The Italian debate on the digital COVID certificate: co-producing epistemic and normative rationalities

Italy's digital Covid certificate, known nationally as the ‘Green Pass,' was enforced through unusual restrictions for a liberal democracy, as part of the government's effort to bolster the Covid-19 vaccination campaign. Since July 2021, the Green Pass provided the main authorizing tool for the public to access a wide spectrum of social spaces and activities, from leisure to public transport and from education to workplaces. The Green Pass therefore served as a normative technology, and triggered intense political controversy and heated debates in the Italian public discourse. In constructing claims about the Green Pass, advocates and critics alike co-produced normative arguments with understandings of scientific evidence. Notably, they articulated competing framings around: conceptions of freedom during a pandemic;what should be considered as ‘evidence that matters' regarding the effectiveness of Covid-19 vaccines;value-laden projections of vaccination as either a solidaristic practice or an act of self-protection;the proper relationship between the state and its citizens;and the most appropriate modes of public health intervention. Accordingly, Italy's Green Pass offers a revealing case study for probing the implications of a normative technology with respect to public health effectiveness and the safeguarding of individual and social rights. It also provides an opportunity for scrutinizing the (re-)structuring of scientific and public health governance in a major Western democracy during a public health crisis. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The impact of the Covid-19 emergency on the protection of tourism in Italian legal system

The Covid-19 pandemic has affected the administration of tourism, a crucial sector for the Italian economy, offering its emergency management the cause for reflection in this paper. In particular, the impact of the pandemic on the constitutional governance of tourism and on the action of the policymaker who has identified various points of balance between safeguarding the health and maintaining tourist flows is analysed, also through a comparison with the Spanish normative data. © 2023, Societa Editoriale Federalismi s.r.l. All rights reserved.

"Society must be controlled” "Green Pass” and the experiment of a society of control in Italy

Purpose: The introduction in Italy in July 2021 of the "COVID-19 Green Certification”, known as the "Green Pass”, was a particularly important moment in the political and social history of the country. While its use for health reasons is debatable both logically and scientifically, its effects should be measured at the general sociological level. The "Green Pass” allowed Italian social life to be shaped according to a social and political profile that can be traced back to a "society of control”. This paper aims to discuss the aforementioned issue. Design/methodology/approach: This paper, of a theoretical nature, intends to verify such an interpretation through a critical survey of Gilles Deleuze's well-known Post-scriptum sur les sociétés de contrôle (1990) and relating the theories to it from cybernetic science, sociology of social systems and the continental philosophy, specifically Michel Foucault. After a short introduction on the history of the instrument's introduction, the paper, divided into parts reflecting the set-up of Deleuze's text, examines the systemic social effects of the "Green Pass” with regard to its logic, and concludes with a reflection on the program of the instrument's future developments. Findings: The "Green Pass” put into practice a model of a society of control as anticipated by Deleuze, verified with particular reference to some instances of Luhmann's theory of social systems, and in the perspective of a Foucault's "normalizing society” in the process of definition and affirmation. Social implications: The "Green Pass” has been a controversial tool that has caused forms of social discrimination and exclusion and has seriously questioned the architecture of the rule of law. The conceptual paper tries to reflect on the premises and implications of this instrument. Originality/value: The approach to the problem both in a critical key and according to concepts and theories of the sociology of social systems, cybernetics and continental philosophy. © 2023, Emerald Publishing Limited.

The "Green Pass" Controversy in the Italian Twittersphere: a Digital Methods Mapping

In this paper we developed a digital methods mapping of the controversy arises from the adoption of the so-called "Green Pass" in Italy Adopting an "agnostic" approach to our object of study, we used a well-established research design: namely, to collect all the tweets that contain words related to conversations about the green pass in Italy (e.g.: green pass, #greenpass). In this way, the sample collected amounts to 4.307.487 tweets, published between June 15, 2021, and December 15, 2021. To bring out the "voices" of the different actors involved in the controversy we adopted a quali-quantitative approach: on the one hand, by means of computational techniques, we reconstructed the structural relations in which the actors are involved and its evolution over time;on the other hand, by means of content analysis we enriched our map with an interpretation of the discourse surrounding the controversy. Finally, these cartographic results are discussed considering the Italian media system functioning, in order to understand how its conformation may have influenced the public debate concerning the green pass.

Delle possibili conseguenze di Circolari ministeriali «gravemente errate». Ancora di fonti del diritto in epoca Covid. Due decreti legge e tre circolari ministeriali in un mese, per prevedere un quid facile facile: ovvero come gettare nella confusione, con una riga di testo di una «non fonte», tutti i Conservatori italiani

The paper examines and criticizes a number of Circulars of the Ministry of University and Research which, issued during the holiday period of 2021 regarding the subjects obliged to possess and exhibit the green certification in the "school system", appeared, when analyzed in the light of the coeval regulations with the force of law and with regard to the particular sub-sector constituted by the Conservatories of Music, to have been adopted ultra, when not actually contra legem. © 2022, Societa Editoriale Federalismi s.r.l.. All rights reserved.

