Even when supply is not the issue, bureaucratic inertia, strategic errors, a diffusion of responsibility and logistical problems in booking appointments have seriously undercut vaccination efforts…

In its initial rollout in late December, Italy gave the Pfizer vaccine to health care workers, giving it an early lead in Europe. But its plan was then to make large use of the cheaper and easier-to-store AstraZeneca vaccine, which has since been dogged by supply shortages and various concerns about its safety and efficacy…

Even before the recent chaos, Italy’s version of the Food and Drug Administration recommended that the vaccine’s use be limited to “individuals between 18 and 55 years” because of questions about how well the vaccine worked for older people.

As a result, Italy moved early on to vaccinate teachers within the age range, but also lawyers, prosecutors and hospital administrative staff. Older people, vulnerable and frustrated, went unvaccinated, while Italy’s death rates remained high. On Tuesday, 551 people died of the virus, the most since January.