ROME — Italy on Friday set a new bar for major Western democracies seeking to move beyond the pandemic by enacting a sweeping law that requires the nation’s entire work force — public and private — to have government-issued health passes, essentially forcing Italians to choose between getting a pass and earning a living.
With the step, Italy, the first democracy to quarantine towns and apply national lockdowns, is again first across a new threshold, making clear that it is willing to use the full leverage of the state to try to curb the pandemic and get the economy moving.
Italy’s measures, which require proof of vaccination, a negative rapid swab test or recent recovery from Covid-19 to go to the workplace, now stand as some of the toughest among Western democracies, which have struggled to balance public health needs with civil liberty concerns.
For many Western governments, that has resulted in refraining from national mandates while seeking other ways to encourage, coax and even mildly coerce people to get vaccinated.
In France, President Emmanuel Macron has tried to make life uncomfortable for unvaccinated people, requiring a health pass to enter restaurants and for long-distance train travel, for instance, but has mandated vaccines only for some essential workers.
President Biden has appealed to private companies to mandate coronavirus vaccinations for employees, asking them to take the initiative as an effort that he announced in September to require 80 million U.S. workers to get the shot undergoes a lengthy rule-making process.
Under Italy’s new rules, those who do not have a Green Pass, as the health certificate is called, must take unpaid leave. Employers are responsible for verifying the certificates, which are for the most part shown on a cellphone app, though hard copies are also acceptable. Workers risk fines of up to 1,500 euros — or about $1,750 — for not complying.
Not everyone has been accepting of the requirements. Last weekend, a demonstration of 10,000 Green Pass opponents — a mix of vaccine skeptics, conspiracy theorists, anti-establishment types and workers livid about having to pay for frequent swabs — was hijacked by right-wing extremists and turned violent, prompting Italy to once again reckon with its fascist legacy.
But on Friday, the rollout went more or less smoothly, with only scattered protests, as the majority of citizens accepted the new pass as a fact of Italian life and a tolerable sacrifice, like wearing masks indoors, to help the country get out of the pandemic and return to normalcy.
The Green Pass has so far faced no serious legal challenge. Government officials said that the measure was already working, and that more than 500,000 previously reluctant people — much higher than expected — have gotten inoculated since the government announced its plan last month.
Under the leadership of Prime Minister Mario Draghi, the country has turned around a faltering start to its vaccination begun under the previous government led by a prime minister affiliated with the Five Star Movement, an anti-establishment party that came to power in 2018 in part by encouraging skepticism about vaccines.
Today Italy has inoculated more than 80 percent of its population over the age of 12, after earlier putting in place tough requirements for health workers and teachers and significantly increasing vaccination rates in those categories.
But to reach the most reluctant unvaccinated workers — an estimated 3.8 million people — the government has now taken one of the Western world’s hardest lines.
Holdouts still remain. At Rome’s Circus Maximus, the ancient chariot-racing track often used for major rallies with tens of thousands of people, a couple of thousand protesters waved banners reading “Liberty” and “The Green Pass Is Just the Beginning” at one end of the field.
Stefano Fuccelli, 58, equated paying for coronavirus tests in order to go to work with extortion by the state and said he resisted getting vaccinated because he “did not want to be a lab rat.”
In Florence, reporters and law enforcement officers outnumbered protesters, some of whom banged bongo drums and came up with creative solutions to get around the Green Pass.
David De Mommio, a 41-year-old furrier from nearby Prato, said that instead of getting vaccinated he would take a swab test every two days to go to work.
“I won’t work on Fridays, to take fewer tests,” he said, adding: “Earning less — is it fair?” He didn’t think it was. “I find it enraging that we have to go through this. It’s a matter of principle.”
Government officials also had to follow the new rules to enter Italy’s government buildings. One unvaccinated councilor in the Lazio region that includes Rome camped out in his office before the law went into effect at midnight, avoiding having to take a coronavirus test before entering the building on Friday.
“Oct. 15, 2021: History books will remember this day as the day of shame,” Davide Barillari, a former Five Star member, said in a video that he posted from his office at midnight.
But the issue was already settled for the Italian government and Mr. Draghi, who has led Italy out of its worst days of the pandemic and toward recovery, and has a reputation for getting things done.
As the European Central Bank president, he famously helped save the euro, declaring that he would do “whatever it takes” for the European Union’s currency to survive. Since becoming prime minister in February after a political crisis, he has enjoyed widespread support across the political spectrum.
What to Know About Covid-19 Booster Shots
The F.D.A. authorized booster shots for a select group of people who received their second doses of the Pfizer-BioNTech vaccine at least six months before. That group includes: vaccine recipients who are 65 or older or who live in long-term care facilities; adults who are at high risk of severe Covid-19 because of an underlying medical condition; health care workers and others whose jobs put them at risk. People with weakened immune systems are eligible for a third dose of either Pfizer or Moderna four weeks after the second shot.
The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.
The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.
It is not recommended. For now, Pfizer vaccine recipients are advised to get a Pfizer booster shot, and Moderna and Johnson & Johnson recipients should wait until booster doses from those manufacturers are approved.
Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.
The once formidable populists who used to spur vaccine skeptics now back his government. Business groups also supported the Green Pass as a way to boost the economy. But the country’s unions largely opposed it, taking issue with the plan to force workers to pay for swabs.
In the northeastern coastal city Trieste, one of Italy’s largest shipping and transport hubs, hundreds of port workers, a high percentage of whom were unvaccinated, gathered to block trucks. Their main objective was to get the government to pay for their swabs.
“We won’t give up until the government cancels it,” said Sandi Volk, a union leader.
The government didn’t budge. It argues that the cost would be exorbitant and that it would erode a vaccination effort and its goal of hitting a 90 percent vaccination rate. The government has said it considers vaccines the only way out of the pandemic. And it has said that if the current formula for the Green Pass failed to promote more vaccinations, it would consider making it even tougher.
“Making the swab free,” Andrea Orlando, Italy’s labor minister, said Tuesday, “substantially means that those who got a vaccine made a mistake.”
While the swabs, each costing around $20, can be a financial burden for workers, the increased volume of tests could also be a logistical burden for the health system, which is already experiencing a backlog.
“It’s been a madhouse,” Anna Laura Pellegrini, a pharmacist, said on Friday. The St. Elena Pharmacy in Rome had been open for less than an hour, but its owners had already done 15 coronavirus swabs, with many more reservations in the hours, and days, ahead.
Not everyone bothered to get the swab. The country’s national security institute reported that 23 percent more people called in sick today than last Friday.
Katia Steinhaus, 28, an unvaccinated beautician, woke up at 7 a.m. on Friday to be the first in the line to get a swab test to go to work, which started at 11. But the prospect of having to get up hours early to take a swab test every two days persuaded her to get inoculated. She planned to book a shot that day.
“Work is the most important thing in life,” she said, adding that without a vaccine, “I can’t do anything anymore.”
Reporting was contributed by Emma Bubola and Elisabetta Povoledo in Rome and Gaia Pianigiani in Florence.