This story first published online at North Carolina Health News.

Turin, Italy—As the Omicron variant spreads throughout the country and the world, some governments have doubled down on vaccination as the best way to combat the coronavirus.

U.S. cities such as New York and Washington now require some sort of proof of vaccination for public indoor activities, but any kind of vaccine passport in North Carolina seems unlikely—for now.

The U.S. Supreme Court recently blocked a Biden administration mandate that would have required large employers to compel their employees to get vaccinated or regularly test for the coronavirus.

I have spent the majority of the COVID-19 pandemic in North Carolina’s Piedmont region, but this winter, I got to see life with a vaccine passport firsthand in the other Piedmont region (or rather, Piemonte) in Northern Italy, visiting my boyfriend’s family in Turin.

The beginning of 2020 may seem like a distant memory now, but Northern Italy was one of the first regions in Europe to experience a devastating toll on its public health system due to the coronavirus, even as life was normal in North Carolina.

With those memories fresh in the minds of many, this country first instituted its “Green Pass,” a digital QR code that can be stored on your phone or be printed originally intended for international travel within Europe and access to large event venues and care homes, in June 2021. At that time, vaccinated people, people who had recently recovered from COVID-19, and people who had recently tested negative could qualify for the Green Pass.

As the Delta variant surge hit, more and more Italians were required to have a Green Pass for work and, increasingly, for leisure. By September 1, the Green Pass was required for domestic flights and long-distance trains and buses connecting more than two regions, Wanted in Rome reported.  

Starting October 15, the Green Pass was required for all workers in both the private and public sectors.

By the time we arrived in Italy at the end of December, Omicron was already surging, and the government had implemented more restrictions. The “basic” Green Pass would no longer be enough as of December 6, now a “Super Green Pass” was required in order to access most public spaces.

The main difference between the “basic” Green Pass and the Super Green Pass: testing negative for COVID-19 would no longer cut it. Italians can only qualify for the Super Green Pass if they have been fully vaccinated or recently recovered from COVID-19.

What’s the difference been for me?

I was fully vaccinated and boosted in the U.S., but before leaving my home country in December, I had only presented my vaccine card a handful of times, mostly at indoor restaurants in Chapel Hill. Most of the time, I left it at home, in a safe place, so I didn’t lose it.

It is impossible for people vaccinated in the U.S. to get the Super Green Pass, but our white cardboard Centers for Disease Control and Prevention card is considered the equivalent to the generic Green Pass. 

Months after my first dose in March 2021, my CDC vaccine card is not as white and shiny as when I first got it. It now has a permanent spot in my wallet and has started to show some wear and tear. 

If you’re going out in Italy, you probably need a Super Green Pass. You need it to eat at restaurants—even if you are eating outdoors, go to the public library, and get on a long-distance train. 

What that has meant for me is usually an awkward conversation about why my proof of vaccination is a white card that can be easily faked, not the usual QR code that Italians with the Super Green Pass show. 

North Carolina doesn’t yet have an equivalent to New York’s Excelsior pass, which works similarly to Italy’s Green Pass. If you want another way to show proof of vaccination, you might be able to download your vaccine information from North Carolina’s vaccine portal. North Carolina Health News previously reported on how to navigate the portal.

Sometimes a waiter or manager will not be familiar with the CDC card and tell me that my vaccination isn’t valid. 

I’ll have to explain that this is the proof of vaccination in America, and it is accepted in Italy as well. It’s what I used to enter the country without a quarantine period. In fact, it is validissimo (this is something my boyfriend actually said). My strong American accent probably helps.

You don’t need a Super Green Pass to go to the grocery store or pharmacy in Italy, but starting February 1, it will be required to enter non-essential stores and shopping malls, Wanted in Rome reported.

Attitudes about vaccination

As recently as March 2021, during a surge attributed to the Alpha-variant (also known as the UK variant) regions of Italy where COVID-19 spread was heightened were put in the “red zone,” with heightened restrictions similar to what North Carolina experienced at the beginning of the pandemic—closing restaurants and bars as well as non-essential shops.

Vaccinations have widely been regarded by the Italian government, and public health experts around the world, as the way to go back to life that looks closer to normal without overwhelming the health system. That’s what Italy saw in early 2020, and the Italian government responded by putting regions on lockdown.

Vaccine incentives in Italy are punitive rather than rewards. Italians over 50 are required to get vaccinated. Unlike states across the U.S., such as North Carolina, which incentivized getting the vaccine with lotteries and cash prizes, those older Italians who do not get vaccinated will be subject to a 100 euro fine, and fines up to 1,600 euros for entering the workplace unvaccinated starting in mid-February, ABC News reported.

The result has been general compliance. Italy boasts some of the highest vaccination rates in Europe. Seventy-five percent of Italians have been fully vaccinated against the coronavirus—and 46 percent have received an additional dose, according to the New York Times vaccine tracker. 

Of Italians over 50, about 88 percent are fully vaccinated, and 70 percent are boosted, according to data from the country’s health authority.

That compares to 63 percent of Americans, and only 24 percent of Americans who have gotten an additional shot. In North Carolina, 57 percent of the population is fully vaccinated.

That doesn’t mean all Italians are on board. As mandates continue to pile up, they have also drawn criticism from Italy’s anti-vaccination movement. 

Amnesty International, a human rights group, asked the country to consider allowing unvaccinated people to go to work or use public transportation if they test negative for COVID-19.

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