The hope in government circles is that increased vaccination rates and warmer weather will bring infections down to manageable levels and make it safe to welcome visitors for the sake of the economy. The numbers suggest that this will be a higher-risk strategy than is publicly acknowledged.
Greece’s Covid-19 vaccination strategy has been closely aligned with the coordinated EU approach. This has guided the mix of vaccines acquired, the rate of delivery and the policy guidance on administration, while the roll-out process has been perhaps surprisingly smooth and free from controversy to date.
The slow pace of delivery resulting from the EU-led approach may, however, delay the reopening of the economy and in particular the all-important tourism sector. The government has recently begun to hint that it may switch to a more targeted roll-out of the vaccines in a bid to stimulate economic activity.
The national Covid-19 vaccination plan, codenamed “Operation Eleftheria (Freedom)” had its symbolic launch on December 27.
Roll-out in numbers
Greece is working strictly within its vaccine allocation under the EU pre-purchasing scheme, which according to early-stage planning could deliver a total 28.3 million doses from all approved suppliers.
Vaccine doses secured by Greece from each supplier through the EU pre-purchase scheme, December 23, 2020 (Source: National Vaccination Campaign).
The numbers published in the national vaccination plan in December 2020 suggest that in fact Greece quietly under-ordered some of the earliest vaccines to become available, that the EU allocates to member states on a population basis. For example, Greece, with just under 2.4% of the total EU population, could have ordered just over 7 million doses of Pfizer/Biontech in December 2020, but opted to schedule 4.7 million. Similarly, with the Moderna vaccine, Greece could have reserved up to 3.8 million doses based on its population but only scheduled 1.8 million. This is a strategy reportedly followed by several of the less wealthy EU states, which relinquished doses of the more expensive, harder-to-handle vaccines, either on grounds of cost or of practicality, preferring to wait instead for cheaper, more flexible formulations further down the pipeline. For Greece, needing to deliver the vaccine to inaccessible locations like small islands may have played a role in the purchasing decision.
There has so far been no discussion of purchasing vaccines from suppliers outside the EU purchasing scheme such as Sinopharm and Sputnik V, thus side-stepping the geopolitical quandary which has presented itself in neighbouring Balkan countries, as well as in EU member states, such as Hungary - but also limiting the potential speed of vaccination.
There is also no reported agreement to partner with other countries on vaccine distribution or donate vaccines to countries which may lack them. Early on, the Albanian prime minister denied that Greece was the source of its first batch of vaccines to Tirana, which was reportedly offered by an EU member state.
Allowing for conservative purchasing decisions, delivery of vaccines to Greece will follow the EU scheme in lockstep, giving the EMA the first word on the approval of new vaccines, and depending on the political clout of Brussels to ensure their timely supply. By March 30, Greece had received 1.955 million vaccine doses (1,342,380 of the Pfizer vaccine, 147,600 of Moderna and 465,600 of AstraZeneca) according to the ECDC.
According to the Ministry of Health, in April the country is due to receive a total 1.1 million doses of the Pfizer vaccine, 450,000 of AstraZeneca and 100,000 doses of the Moderna vaccine. Johnson&Johnson are scheduled to deliver 1.2 million doses over Q2. The original scheduling had included 5 million doses of the AstraZeneca vaccine by the end of April. This now looks unlikely to materialise due to the well-publicised delivery bottleneck which the subject of a dispute between the European Commission and the Anglo-Swedish company.
Advance delivery schedules are not available beyond this, however if Greece were to keep following the EU path, it could expect to see a delivery curve along the lines of the one recently published for Germany, which foresees a substantial step up in deliveries in the third quarter, leading to a potential glut of vaccines in the EU by year end. Greece has continued to administer the AstraZeneca vaccine according to the EMA’s guidance, and did not emulate the decision of several European countries to temporarily suspend its use due to feared side-effects.
