Italy's government has passed a decree making vaccination mandatory for all healthcare and pharmacy workers with the aim of protecting medical staff, patients and vulnerable people.
Healthcare workers who refuse the vaccine will be reassigned where possible to roles where they are not in contact with patients. Where that is not an option they now face being suspended without pay.
The Italian Federation of Doctors and Dentists argues that the government should have gone further and made the legal procedure to suspend non-vaccinated workers easier and faster. However, a minority in the healthcare community remain strongly opposed to compulsory vaccination.
It remains unclear whether the decree is constitutional, and many believe that future legal cases on the Covid vaccines are likely.
Roberto Lanna, a pharmacist and owner of a pharmacy on the outskirts of Naples, told CNN he was unconvinced.
"I am not against all vaccines," he said, adding that "we know very little" about the coronavirus shots. "I don't like that they oblige us to do the vaccine. An obligation has to be accompanied by certainties and guarantees, that this vaccine doesn't have," he said. "What am I going to do now [after the government decree]? I don't know."
For others, the measure is an essential step as Italy battles to contain a third wave of coronavirus infections.
Roberto Agresti, the owner and director of a care home in Fiano Romano, about 20 kilometers (12 miles) from Rome, told CNN an outbreak of Covid-19 cases appeared to be linked to an unvaccinated caregiver.
Out of 36 guests in Agresti's care home, 27 tested positive for the virus in mid-March, two of whom had to be hospitalized, he said.
Agresti said the cluster originated "presumably" from a caregiver who had refused to be vaccinated and began to suffer a fever during her shift on March 16. She was sent home and tested positive for Covid-19 after a swab test, he said.
"It should have been done earlier," he said of the mandatory vaccination measure, passed Wednesday. "I only wanted vaccinated people to work in my care home, but before the decree I couldn't say it."
He believes that the caregivers were mainly "scared from the collateral effects of the vaccines that are amplified by the media," and hopes that all of them will now change their mind.
Three Covid-19 vaccines are now administered in the country -- AstraZeneca, Pfizer and Moderna -- all approved by Italy's medicines agency. Common symptoms of inoculation include soreness, redness and swelling at the site of the injection. Some of those vaccinated may also develop headache, fever, fatigue and muscle aches. However these minor side effects are normal and expected.
Reports of rare blood clots affecting a small number of people in Europe who had had the AztraZeneca vaccine made headlines last month and led to a brief suspension of use of the jab in Italy. However, the European Medicines Agency and the World Health Organization both said there seemed to be no link between blood clots and the vaccine, and both bodies said the benefits of the vaccine outweigh the risks.
Even before the decree was passed, it was lawful to move anti-vaccine health workers around in Italy to non-patient-facing roles, but the decree will make it harder in theory for employees opposed to vaccination to seek legal action.
Last week, a care home in Belluno, northern Italy, that placed employees who refused to be vaccinated on paid leave had its decision upheld in court, in one of the first legal cases in Italy of a company insisting on staff being vaccinated as a condition of their employment.
A Covid-19 cluster spread in the facility this past winter, killing 15 guests between November and December. When at the end of December the Pfizer vaccine was made available for all medical personnel in Italy, eight out of the 80 caregivers of the facility refused the shot, Paolo Santesso, director of the elderly care home, told CNN.
The lawyer for the eight caregivers in question, Andrea Colle, told CNN he was ready to appeal the court's decision. The reason the workers are hesitant to take the vaccine is because they "fear that their health can be damaged," he said.
Meanwhile, Filippo Anelli, head of the Italian Federation of Doctors and Dentists, said he was disappointed that the decree didn't meet all of the federation's recommendations. The measure "will not have a strong enough impact, limiting itself to the suspension, through a muddy process, of the right to carry out a job that implies personal contact," Anelli said in a press statement.
Michela Molinari, a spokeswoman for the federation, told CNN that the body was also disappointed that the decree extends only through December 31.
Most of the doctors, nurses, and dentists in Italy have already received or will soon receive the Covid-19 vaccine, she said. The proportion of so-called "no vax" medical staff is very small, roughly 100 out of 1 million doctors and nurses in the country, she said, "but they are very loud, and very active on social media."
Some doctors and nurses cannot get vaccinated due to some specific health issues, Molinari said, but even that percentage is low, around 1 to 2%.
According to Molinari, the greater issue is with healthcare workers who carry out less skilled work at hospitals and clinics, as well as sites like nursing homes, and that is "why the decree was needed."
As of Thursday night, according to Italian government data, 10,324,127 vaccine doses had been administered, of which more than 3 million had been given to health workers. More than 3.4 million people have had both first and second doses.
'Restart of the country'
Italian Prime Minister Mario Draghi signaled last Friday that the government intended to take a tough line amid concern that health workers who refuse Covid-19 vaccines could become a national problem.
"It is unacceptable that healthcare workers who are in direct contact with the sick patients refuse to be vaccinated. The government intends to take action on this," he told a press conference.
The president of the northwest Italian region Liguria, Giovanni Toti, said 15% of the region's care workers had refused the vaccine. A judge in Genoa, a city in Liguria, has opened an investigation on a Covid cluster potentially caused by a "no-vax" nurse working in the San Martino hospital.
Health Minister Roberto Speranza expressed "great satisfaction" about the decree's passage, adding that winning the "health battle is a prerequisite for a real restart of the country."
The decree also protects those who administer the vaccine by excluding them from criminal liability as long as the inoculation has been carried out in accordance with instructions laid out by the Health Ministry.
Vaccine confidence has risen significantly in Italy in recent months, according to polling by the World Economic Forum. A survey conducted in late February indicated that 85% of Italy's population would be likely to get a Covid-19 vaccine when offered, with the proportion of those surveyed saying they strongly agreed up by 36% since December.
Hada Messia and Livia Borghese reported from Rome, Laura Smith-Spark wrote in London.