Greek government's ageist vaccination policy
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2022)

From Jan 17, 2022, people aged 60 years or older in Greece who have not yet received or booked their COVID-19 vaccination will be fined €50. If they still refuse the vaccination, this fine will be increased to €100, and will continue monthly without any pre-defined end. The money received will be ring-fenced and allocated to the Greek health-care system, which is currently struggling with capacity in response to a rise in the number of hospital admissions related to COVID-19. About 300 000 people in this age group are unvaccinated, approximately 2·7% of the Greek population. The Greek health minister Thanos Plevris was quoted as saying that “the age factor is important because of its impact on the public health service”, presumably referring to the fact that older people are at an increased risk of worse outcomes with an infection. In Greece, about 90% of deaths due to COVID-19 have been in people older than age 60 years. The measure seems to be somewhat effective. News regarding the implementation of a fine for this group was first announced in November, 2021. At that point, about 520 000 people older than age 60 years were unvaccinated; around 220 000 have now subsequently received the vaccine. Greece is not the only state to mandate vaccination—for example, in Austria, Ecuador, and Germany vaccination is to be made obligatory for all adults. In many countries, vaccination is mandatory for health-care workers or public and government workers. Quebec (a Canadian province) is considering fining any resident who has refused a COVID-19 vaccine. But Greece is the only country to fine a group for being unvaccinated on the basis of solely their age. What is remarkable about Greece's mandate is the lack of outcry about age-related discrimination. The argument for mandating vaccination in this population group is that they are at higher risk for worse outcomes from COVID-19 than the general population, and the decision therefore to remain unvaccinated will thus impose a disproportionate burden on the health-care system. However, the same is true of those who have obesity or other underlying health conditions. These risk factors were the conditions used to stratify vaccine availability to different population groups in many countries. Yet no one is suggesting or endorsing fining people with higher body-mass indexes who refuse the vaccine: indeed, when the British cancer charity Cancer Research UK ran a series of adverts in 2018–19 that aimed simply to raise awareness between the scientifically uncontested link between obesity and a range of cancers, it was criticised for oversimplifying complex, multifactorial issues. We do not believe that any such similar demarcation of a society for financial penalty would have been met with so little reaction. The fact that the Greek government's decision has widely been received as a pragmatic decision has concerning implications for how societies regard older people's right to autonomy and self-determination. This is not to be taken as a statement against vaccination. The Lancet Healthy Longevity fully supports vaccination programmes for COVID-19 and as many other preventable diseases as possible. However, this is a concerning development that must be highlighted. Why is it acceptable to fine only older people when there are others who are also at greater risk? Considering that age is the single biggest risk factor for most non-communicable diseases including cancer and cardiovascular disease, does this mean it is acceptable to levy extra charges against older people for their disproportionate use of health care? Everyone's risk of needing health care varies throughout life. For example, if you give birth, you will need more health-care resources than you would normally. This is also the case for those who undertake extreme sports. Universal health care operates on the idea that everyone pays in a proportionate amount and that it is paid back to you in kind at your time of need. Singling out older people is not just discriminatory; it is also astonishingly short-sighted. We might not all have cancer or skydive, but we will all age. If such measures are accepted without demur, then we have not only accepted discrimination against people on an arbitrary basis which is out of individual control, but we have also accepted a precedent which might well come back to haunt us a few decades down the line. Ageism will continue to prevail unless we call it out, and the Greek government's policy is ageist.