As Italian vaccine passports come into force, tiny San Marino is left isolated.

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At the troubled beginning of Europe’s vaccine rollout, the Republic of San Marino found itself short on promised doses and turned to Russia for help. The tiny city-state, surrounded on all sides by Italy, quickly vaccinated most of its population with the Sputnik V vaccine, reaching levels of immunity that were the envy of larger European nations.

But in a reversal of fortune, the same Sputnik vaccines that liberated San Marino’s residents from the virus may now trap them within its narrow borders. Italy is set to introduce a vaccine passport for many social activities that will only recognize vaccines approved by the European health authorities. With Sputnik V not on the list, San Marino is out of luck.

“We are stuck here,” said Donata Bucci, 57, a shop assistant in a bridal shop in San Marino, who received the Sputnik V vaccine and has held off booking a vacation in a Tuscan farmhouse because of the new requirements. “We feel discriminated against.”

San Marino’s isolation has become a vivid preview of the potential tensions that new vaccine passports and requirements could create in Europe, as millions of travelers who received vaccines that haven’t been approved by European regulators may be barred from engaging in social activities.

Starting on Friday, Italy will require a proof of inoculation with the vaccines manufactured by Pfizer, Moderna, AstraZeneca or Johnson & Johnson to dine indoors in restaurants and bars, or go to concerts and museums. Those who have recovered from Covid or taken a recent negative swab will also be allowed in. The authorities have said they might extend the requisite to an even wider range of activities.

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San Marino, 140 miles north of Rome, isn’t part of the European Union, but the lives of its 30,000 residents have always been closely intertwined with Italy — before the pandemic made this porous border palpable.

Its inhabitants and those of the neighboring northern region of Emilia Romagna speak the same Italian dialect, eat the same tagliatelle, and share workplaces, schools and beach days on the Riviera. Its medieval battlements, picturesque alleys and duty-free shops also attract scores of foreign tourists visiting the Italian coast.

San Marino’s health minister, Roberto Ciavatta, said he feared that as the health pass becomes an increasingly essential part of Italy’s social activities, life would be much harder for many Sammarinese who regularly cross the border.

On Wednesday, Mr. Ciavatta drove to Rome as he hoped to convince Italian officials to free up the Sammarinese through a bilateral agreement. In a telephone interview from his car, Mr. Ciavatta said he did not see why the largely vaccinated San Marino — 70 percent of the population has received two shots — should be treated like a “no vax-land” with its residents required to take a swab before every cappuccino.

“It’s humiliating,” he said.

A peer-reviewed article in The Lancet rated the efficacy of the Sputnik vaccine at 91.6 percent, but Russia has repeatedly failed to provide data requested by foreign drug regulators to approve the shot.

So far, Italy has not recognized Sputnik V vaccinations as meeting the requirement to obtain its health pass, known as a “green pass,” meaning those who have received the shot would still need to show proof of a negative test.

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Diplomatic tensions emerged last year when San Marino offered evening dining as Italians faced stringent lockdown restrictions. Then, as the independent nation received the Sputnik vaccines and reached higher vaccination rates than Italy’s, they turned away Italian interlopers who also wanted a shot.

Italy had promised that it would include San Marino in the delivery of doses that was negotiated at European Union level, but Mr. Ciavatta said that San Marino did not receive any doses during the first two months of Italy’s vaccination campaign as Europe struggled with shortages.

As Covid patients filled hospital beds in San Marino, which once had one of the world’s highest Covid death rates, the tiny state decided to find a solution on its own, and bought doses from Russia, which it has close ties with.

“We did not want to fall into geopolitical struggles,” Mr. Ciavatta said. “We just did not want to die.”

Carlotta Porcellini, a 30-year-old owner of an ice cream shop in San Marino, said she would grudgingly spend the summer among the city-state’s quiet stone streets instead of enduring testing to go to the picturesque beach town of Rimini.

“It’s absurd — we are all vaccinated,” Ms. Porcellini said, “but we have to stay put in our tiny reality.”

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