According to the government’s roll-out strategy, the capacity will be in place to deliver up to 2 million doses a month once the programme is in full swing. The present rate averaging around 28,000 shots a day translates into roughly 800,000 administered per month, and there are plans to accelerate to 1.5 million shots per month in April.
The strategy is functioning well so far
By mid-February, there were more than 750 vaccination points established nationwide in public hospitals and health centres, with plans for another 272 by the beginning of April. Two mega-vaccination centres have been set up in Athens and Thessaloniki under the administration of the army, which also manages logistics and distribution, while two more are due to become operational in Athens by the beginning of April.
Vaccination appointments are booked through a centralised online platform or via the recently-launched e-prescription system. For the current crop of two-dose vaccines, both vaccination appointments are booked concurrently, reserving two doses from the existing supply.
At the time of writing (March 30), Greece is close to the EU median in the absorption of vaccines, having administered 78.5% of the doses received.
Covid-19 vaccination uptake in Greece vs other EU countries. (Source: ECDC Covid-19 Vaccine Tracker).
To date, 5.7% of the population (a little over 550,000 people) are fully vaccinated, and 11.7% (just over 1 million people) have received at least their first shot, placing Greece marginally above the EU median in terms of full vaccination, and a little under for the first dose. This means that – along with most of the EU – Greece still has a long way to go to hit the target of vaccinating 70% of adults by the end of the summer, however its own target to administer the first dose to the majority of over-60s by May seems to be within reach.
Regular procedures of vaccination
Vaccination is provided free of cost on the national health system. Its uptake is voluntary, as the Greek constitution precludes compulsory vaccination. However, there is a precedent for requiring vaccination in certain settings where it is in the public interest (for example in public day care facilities).
The vaccination strategy is directed by the National Vaccination Committee, an expert body convened by the Department of Health. The Committee has so far followed a fairly conventional path with respect to prioritising by occupation (healthcare workers, key personnel), age group and known medical conditions. Mass vaccination of remote islands has been undertaken along with the older age groups for reasons of access.
Public attitudes have shifted significantly in favour of vaccination over the course of the last few months, while the significant scepticism noted earlier in the pandemic seems to have abated. In February, 59% of respondents to a Pulse/Skai survey said they would definitely get vaccinated, compared to 37% in November 2020. At the same time those categorically opposed to being vaccinated have declined from 14% to 8%. The approval and availability of vaccines, along with the publicity given to the successful mass roll-out in Israel may have helped to shift public attitudes.
An earlier poll by Metron Analysis/Mega had found attitudes to the vaccine divided along generational lines, with 80% of those aged 65+ in favour of receiving it, compared to 54% in the 17-34 age group.
No significant awareness campaigns
Aside from weekly televised briefings, very little resource has been invested in public awareness campaigns promoting vaccination, or seeking to dispel the resistance to it. The first TV spot, designed around references to 1960s films, clearly struck a note with the older audience who clearly needed little convincing to begin with. A second, recently launched, features two veteran players from the glory days of Greece’s national basketball team. More unconventional messaging may be required to reach the more resistant younger age groups who are also less trusting of traditional media.
Uptake has also been worrying low among medical personnel. Despite being included in the first priority group, only 48% of healthcare workers in Greece have received a first dose, well below the EU median of 60%, though fully vaccinated healthcare workers are closer to the European average of 44%. The uptake is higher among doctors than among nursing staff (77% and 51% respectively), leading some to suggest that uptake is related to educational level. Recent hospital outbreaks have been linked to unvaccinated healthcare staff. A twice-weekly testing regime has been introduced for unvaccinated hospital staff to manage the risk.
Greece is currently experiencing a surge in infections, and while policy makers are optimistic that the vaccine roll-out will begin to have an impact, there is little concrete evidence to suggest that at the current low rates vaccination is having the desired effect of reducing serious illness among the groups vaccinated. A hopeful indication was given by the head of the vaccination committee who stated in recently that there were no vaccinated individuals reported among ICU admissions.
