First-wave champion Greece stumbles at vaccine roll-out
After suppressing the first wave of Covid-19, Greece was regularly cited as an exemplar in tackling the pandemic. Now in its fourth wave, low vaccination coverage is proving to be the country’s Achilles heel in definitively beating the pandemic.
Following several lockdowns of varying severity (the strictest of which lasted over five months up to the middle of April 2021), the Greek government announced that it is lifting all restrictions, including night-time curfews and capacity limits on indoor venues for vaccinated citizens. The unvaccinated are still subject to entry restrictions for most indoor activities and have to pay for their own workplace testing.
Between the start of the SARS-CoV-2 pandemic in February 2020 and October 8, 2021, Greece has recorded a total 673,317 confirmed cases of Covid-19 and 15,069 deaths from the virus in a population of approximately 10.5 million people. This places the country in 69th position globally for confirmed cases relative to population among the 200 entities tracked by the Our World in Data platform, and in 49th position for deaths, both below the EU average.
Greece is currently battling the fourth wave of Covid-19. The daily case load at the peak of this wave has increased compared to the earlier ones, exceeding 4,000 daily cases on a few occasions. This is due in part to of the dominance of the more transmissible Delta variant over the course of the summer, and in part to the increase in systematic testing which has allowed more cases to be detected.
At the time of writing, Greece is one of the most intensively tested countries in the world with 18.4 daily tests per thousand people according to Our World in Data, ranking 4th globally after Cyprus, Austria and the UAE, while at the end of 2020 it was administering just 2 tests per thousand people. The number of tests increased with the introduction of mass testing in schools and workplaces, and the requirement of Covid status certificates for travel and other activities, both of which were phased in over the summer.
Deaths and serious hospitalisations have not increased at the same rate, a fact that testifies to the efficacy of the vaccines which were introduced at the start of the year. Greece, however, has not been able to control the impact of the virus to the same degree as its peers in Europe.
The country was hailed as one of the success stories of the first wave thanks to low exposure and prompt enforcement of measures, and its Covid-19 death rate was slightly above half the EU average up to the end of 2020. Since the start of 2021 the death rate has exceeded the EU average, and stands 60% higher for the same period than that of Sweden, which famously did not impose a lockdown (Greece spent the first four months of the year under strict lockdown).
More than two thirds of deaths occurred in the nine months after the vaccines became available, compared to the eleven months prior.
While several factors are clearly at play, including patchy imposition of and compliance with public health measures and a weak healthcare system, it is clear that Greece has failed to make full use of the plentiful availability of vaccines to suppress the most serious effects of Covid-19 in the way that comparable European countries have.
Freedom out of reach
Greece did not hit the EU’s target of vaccinating 70 pct of the adult population by the end of the summer (the EU as a whole also failed to achieve the overall target despite several notable exceptions proving that it was possible). It also failed to make significant progress on its own target of delivering the first dose to the majority of over-60s by the summer.
Just over 60% of the population had received a first dose by October 8, and 58% were fully vaccinated, according to the ECDC. Across the EU, 68 % of the population have received one dose, and 63% are fully vaccinated. According to the ECDC’s most recent rapid risk assessment, falling below these levels, as Greece has, means the country is still at risk of experiencing a significant surge in cases, hospitalisations and mortality going into autumn and winter.
The situation is even more concerning for the older, more at-risk age groups, where significant portions of population are unvaccinated and Greece significantly lags its peers. At the end of September coverage with one dose of the 80+ age group stands at 74 %, meaning one in four in the most senior age group remains unvaccinated (compared to 100 % vaccination rate in seven of its European peers and 86.5 % EU-wide). For the 70-79 group vaccination coverage is at 83 % (compared to the EU-wide figure of 88 %) and for 60-69-year-olds the coverage is 80 % (compared to 85 % EU-wide). Portugal, to which Greece is routinely compared due the similarity in population size and economic scale, has vaccinated 100 % of its citizens over the age of 60.
Greece’s “Operation Freedom” vaccination programme kept pace with the rest of the EU up until the start of the summer, but the daily vaccination rate dropped precipitously from mid-June onwards from over 100,000 doses a day to the current rate of around 25,000. By contrast, European countries which lead in vaccination coverage, like Portugal and Ireland, accelerated their vaccination delivery over the summer months.
While government officials carefully avoid using the word “failure” and continue to defend the vaccination roll-out, it is now being widely acknowledged that Greece is entering the autumn with vaccination coverage well below safe levels.
Moreover, surveys suggest that only a small fraction of the unvaccinated population is prepared to get vaccinated in the immediate future (for example in a recent sounding only 2% of respondents said they have an appointment booked).
Gaps, blind spots and miscalcuations
Several factors can be blamed for the stalling of the vaccination programme, but it is clear that the authorities underestimated from the outset the degree of vaccine hesitancy in the general public, and as a result did not design their campaign appropriately. A scientific study published near the start of the vaccine roll-out in Greece found that almost half the adult population was hesitant towards the Covid-19 vaccine, and particularly younger people, those relying for information on social media and non-official sources, and people espousing the theory that the virus was man-made.
The roll-out strategy, however, while near-flawless logistically, did not include a strong persuasion element, while the public information campaign was heavily skewed towards the traditional media favoured by the groups who were already persuaded. Moreover, the process of booking appointments was almost entirely digital, a feat justly extolled as part of Greece’s “digital transformation”, but seemingly ignoring the low levels of digital literacy in the general population.
Polls conducted more recently confirm the weak points in the campaign and show that the authorities failed to adapt their approach sufficiently over the intervening months. A survey published in August by Kapa Research compared attitudes between vaccinated and unvaccinated citizens, and found two sharply divided worldviews: the unvaccinated were much more likely to be informed by social media, and showed much lower trust in public institutions, with the exception of social media and the church.
