This brief highlights how structural discrimination and social exclusion shape attitudes to COVID-19 vaccines among Roma communities in Italy, and the role trusted communal and public authorities can play in supporting vaccine uptake and tackling broader exclusions. Contradictions in the Italian state’s response to COVID-19, alongside ongoing forms of exclusion can increase Roma mistrust in state initiatives and prevent vaccine participation. This brief aims to aid and inform local government and public health authorities in Italy that serve populations inclusive of Roma communities. This brief is based on research conducted in-person and remotely from November 2021 to January 2022 with Roma and Sinti communities in Milan, Rome and Catania, Italy, which have distinct historical, linguistic, geographical, religious, and other forms of identification. Similarities in how the different Roma communities experience the COVID-19 pandemic, and in their vaccine decisions were identified. This brief was developed for SSHAP by Iliana Sarafian (LSE) with contributions and reviews from Elizabeth Storer (LSE), Tabitha Hrynick (IDS), Dr Marco Solimene (University of Iceland) and Dijana Pavlovic (Upre Roma). The research was funded through the British Academy COVID-19 Recovery: G7 Fund (COVG7210058). Research was based at the Firoz Lalji Institute for Africa, London School of Economics. The brief is the responsibility of SSHAP.Foreign, Commonwealth & Development Office (FCDO)Wellcome Trust