Public interest issues
The biggest controversy surrounding the vaccination roll-out has involved queue-jumping by politicians and those with political connections, which marred the symbolic launch of the campaign. The government was forced to cut back the list of “critical” staff included in the first priority group after several of them, including junior ministers and officials in their 40s and 50s, posted selfies from the vaccination clinic.
Other aspects of the vaccination programme have attracted less scrutiny than they might merit. They include the procurement process for medical supplies, which has yielded some instances of overpricing and monopolistic behaviour in relation to the purchasing of rapid tests.
The role of private sector donations to the vaccination campaign also remains underexplored. Private donations such as those from the Stavros Niarchos Foundation have been pivotal in supporting the health system during the pandemic, and it was recently announced that a major property developer would fund Athens’s second mega-vaccination centre. The potential implications of such gestures for the relationship between the state and its growing list of benefactors have not been part of the public discourse on the healthcare crisis.
An issue more likely to emerge as a flashpoint is the future direction of the vaccination campaign, after the government hinted that an estimated 800,000 workers in the tourism sector could be given priority for vaccinations in a bid to kick-start tourism in May. Reopening tourism is high on the government’s agenda - the sector amounts to about a fifth of the country’s GDP and around 10% of jobs, and the prospect of another “lost summer” is one which policy makers would prefer not to contemplate. No further details of this plan have been released, however, and it is not clear that it is a foregone conclusion.
Efforts to ease tourism
The Greek government under PM Kyriakos Mitsotakis spearheaded the initiative behind an EU “Digital Green Certificate”, a certificate based in part on vaccination status, in a bid to ease cross-border travel and help tourism. The certificate looks likely to be approved after the European Commission agreed to move ahead with planning, however many doubt the scheme will be operational in time for the start of the Greek tourist season, which is scheduled for May 14.
On the other hand, the concept of “Covid free” islands, which briefly made the rounds in the international press before being disowned by the government, retains some of its currency in travel marketing circles despite the practical and ethical questions it raises. While some remote islands have achieved almost total vaccination coverage, this was apparently done for practical reasons, to avoid repeat deliveries of small vaccine batches.
On March 23, Greece officially opened its borders to Israeli visitors with proof of vaccination, Covid-19 antibodies or a negative PCR test, in what the government clearly hopes will be pilot of a broader reopening in May using similar criteria. There has been strong criticism of the way borders were reopened in June 2020, a decision which was followed by disappointing revenues and spiralling case numbers. In the aftermath, almost half of citizens blamed tourism for the surge in infections. The government, however, vehemently denies the existence of a link, and appears determined to push ahead with reopening. This quest appears particularly quixotic, given that the country is currently battling the worst infection rates of the pandemic to date, which have repeatedly delayed the reopening of the vast majority economic activities after more than four months of national lockdown.
The hope in government circles is that increased vaccination rates and warmer weather will bring infections down to manageable levels and make it safe to welcome visitors for the sake of the economy. The numbers suggest that this will be a higher-risk strategy than is publicly acknowledged. Vaccination rates domestically will remain well below the population immunity threshold 70% even if the efficiency of the roll-out to date is combined with a big push over the next couple of months. Meanwhile any plan to divert vaccines selectively to specific economic sectors is likely to prove practically challenging, divisive, and probably ineffective as a defence against the virus.
However, all of these issues are yet to surface fully in public discourse, which is currently focussed on more immediate concerns, such as the state of the health system and the prospects for reopening the domestic economy.
This blog is published as part of the regional blogging initiative “Tales from the Region”, led by Res Publica and the Institute of Communication Studies, in partnership with Macropolis (Greece), Lupiga (Croatia), Sbunker (Kosovo), Ne Davimo Beograd (Serbia), Analiziraj (Bosnia and Herzegovina), and Pcnen (Montenegro).
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Note: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Institute of Communication Studies or the donor.