Contribution to the study of the constitutional profiles of the green pass: “indirect” and “de facto” compulsory health treatment?

The paper analyzes green pass in the Italian legal system, first operating a historical reconstruction and then, highlighting the change of this instrument when it was requested for activities such as work: becoming, de facto, an "indirect" compulsory medical treatment. Finally, retracing the constitutional discipline and constitutional jurisprudence on compulsory medical treatment, we investigate the constitutionality of the green pass. © 2022, Societa Editoriale Federalismi s.r.l.. All rights reserved.

Exploring the effectiveness of the Digital Green Certificate Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area.

Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population. In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory "Digital Green Certificate" (DGC) to access workplaces for some categories considered at risk. Methods: We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influence of the introduction by law of the Digital Green Certificate (DGC) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022. Results: Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the DGC. The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom (Adj-OR = 2.45, 95%CIs = 1.51-3.97, p-value: < 0.001) but a lower sense of safety (Adj-OR = 0.19, 95%CIs = 0.12-0.29, p-value: < 0.001) after vaccine administration. Conclusions: Our findings, in line with the available literature, suggest that the introduction of DGC has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy.

Online Monitoring of Stance from Tweets: The case of Green Pass in Italy

Stance detection on social media has attracted a lot of attention in the last few years, as opinionated posts are an invaluable source of information which can possibly be exploited in dedicated systems. This is especially true in the case of particularly polarizing topics for which there is no clear consensus among population. In this paper, we focus on one of these topics, namely the EU digital COVID certificate (also known as Green Pass), with the objective of uncovering the stance towards it in a specific time period for the Italian Twitter community. To this aim, we first tested some classifiers for determining the most suitable one in terms of performance and complexity for the stance detection problem under consideration. Then, we compared several approaches aimed at counteracting the occurrence of concept drift, i.e., that phenomenon for which the characteristics of the dataset vary over time, possibly resulting in a degradation of classification accuracy. Our experimental analysis suggests that updating the classifier during the stance monitoring campaign is crucial for maintaining a satisfactory level of performance. Finally, we deployed our system to monitor the stance on the topic of Green Pass expressed in tweets published from July to December 2021 and to obtain insights about its evolution.

A Lesson from the Green Pass Experience in Italy: A Narrative Review.

The COVID-19 outbreak has raised several global challenges related to disease management while highlighting the need to embrace a multidimensional approach in dealing with events such as. Due to the singular features of SARS-CoV-2, an appropriate medical response was required to develop new vaccines able to tackle it effectively. Mass vaccination plans were thus promptly launched around the world. However, vaccine uptake has been coupled with growing concerns that have affected people's willingness to get vaccinated. To promote compliance with vaccination campaigns, many governments introduced the use of vaccination certificates and immunization passports. Studies have discussed some benefits and cons coupled with the rollout of vaccine passports or certificates. This paper takes up and extends this discussion by showing the results of a mini- narrative review we undertook with the aim of critically summarizing the existing scholarly research on the Green Pass in Italy. In analyzing the 12 included records, we explored the scientific viability of this measure, as well as the concerns and criticisms it has raised and the recommendations that have been proposed to address them, as a starting point to consider how the lesson learned in the Italian context can contribute to informing future reflections and strategies in view ofanother pandemic event.

A Survey on Undergraduate Medical Students' Perception of COVID-19 Vaccination.

The objectives of this study were to obtain information on medical students' attitudes toward COVID-19 vaccination and to identify the main barriers to its acceptance. We conducted an anonymous online survey on a sample of undergraduate medical students from one main Italian University. The questions were aimed at exploring their attitudes toward vaccination to prevent COVID-19, their perceptions of the risk/threat of COVID-19 and the factors associated with their attitudes toward COVID-19 vaccination. A high percentage of students in our sample stated that they had been vaccinated or that they intended to be vaccinated against the COVID-19 coronavirus. A total of 239 questionnaires were analyzed. Age, social, geographic and demographic characteristics, health conditions and interest in vaccination were recorded; 93% of the students declared that they encouraged vaccination and 83% stated that the reason was "Moral responsibility towards the community". Four students had not yet been vaccinated, mainly because of "Contradictory information on efficacy and safety". The Likert-type questions revealed high agreement on the importance of vaccination and whether it should be made mandatory ("indispensable tool" and "ethical duty" were cited to explain this position). The results show a high level of acceptance of COVID-19 vaccination among these medical undergraduates who, being halfway through their training and involved in clinical practice, are already in possession of specific scientific knowledge and, to a small extent, come from different areas of Italy.

Humoral Immune Response Diversity to Different COVID-19 Vaccines: Implications for the "Green Pass" Policy.

