More than 700,000 foreigners in Italy are "invisible" in the eyes of the country's COVID-19 vaccination campaign and are being denied legal access to the vaccines, warned a top public official.

This situation "creates a bubble of people who can't be reached" by the vaccination campaign, said Gianfranco Costanzo, the health director of the Ministry of Health's National Institute for Health, Migration and Poverty.

"To obtain herd immunity, in fact, if we exclude important parts of the population living in Italy from the vaccines offered, we damage individual health on one side while creating a problem for collective health on the other," he told ANSA, the Italian news agency, May 25.

Italian law guarantees access to essential and emergency clinical and hospital care, particularly in the prevention, diagnosis and care of infectious diseases, including vaccinations, to all Italian citizens and foreign citizens present on Italian territory, even those who are undocumented or not in compliance with border entry and residency regulations.

However, the online reservation systems for the COVID-19 vaccinations, run by Italy's different regions, require a fiscal code and a health insurance card number, Costanzo said. Some regions even ask for further requirements such as a digital identity code or a certified cellphone number, he added. "The only exception is the Emilia Romagna" region.

"With such levels of access, obviously these groups of foreign citizens who don't have a health insurance card or other codes are cut off," he said. "The framework of regional platforms for reservations is distressing."

Costanzo said that those being denied access include: more than 700,000 people from non-EU countries currently living in Italy, but without a health insurance card or a fiscal code number; several thousand legal EU citizens present in Italy who do not have an Italian health insurance card, in some cases because it would require opting out of the healthcare system in their home country; and people with expired cards or those with old, but valid codes not recognized by the online system.

Dr. Salvatore Geraci, head of Caritas Rome's health care services, told Catholic News Service May 27, "The fact that a person is not enrolled in the health care system in Italy does not mean that they have no right to the vaccination," but this fact was not considered when designing the site or in setting up the reservation system.

Caritas Italy and other organizations that belong to an immigration and health taskforce had already flagged the problem in a letter to Roberto Speranza, the Italian health minister, back in early February soon after the national vaccination system was launched, he said.

In that letter, they had warned the government minister about the huge numbers of people who risked being left out because of the way the system worked and urged they find a solution.

Dr. Geraci, former president of the Italian Society of Migration Medicine and a medical doctor who has spent 30 years working in the field of migrant health care, said there has been no response from the government.

"There needs to be someone who tells the regions how they have to proceed, or the regions have to take the initiative and do something themselves," he said, but for now, the two sides oscillate back and forth over who needs to make the first move with a new procedure.

In the meantime, he said Caritas Italy is working hard on advocacy and asking that there be a technical fix to the site so health card or fiscal code numbers are not required.

Caritas is accompanying those waiting to get access and volunteering their centers be used as potential vaccination sites, he said.

Caritas, he said, is trying to convince regional health authorities that they will eventually have to seek out specific segments of the population to be vaccinated because they are unable to use the online site -- for example, those without Internet access, those who cannot navigate or understand the online process, itinerant Roma, the homeless, the mentally ill, the homebound, the socially excluded and substance abusers.

Local Caritas workers are compiling lists of as many vulnerable people as possible in their communities so when the region is ready, it will know who it needs to help, he added.

Dr. Geraci said getting everyone vaccinated is a question of "social justice," not just charity.

"If we want to guarantee the health of everyone," he said, "we have to guarantee the health of each and every individual, even the most fragile."