This brief sets out key considerations linked to the promotion of COVID-19 vaccine uptake among undocumented migrants residing in Rome, Italy. We focus on strategies to equitably distribute COVID-19 vaccines. Evidence from Italy is applicable to other contexts where vaccine administration is tied to “vaccine passports” or “immunity passes”. Undocumented migrants have been considered as some of the “hardest to reach” groups to engage in COVID-19 vaccination outreach. This brief uses the term undocumented migrant or migrant for brevity, but we refer to people living without formal Italian citizenship, refugee status or right to remain in Italy. This brief explores the everyday context of undocumented migrants lives, and how experiences of the COVID-19 pandemic have exacerbated difficult conditions. It links emerging vulnerabilities to perceptions of vaccines, and we suggest that migrants orientate themselves towards the vaccines within frameworks which prioritise economic survival. In many cases, migrants have accepted a COVID-19 vaccine to access paid employment, yet this has often generated mistrust in the state and healthcare system. Accordingly, this brief considers how vaccines can be distributed equitably to boost trust and inclusion in the post-pandemic world. This brief draws primarily on the ethnographic evidence collected through interviews and observations with undocumented migrants in Rome, along with civil society representatives and health workers between December 2021 and January 2022. This brief was developed for SSHAP by Sara Vallerani (Rome Tre University), Elizabeth Storer (LSE) and Costanza Torre (LSE). It was reviewed by Santiago Ripoll (IDS, University of Sussex), with further reviews by Paolo Ruspini (Roma Tre University) and Eloisa Franchi (Université Paris Saclay, Pavia University). 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.Wellcome TrustForeign, Commonwealth & Development Office (FCDO)