In the COVID-19 pandemic year 2021, several countries have implemented a vaccine certificate policy, the "Green Pass Policy" (GPP), to reduce virus spread and to allow safe relaxation of COVID-19 restrictions and reopening of social and economic activities. The rationale for the GPP is based on the assumption that vaccinated people should maintain a certain degree of immunity to SARS-CoV-2. Here we describe and compare, for the first time, the humoral immune response to mRNA-1273, BNT162b2, Ad26.COV2.S, and ChAdOx1 nCoV-19 vaccines in terms of antibody titer elicited, neutralizing activity, and epitope reactogenicity among 369 individuals aged 19 to 94 years. In parallel, we also considered the use of a rapid test for the determination of neutralizing antibodies as a tool to guide policymakers in defining booster vaccination strategies and eligibility for Green Pass. Our analysis demonstrates that the titer of antibodies directed towards the receptor-binding domain (RBD) of SARS-CoV-2 Spike is significantly associated with age and vaccine type. Moreover, natural COVID-19 infection combined with vaccination results, on average, in higher antibody titer and higher neutralizing activity as compared to fully vaccinated individuals without prior COVID-19. We also found that levels of anti-Spike RBD antibodies are not always strictly associated with the extent of inhibition of RBD-ACE2 binding, as we could observe different neutralizing activities in sera with similar anti-RBD concentrations. Finally, we evaluated the reactivity to four synthetic peptides derived from Spike protein on a randomly selected serum sample and observed that similar to SARS-CoV-2 infection, vaccination elicits a heterogeneous antibody response with qualitative individual features. On the basis of our results, the use of rapid devices to detect the presence of neutralizing antibodies, even on a large scale and repeatedly over time, appears helpful in determining the duration of the humoral protection elicited by vaccination. These aspects and their implications for the GPP are discussed.

Vaccine Passports and Discrimination: Social Stigma and Unjustified Inequality

In Italy, requirement by law of a digital Covid-19 vaccine certification for accessing public transportation, workplaces, bars and restaurants, museums, etc. has raised accusations of state discrimination against those who are not vaccinated by choice or for health reasons. Such accusations are seldom argued for and they are untenable if direct discrimination is being referred to. However, the social meaning of the measures in question could convey a discriminating message of degradation and stigma of the unvaccinated. Moreover, indirect discrimination of already disadvantaged groups could ensue. Careful communication of the reasons underlying vaccine passports, as well as appropriate argumentation in public debate, are crucial to minimize the risk of discrimination. © 2022, Tipolito Subalpina. All rights reserved.

Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach.

BACKGROUND: The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places. OBJECTIVE: This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization. METHODS: We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach. RESULTS: Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti-green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health. CONCLUSIONS: A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for public health.

Lessons from Israel's COVID-19 Green Pass program.

As of the beginning of March 2021, Israeli law requires the presentation of a Green Pass as a precondition for entering certain businesses and public spheres. Entitlement for a Green Pass is granted to Israelis who have been vaccinated with two doses of COVID-19 vaccine, who have recovered from COVID-19, or who are participating in a clinical trial for vaccine development in Israel. The Green Pass is essential for retaining immune individuals' freedom of movement and for promoting the public interest in reopening the economic, educational, and cultural spheres of activity. Nonetheless, and as the Green Pass imposes restrictions on the movement of individuals who had not been vaccinated or who had not recovered, it is not consonant with solidarity and trust building. Implementing the Green Pass provision while advancing its effectiveness on the one hand, and safeguarding equality, proportionality, and fairness on the other hand may imbue this measure with ethical legitimacy despite involving a potential breach of trust and solidarity.

Acceptance of COVID-19 Vaccination in the Elderly: A Cross-Sectional Study in Southern Italy.

In Italy, at the end of 2020, a voluntary immunization plan against COVID-19 was introduced, involving elderly among the first target categories. The aim of this study was to assess, through an online questionnaire, the acceptance of COVID-19 vaccination in a sample of older adults from southern Italy. Of a total of 1041 respondents (41.7% males, mean age 76.6 ± 6.5), 965 (92.7%) were vaccinated or willing to be vaccinated against COVID-19, although less than half of the sample was favorable to vaccinations and agreed with mandatory immunization. Acceptance of COVID-19 vaccination was found to be positively related with higher educational level (OR = 1.875, CI95% = 1.113-3.161; p = 0.018) and having social/mass media as a main source of information (OR = 2.415 CI95% = 1.358-4.296, p = 0.003). On the contrary, an inverse relationship was found between acceptance of COVID-19 vaccination and having fulfilled the questionnaire after the introduction of green pass (OR = 0.218, CI95% = 0.129-0.369; p < 0.001). Therefore, although this evidence needs to be further confirmed, it is possible to agree with previous studies reporting that compulsory measures, such as green pass implementation, must be accompanied by effective education and information strategies of the target population.