COVID-19 Vaccination Campaign Among Migrants in Rome and the Emilia-Romagna Region: Intercultural mediation and vaccine hesitancy

The migrant population in Italy constantly increased in the first two decades of the 21st century, reaching 5 million on 1 January 20202 . Italian legislation guarantees foreign residents full access to vaccines, as the right to health is enshrined in the sistema sanitario nazionale universalistico, universal access national healthcare system. Vaccine equality is linked to legal residency (Law 40/1998) not citizenship status. However, on 3 February 2021, the Agenzia Italiana del Farmaco (AIFA, Italian Medicines Agency) stated that vaccination rights extended to all residents regardless of their migrant or residency status. Therefore, the 2021-2022 COVID-19 vaccination campaign targeted everybody living in Italy, national and foreign residents. The principle of equal healthcare access, however, was not easy to implement in practice. For migrants to be able to fully benefit from healthcare, they also need reliable medical information in a language, format, and channel of communication to which migrants have access3 . Across Europe, migrant languages have been considered among the factors contributing to low rates of vaccine uptake4. In Italy, local health authorities at regional level (azienda, or azienda unità sanitaria locale) adopted different approaches to disseminate information about the COVID-19 vaccination campaign to members of migrant communities (including irregular migrants). On 12 May 2021, the Società Italiana di Medicina delle Migrazioni (SIMM, Italian Society of Migration Medicine) denounced serious issues on several regional online platforms that were used to book the vaccination. Online booking forms demanded proof of residency defined as ‘regularly present’ (stabilmente presenti) even though, in February, AIFA had reiterated that healthcare codes assigned to migrants who were ‘temporarily present’ (STP, stranieri temporanemente presenti) were legally sufficient to access COVID-19 vaccination. On the platform, the rule of law was contradicted by the bureaucratic requests. Practical issues and confusing information created vaccine inequality at point of access, and may have contributed to increasing vaccine hesitancy among migrants in Italy. Combined with limited proficiency in Italian, which may have prevented many from navigating these bureaucratic issues, there was a concrete risk of exclusion from the vaccination campaign. Other factors, such as distrust in the authorities and/or medical language through social media, led some migrants to opt out of vaccination. The STRIVE project, whose findings are reported here, aimed to understand whether effective translation practices can contribute to reducing the impact of linguistic differences as factors determining lower rates of vaccine uptake among migrants in Italy. To address the research question, the STRIVE team carried out 33 interviews. Interviewees included personnel of civil society organisations and personnel of local health authorities (ASLs, AUSLs) who organised language mediation for local migrant communities, as well as translators, interpreters, and intercultural mediators. The researchers analysed language access policies, and evaluated quantitative data on migrants’ preferred languages, as distributed in Rome and the Emilia-Romagna Region. Information about language distribution was necessary to compare and contrast local language needs, provision, and budgeting issues with the language mediation.5 Rome and the Emilia Romagna region host similar numbers of migrant residents; their migrant population combined adds up to over 1 million and represents 20% of the national total. The STRIVE team was able to evaluate and compare approaches in rural, semi-urban, and urban areas, which have shown different levels of testing, infection, and vaccine hesitancy.