ROME — Looking at the day-by-day chart tracking Italy’s relentless coronavirus death toll, it would be impossible to tell that the country has had vaccines since late December.

At a point when the pandemic has become a race between those vaccines and a more lethal coronavirus variant, most Western European nations have managed to push down their death rate through a combination of lockdowns and vaccinations. Italy’s death rate, though, is much the same as it was 3 1/2 months ago, despite receiving the same proportion of doses as other European Union members. On Wednesday, the country reported another 627 deaths of coronavirus-caused COVID-19, the highest daily figure since early January.

The question of what’s gone wrong in Italy is perplexing a hard-hit nation that had thought it was over the worst. There are numerous factors at play. Italy, whose population is the second oldest, has more elderly people to vaccinate than most. In February, according to mobility data, it was slightly more open than other major European countries, leading to a higher spread of the virus; it has since clamped back down. At the same time a new, more lethal variant has gained dominance here and elsewhere across the continent.

But some scientists and data analysts say Italy’s vaccination campaign also deserves blame. The country, they say, has been vaccinating too many of the wrong people, overprioritizing young workers and leaving the elderly vulnerable.

“Things have not been done appropriately in the last three months, that is clear,” said Sergio Abrignani, an immunologist and a new member of a scientific committee advising the government. “Otherwise we wouldn’t be having 300, 400 deaths every day, as we have now.”

Italy’s predicament has lessons for other countries that are facing their own tough decisions about whom to prioritize with a limited vaccine supply. European countries, including Italy, have mostly been aligned in devoting the first doses to front-line health-care workers and nursing-home residents. But if the primary goal is to avert deaths, the take-away from Italy seems to be: Once that work is done, keep giving doses to the old, and be very selective about which younger workers might be eligible.


Among European Union countries, Italy ranks toward the bottom in inoculating people in their 70s — a group that is still highly vulnerable to the ravages of the coronavirus. Just over 2% of that age group is fully vaccinated. Every other age group in Italy — including people in their 20s and 30s — has received a higher proportion of full protection.

It is also paying for an initial decision to devote its first phase solely to health-care workers — whether on the front lines or not — rather than vaccinating that group more slowly while addressing the elderly. Most people in their 80s had no protection into March, a pace that put it behind other European countries. It has since raced to catch up. The people infected weeks ago are now dying.

As a result, the profile of the average victim has changed little. In late December, that victim had a mean age of 81. Now, the mean age is 79.

“Every minute of these delays [in vaccinating the elderly], it leads to a dramatic loss of human life,” said Piero Ragazzini, the secretary-general of a union for retirees.

The sharpest contrast to Italy comes from France, which has devoted the majority of its doses to seniors and has given at least one dose to 50% of people in their 70s. Although France is well-known for its vaccine skepticism and got off to a slow start, Prime Minister Jean Castex insisted in late February that the country was ahead of others by vaccinating “the right people.” Anyone in France age 70 and over became eligible for a vaccine late last month.

The countries make for a good comparison because they have been fairly similar in terms of lockdown rules and mobility in recent months.


Over the past week, France has recorded 1,900 COVID-19 deaths. Italy has recorded 3,000.

“We need to continue the vaccination of people over 75 years of age and increase the vaccination of people with comorbidities, because statistics show us that they have a higher probability of being hospitalized or seriously affected,” Castex said.

In assessing why Italy has gone off course, some experts point to a decentralized system of health care, in which the nation’s 20 regional governments have wide latitude to determine who gets shots. Although the central government’s health ministry laid out guidelines for whom to prioritize at the beginning of the rollout — front line health workers, nursing-home residents, people over 80, then essential workers — some regions have opened the doors wide to midcareer workers while barely beginning to administer doses to those 70 and older.

In recent weeks, Italian newspapers have been full of stories about the vaccinations of chefs, models and magistrates. Several regional investigations have begun. Italian Prime Minister Mario Draghi, who took office in February, accused some regions two weeks ago of “neglecting” the elderly and favoring groups “that have probably gained priority on the basis of their contractual strength.”

For several weeks, Italy was giving shots to middle-age workers because it had little other choice. The national drug regulator had advised that AstraZeneca be used only for those 55 and younger. But officials say that even after that guidance was lifted — with AstraZeneca approved for the entire population — regions were slow to adjust their strategies.

There are also questions about why some young people received their shots. According to the government’s data, about 250,000 people in their 20s and 30s have been given doses even though they are neither teachers, health-care workers, nor law enforcement members — the essential groups. The health ministry did not respond to a question about the rationale for vaccinating those people. In the government data, they are categorized as “other,” or “altro.”


“In some regions they vaccinated journalists. In others, they vaccinated lawyers,” said Roberto Burioni, a professor of microbiology and virology at Vita-Salute San Raffaele University in Milan. “University professors have been vaccinated now, and they are working remotely. I don’t see the rationale behind this. It’s so foggy.”

Abrignani said that in the wake of Draghi’s comments, the situation appears to be improving. Doses given to people 70 and older have accelerated over the past week.

But Matteo Villa, a research fellow at the Italian Institute for International Political Studies, said earlier mistakes — particularly the slowness of vaccinating those 80 and older — are still playing out.

Villa projects that Italy has saved 4,000 lives with its vaccine campaign, but it could have been as many as 12,000, under the optimal model.

He said that there is an argument for inoculating key workers during subsequent phases, but that those doses should be given to people only above a certain age.

“I can tell you they’ve been vaccinating the wrong people, because they vaccinated me, as well,” said Villa, 37.


He received his vaccine appointment weeks after a dose was given to his grandmother, who is 92. Neither of his parents, who are in their 60s, have been vaccinated.

“If you look at the lethality of the virus, I should not be getting a vaccine right now,” he said.

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Noack reported from Berlin. The Washington Post’s Stefano Pitrelli contributed to this report.