about these people,” said Marco Mazzetti, a doctor and the president of the Italian Society of Migration Medicine, “but they are the most fragile.”
Italy was the first country in the West to be severely hit by the coronavirus. To date, more than 125,000 people there have died from the virus, and the vaccine rollout started at a sluggish pace, with a shortage of doses and strategic hiccups. It has picked up in recent weeks, with about half a million vaccines distributed every day. On Thursday, Italy broadened eligibility and removed age restrictions. Government officials said that the increase in supply will soon mean that migrants and asylum seekers will get a shot.
But so far, advocates say that little has happened.
Several doctors who work with migrants said they did not believe that the inaction was a result of intentional discrimination, but that it was more a symptom of continued inattention to marginalized people.
Expats living in Italy without a social security number, including diplomats and people working for international organizations, have also had problems booking a shot. But while the Italian postal service — which provides the most-used booking platform to Italian regions — began allowing those groups to sign up this week, it does not yet have a date for when it will let undocumented migrants do so.
Some politicians have also made the issue part of the immigration debate.
When the authorities in the northern region of Lombardy said they planned to include “irregular,” or undocumented, migrants and homeless people in the vaccination campaign this month, regional council members protested.
“I think of business owners exhausted by one year of closures, supermarket cashiers always on the front line, young people who saw one year of life and social life taken from them: all stepped over by irregular immigrants,” Viviana Beccalossi, a council member in Lombardy, said during a regional meeting.
She called the initiative to vaccinate undocumented migrants “a slap in the face.” The region will start giving shots to homeless people next week. But pointing to an “ongoing discussion at a national level,” it said it wasn’t sure when it would be able to vaccinate foreigners with temporary social security numbers.
Social workers and doctors who care for migrants say that by inserting bureaucratic obstacles between migrants and vaccines, Italian authorities are violating the law — which guarantees essential health care to migrants — and creating a significant public health problem.
Dr. Mazzetti points out that migrants are often domestic workers.
“If we don’t control the virus circulation among these people who come inside our homes to help us,” Dr. Mazzetti said, “we don’t control the virus circulation in the country.”
A spokesman for Italy’s health minister said in an interview that the government planned to vaccinate those who live in shelters and migrant centers soon, but had been stymied by the earlier vaccine shortages. He said that as soon as Italy received enough vaccines, it would give a shot to everyone who wants one.
Foad Aodi, a doctor and expert in global health with Fnomceo, the Italian federation of medical associations, said that such delays were dangerous. Migrants have a higher risk of contracting the virus than Italians of the same age, he said. Debilitating migration trips and bad nutrition undermine their immune systems, and they often live in crowded refugee centers where social distancing is often not possible.
“They are physically weaker,” said Dr. Aodi. “We cannot neglect them.”
In Germany, by comparison, adult refugees of all ages living in group homes or refugee centers were considered high priority and got their shots around the same time as people aged 70 and older.
Around the country, scattered attempts to find solutions have emerged. Pope Francis has offered hundreds of vaccine doses to Rome’s homeless. And local health authorities in Rome and some other Italian regions have told organizations that care for migrants that they can call and request vaccine appointments for undocumented people.
But doctors from the clinic that cares for Vlado, which is managed by the Catholic charity Caritas, said they had called and emailed but gotten no appointment.
“The government says they want to vaccinate everyone,” said Giulia Civitelli, the clinic’s director, “but they have to tell us how to do that.”
A 48-year-old Moldovan migrant who works off the books as a caregiver in Verona said she tried to call a regional hotline on her own, but was turned down because she did not have a social security number. She was disappointed, she said, but not surprised.
“I don’t have a contract,” said the woman, who asked not to be identified by name for fear of losing her job. “I don’t have a number, and I don’t have the right to anything.”
Problems with vaccinating migrants are not unique to Italy.
In the United Kingdom, although the government said that people could get vaccinated regardless of their immigration status, some undocumented migrants have said they were denied registration at local doctors’ offices. In France, where the government has said it would give undocumented migrants a temporary social security number for vaccination, advocates for migrants worry that little access to the internet and information about the process will hamper inoculations.
Vlado said he did not think deliberate discrimination was keeping him from a shot, but he was upset about the bureaucratic hurdle. “It’s unfair,” he said, “but I live on the street and I can’t change anything.”
As he waits for a vaccination appointment, he tries to avoid crowded places. But last week, he had to take a packed bus to the southern neighborhood of Eur for a heart checkup. “I was worried,” he said, “but I can’t bury myself alive because they won’t vaccinate me.”
Constant Méheut and Christopher F. Schuetze contributed reporting