In 2011, the Greek economy was in serious trouble: bailout loans from the International Monetary Fund and the EU were required to keep public services open and the public was already exhausted by endless austerity measures.
Then, amid all the pension cuts, clinic closures and tax hikes, something altogether surprising happened. The government found just enough funding to extend its vaccination programme to include healthy adults as well as those with underlying conditions.
Dr Kostas Athanasakis, Health Economist at the National School of Public Health Athens says the move was not as shocking at it may have seemed to outside observers. “It was a pleasant surprise but the key to understanding why vaccination was prioritised is to look at the great legacy of the childhood immunisation programme over the past 40 years,” he told a symposium at the European Public Health Conference in Vienna on 11 November, 2016.
Vaccination coverage has remained high in Greece and is viewed in a very positive light by the Greek public. “Vaccination is considered a public good, and adult vaccination is also seen as a measure that indirectly protects children as well as older people,” Athanasakis said. “At that time the state was constantly taking from citizens. The government wanted to give something back that was highly valued by the people.”
The Greek population is a little older than the EU average so there was political, economic and public health logic to extending protection to citizens of all ages, according to Athanasakis.
Prior to 2011, there was no adult immunisation programme in place, aside from certain vaccines recommended for people in high-risk groups. Since 2011, influenza and herpes zoster vaccination have been recommended in Greece for everyone over 60 years of age, and the pneumococcal disease vaccine has been recommended for those aged 50 and older.
Adult catch-up campaigns were run for MMR (measles, mumps and rubella) vaccine and the Tdap (tetanus, diphtheria and acellular pertussis), herpes zoster (shingles). In 2015, the level of coverage and eligibility expanded further still.
The Greek experience remains a remarkable – and telling – exception. Even faced with the strains of budget cuts, the government found the resources to invest in adult immunisation, putting Greece in the vanguard of a trend likely to spread across the continent.