Italy made COVID-19 immunization mandatory for adults over the age of 50 on Wednesday, becoming one of just a few European countries to do so in an effort to relieve burden on its health-care system and cut mortality.

The legislation goes into effect immediately and will last through June 15.

Since the epidemic began in February 2020, Italy has recorded almost 138,000 coronavirus fatalities, the second largest toll in Europe behind the United Kingdom.

The administration of Prime Minister Mario Draghi had previously made vaccination mandatory for teachers and health professionals, and all employees have had to be vaccinated or present a negative test before entering the workplace since October last year.

Refusal leads in a one-week suspension without pay, but not dismissal.

The order issued on Wednesday makes it more difficult for workers over the age of 50 to opt for a test rather of immunization. It was not immediately obvious what the penalty would be for individuals who violated the regulation, which went into force on February 15.

The order was accepted during a two-and-a-half-hour cabinet meeting during which there were squabbles within Draghi’s multi-party coalition.

“Today’s actions seek to keep our hospitals running smoothly while also keeping schools and businesses open,” Draghi told the cabinet, according to his spokeswoman.

Right-wing League ministers released a statement condemning the over-50 vaccination regulation, calling it “without scientific foundation, given that the clear majority of patients hospitalized with Covid are well over 60.”

The League was successful in modifying an earlier form of the order, which recommended that only persons with proof of vaccination or recent infection be allowed to attend public offices, non-essential stores, banks, post offices, and hairdressers.

The final decision said that certain locations will be available to the unvaccinated as long as they can provide a negative test.

In other parts of Europe, Austria has announced plans to make vaccination mandatory for everyone over the age of 14 beginning next month, while Greece will make it necessary for those over the age of 60 beginning January 16.

Italy was hit by the highly contagious Omicron type later than some northern European nations, but its case load has gradually increased in recent weeks, putting further strain on hospitals and intensive care units.

Over the previous two weeks, it has witnessed an average of more than 150 deaths every day, with 231 fatalities on Wednesday and 259 on Tuesday. On Wednesday, the number of new illnesses reached 189,109, the most since the epidemic began.

According to Our World in Data, over 74% of Italians have had at least two immunization injections, while 6% have only received one. Some 35% have had a third “booster” shot.