In a repeat of the first generation of Covid measures in 2020, the authorities have been preaching to the converted, while very little effort has been expended on identifying and persuading the doubters.
The government’s frustration over low vaccination rates, which became evident as the summer progressed, found a solution in the introduction of a vaccine mandate for healthcare workers and Covid passes for most indoor activities. While this may have solved highly localised problems (e.g. preventing hospital outbreaks), it appears to have stoked wider social resentment. It was pointed out at the time that the government chose to ignore the recommendations of its own committee on medical ethics, which had advised it to exhaust all avenues of consultation and education before making vaccination mandatory in hospitals.
Beyond the healthcare professions, reaction to pressure to get vaccinated is cited among the top three reasons for avoiding the vaccine, alongside concerns about the vaccines’ effectiveness and safety. While anti-lockdown and anti-vaccination protests had been rare and sparsely attended events up until this point in Greece, the vaccine mandate brought out the first organised rallies, apparently promoted by quasi-religious and ultra-nationalist fringe groups calling for general civil disobedience.
There has also been a lack of clear political consensus as the pandemic has progressed and the opposition has sensed weakness in the government. While only the far-right Greek Solution party, one of the smallest in Parliament, took an overtly vaccine-sceptical stance, the main opposition party, left-wing SYRIZA, allowed its former Deputy Health Minister to go on anti-vaccine tirades for months before being reined in by the party leadership. Similarly, the powerful and influential Church of Greece has tolerated mixed messages from its ranks on the subject of the pandemic and vaccination.
Regional disparities in vaccination rates, which have become painfully evident through localised outbreaks in Crete over the summer and in northern Greece at the current time, highlight another weakness of the roll-out, which is that it was for the most part highly centralised and driven from Athens. While more proactive local efforts enlisting a variety of persuasion tactics and trusted local figures have shown some degree of success, there has generally been a lack of imagination and an over-reliance on the top-heavy bureaucratic structures which traditionally characterise the Greek state.
One of the unexpected developments of the past year has been the surprise success of the tourism season. Despite several Covid outbreaks in busy resort areas, including a fairly serious one in Crete which threatened to bring the regional health system to its knees, the government’s gamble on opening up the borders and lifting restrictions on interregional travel and most leisure activities seems to have paid off better than the more limited attempt in 2020 – at least in economic terms.
At the start of the summer season, the government and the tourism industry had set the goal of equalling half its pre-pandemic income from the sector, which at the time seemed highly ambitious. The recent figures from the Bank of Greece suggest that the target of 8-9 billion euros will be achieved well before the end of the year, while flight and accommodation bookings suggest that visitors will continue coming well into autumn, after the end of the traditional tourism season. These positive developments have allowed the government to improve its economic growth expectations for 2021 from 3.6 % to 6.1 % of GDP.
It is perhaps because of the euphoria brought by tourism – both the ability of Greeks themselves to enjoy a holiday, and the positive impact on the national economy - that the general public has been willing to tolerate daily case numbers averaging between 2,000 and 3,000 throughout the summer, and double-digit daily fatalities climbing above 40 going into September, which experts have taken to describing as “a busload of people going off a cliff every day”.
The euphoria only goes so far, however, and the combination of the tapering of pandemic support programmes, rising inflation, and the fear of a winter surge of Covid are leading to dissatisfaction and pessimism.
Heading for a winter of discontent
Polls now regularly find more than half of Greeks are unhappy with the way the government has handled the pandemic – for example the latest sounding by Metron Analysis for Mega TV shows dissatisfaction in this area at a record 53 %. And while the conservative New Democracy government remains unchallenged and is said to be considering early elections to lock in another term, general assessments of its competence are slipping (51 % told the same pollsters they believe the country is going in the wrong direction, compared to 38 % with a positive outlook). The recently announced 3.5-billion-euro package of tax cuts and support measures met with a flat reception from voters.
The government stubbornly refuses to accept the responsibility for any missteps. This is the case both for the pandemic and the catastrophic forest fires that ravaged the country in August. However, in a series of moves over recent weeks all the faces of the pandemic campaign have been removed from centre stage. These include Health Minister Vassilis Kikilias, Deputy Civil Protection Minister Nikos Hardalias who was responsible for implementing the pandemic lockdown measures, and most recently the head of the National Public Health Organisation EODY, the authority in charge of epidemiological surveillance and testing. It is also rumoured that the government’s pandemic advisory committee is headed for a shake-up.
While the official narrative posits that these changes signal the start of a post-pandemic “return to normality”, the epidemiological evidence suggests that such an interpretation is premature – and the public seem unconvinced too. While the government spokesman recently repeated the assertion that there will be no more lockdowns like we have previously known, 4 in 10 Greeks appear to think a new general lockdown is likely.
If history is any guide, their doubts may not be misplaced.
The blog was created as part of the “Tales from the Region” initiative led by Res Publica and Institute of Communication Studies, in cooperation with partners from Montenegro (PCNEN), Croatia (Lupiga), Kosovo (Sbunker), Serbia (Autonomija), Bosnia and Herzegovina (Analiziraj.ba), Albania (Exit), Slovenia (DKIS) and Greece (Macropolis), within the project "Connecting the Dots: Improved Policies through Civic Engagement" with the support of the British Embassy in Skopje.
*Georgia Nakou writes about current affairs, policy and culture. She has several years' experience in the alternative finance sector, has worked for think tanks in the energy sector, and produced influential academic research. She maintains an interest in her first field of study, archaeology.