Exactly a year ago, Emmanuelle Seris, an emergency-services doctor in the East of France, pleaded on YouTube for people to maintain social distance and mask up, as overstretched health workers struggled with soaring COVID-19 cases. “We are tired,” she said in her message, speaking from one of France’s hardest-hit regions.

Now Seris’s hospital faces a new problem: About 10 staff members have been suspended from their jobs for refusing to be vaccinated, under France’s hard-line vaccine mandates, which President Emmanuel Macron imposed in mid-July. They are among thousands of health workers suspended without pay, including 3,000 nurses, since the mandate took effect in mid-September.

Even to Seris—fully vaccinated herself—firing unvaccinated staff seems a step too far.

“There were already too few staff in the hospitals in France,” she told Fortune from her hospital near the German border; Seris, a spokesperson for the French emergency-physicians’ labor union, said it was difficult to attract nursing staff in particular. “There are bad working conditions and the salaries are too low,” she says.

Macron’s mandates—and similar measures in Italy, where unvaccinated employees of all stripes now face losing their jobs—are a crucial test for politicians: Will people support such tough measures, or turn against their elected officials?

In Italy, "Green Pass" protesters—so named for the Green Pass certificate that, as of tomorrow, will be required for all public- and private-sector employees to enter a workplace—marched on Rome in demonstrations that turned violent last weekend. And port workers and truck drivers temporarily blocked access to the vital Port of Genoa on Tuesday. Undeterred, Italy’s popular prime minister, Mario Draghi, signed the stringent new workplace rules into effect that same day.

A gamble paying off

Judging by what has happened since France’s strict rules were announced on July 12, Macron’s gamble appears to be paying off.

The rules include barring people from entering cafés, restaurants, museums, cinemas, and sporting events without proof of full vaccination, or fresh negative COVID-19 tests.

Over the last three months, France’s vaccination rates have rocketed, and its COVID-19 cases have plummeted. About 85.5% of French people over 12 are now fully vaccinated—up from 28 million in mid-July to about 49.3 million now, according to government statistics; about 117,000 people in France have died of COVID-19.

The decision to suspend unvaccinated civil servants—including firefighters and even library workers—proved deeply controversial, especially since Macron faces a tough reelection battle next April. His foes seized on the issue, holding weekly protests that at one point brought tens of thousands of people into the streets, with signs like “vaccinated for freedom” and “It’s our choice.”

Risky politics

“It was risky politically, because these are professions that are very popular,” said Emmanuel Rivière, head of international polling at the polling agency Kantar Public. Indeed, millions of French came out to applaud public workers every evening, during the early months of the pandemic—something those who deplore the vaccine mandates have repeatedly pointed out.

Despite that, Rivière says Macron’s decision has been increasingly accepted by the French: “Slowly but surely, the proportion of refusals has declined.” Ironically, Macron risks facing an electorate for whom the pandemic has “become normalized,” Rivière says, depriving him of running as the leader who saved France from disaster.

Jean-François Delfraissy, president of Macron’s scientific advisory council, told Le Monde newspaper on Thursday that the fourth coronavirus wave has had no major impact, thanks to France’s sky-high vaccination rates.

“After a lot of criticism of the French response and the political choices, France is among the best vaccinated countries,” he said. “Our fellow citizens on the whole have been very tolerant of the health restrictions, and for that, I thank them.”

New average daily COVID-19 cases have shrunk from about 25,000 in August to about 5,000 this week. Seris says those in the ICU at her hospital “are unvaccinated.”

The Italian job

Beginning tomorrow, any worker in Italy (in either the public or private sector) who shows up to their workplace without a valid Green Pass will be sent home without pay. Fines of up to €1,500, or $1,740, kick in for those who try to flout the law. It is among the toughest workplace measures anywhere in the world, and it is being cast as a way to protect workers in Italy, a country where labor rights are a central plank to politics.

Even still, the tough measures are doing little to dent the popularity of the Draghi government. The former European Central Bank president has an approval rating of close to 70%, the highest of any G7 leader, and the main opposition party, the pro-business League, is mainly onboard with the move.

In addition, a majority of Italians approve of the Green Pass, unsurprising in a country where more than 80% of adults 12 and over have received at least one COVID jab.

Still, rifts are appearing. A day after Draghi signed the mandate into law, alarming new data emerged detailing how large a disruption this could become for the eurozone's third-biggest economy. According to a government document seen by Reuters, a combined 23% of private and public sector workers have no valid Green Pass, fanning fears the new no-pass, no-job law will create massive labor shortages in the middle of a much needed economic recovery.

Italy's biggest industrial lobby, Confidustria, has backed the Green Pass as a way to maintain workplace safety. But fears of a worker shortage are growing. On Thursday, a head of one of the country's main logistics and shipping lobbies told the Italian newspaper Corriere della Sera that it estimates the new workplace mandate will force 30% to 40% of its members, mainly truckers, to sit out work beginning tomorrow. "And keep in mind that this is a sector impacted by a chronic lack of personnel," said Umberto Ruggerone, president of Assologistica-Confindustria.

“Their choice”

As Paris increasingly becomes nearly a fully vaccinated city, life has changed dramatically in recent weeks.

Cafés and restaurants are packed, as are museums—all of whose staff scan vaccination QR codes at the door.

Huge public events are back. Two weekends ago, more than 20,000 people packed the Champs de Mars lawns under the Eiffel Tower, for a concert with Elton John, Ed Sheeran, and the Black Eyed Peas; booking a ticket required uploading vaccination proof. The school calendar includes regular outings, including trips to the theater—unimaginable a year ago, when theaters were all shut.

Despite that, thousands remain unvaccinated—even at the risk of losing their jobs. Seris says fewer than 10% of nurses have refused COVID-19 vaccines. Yet even so, she believes they should not face punishment, saying, “It is their choice.”

More health care and Big Pharma coverage from Fortune:

• Experts warn of a resurgent flu season and a ‘twindemic’ winter

• Vaxxinity CEO says the U.S. needs more vaccine options

• New U.S. COVID cases are down 21%. See how your state is doing

• Commentary: How to find the best healthcare benefits deals

• India is unlocking its borders to tourists after 18 months. Some say it’s too soon

This story was originally featured on Fortune.com