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How Greece moved quickly and decisively to keep Covid-19 out

Contractors dressed in personal protective equipment (P.P.E.) remove debris from a home in the Little Venice neighborhood on May 25, 2020 in Mykonos, Greece - Getty
Contractors dressed in personal protective equipment (P.P.E.) remove debris from a home in the Little Venice neighborhood on May 25, 2020 in Mykonos, Greece - Getty
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By all accounts, Greece has had a very successful – albeit unexpected – pandemic so far.

Indeed, as the UK now has the highest Covid-19 death rate per capita, Greece hopes to welcome foreign tourists from June 15. However, it has been suggested by the country’s tourism minister that Britons, along with those from the US and Russia, will face a longer wait before they can return to Greece because of our relatively high infection rate.

At the time of writing, Greece has recorded just 2,882 cases of Covid-19 and 172 deaths. In comparison, Belgium – with a population size similar to Greece – has reported 57,455 cases and 9,334 deaths.

Greece had all the trappings of a Covid-19 disaster waiting to happen: a decade-long financial crisis had weakened the country’s healthcare system, political instability and corruption reigned, and it has the second-oldest population in the EU. It was for these reasons that many experts expected Greece’s outcome to mirror Spain’s or Italy’s, but it managed to defy the odds.

“When the virus first emerged, the Greek health system was under-prepared to respond to a pandemic threat of this nature,” said Professor Elias Mossialos, head of health policy at the London School of Economics, co-director of the European Observatory on Health Systems and Policies and adviser to the WHO and Greek Government on the pandemic.

“Had Greece not recognised its vulnerability and taken early and decisive action, it might be facing a very different situation today.”

 A fisherman cleans fish on May 26, 2020 in Mykonos, Greece - Getty
A fisherman cleans fish on May 26, 2020 in Mykonos, Greece - Getty

When the virus first came to international attention in early January, Professor Mossialos was immediately concerned about the potential for the outbreak to escalate into a global pandemic, and contacted the Greek Government to “raise the alarm”.

At this point, he said, many experts in Europe viewed the virus as closely equivalent to the common flu, and thought a pandemic unlikely.

“Thankfully, the Greek Government listened and took swift action,” he told the Telegraph.

By mid-February, international concern around the virus was intensifying and the Greek Prime Minister Kyriakos Mitsotakis held a special cabinet meeting, which Prof Mossialos was invited to attend.

“Even though case numbers in Greece were very low at this point, the outcome of this meeting was a decision to take pre-emptive action in introducing physical distancing measures such as school closures and bans on large gatherings, swiftly followed by full lockdown,” he said.

On February 27, just one day after the country’s first Covid-19 case was diagnosed in Greece’s second-largest city, Thessaloniki, the Government cancelled the annual Carnival. On March 11 it closed down schools, and within days it limited non-essential travel and bars, cafes, restaurants, malls, cinemas and museums were also shut.

Anyone who came in from abroad had to go through a two-week mandatory quarantine or risk a fine, and everyone in the country was required to notify the Government each time they left their homes.

A coast guard officer wearing a face mask to prevent the spread of the new coronavirus, walks on the dock as a ferry, right, leaves and another one approaches the Aegean Sea island of Milos, Greece - AP
A coast guard officer wearing a face mask to prevent the spread of the new coronavirus, walks on the dock as a ferry, right, leaves and another one approaches the Aegean Sea island of Milos, Greece - AP

At the beginning of the crisis, Greece had just 560 ICU beds, but it now has close to 1,000 today. “Acting early bought time to prepare,” said Prof Mossialos. “Importantly, Greece implemented access restrictions to reduce the risk to care home residents. As a result, there has been very little transmission of the virus within health and care facilities.”

“Greece’s low number of Covid-19 deaths and hospital admissions relative to other Western European countries is largely attributable to this,” he added.

How quickly Governments across the world responded to the virus, and what impact that had on the number of deaths, has become an increasingly fractious topic, with the British Government facing accusations that it didn’t act soon enough.

As to whether Britain could have found itself in a situation more similar to Greece had the Government acted sooner, Prof Mossialos says that is “likely”.

“The early, decisive and transparent actions of several governments in Europe has been paramount to their successes,” he said. “By comparison, after the UK Government’s initial policy – which was to limit the disease’s spread rather than control it completely – was revised, there was a period of mixed messaging.”

“This may have hindered the ability of the NHS and the UK’s public health system, which have long been considered – and indeed remain – among the world’s best, to mount a decisive and coordinated response,” he added.

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If and when a vaccine for the virus comes, concerns have been raised over how long it would take to distribute, and indeed who is able to access it and for what price.

In a bid to assuage these fears, and ensure that any vaccine is distributed more equally and fairly, the EU submitted a resolution to the World Health Assembly this month that proposes a voluntary patent pool.

Simply put, this means that drug and vaccine companies would then be under pressure to give up the monopoly that patents allow them on their inventions, and would allow for more widespread, low-cost manufacturing of any vaccine.

Greece has been an advocate of such an approach: last month, it suggested that EU member states jointly buy patent rights for vaccines against Covid-19 as should they be effective, they can be quickly distributed across the bloc.

“A successful Covid-19 immunisation programme will depend upon both public and private investment in vaccine development, manufacturing and distribution,” said Prof Mossialos, an early advocate of this plan.

“To ensure that private companies are not dissuaded from participating in innovation, they should be rewarded properly for the research and development risk they have taken on,” he said, adding that the Governments which fund the majority of investment should be able to access any vaccine “quickly and affordably”.

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Ending the pandemic, he says, will require “large-scale manufacturing and equitable distribution” – and currently we don’t have the capacity for this.

“We need to safeguard access for vulnerable people in low and middle-income countries and the Global South, who are the most likely to be negatively affected by inadequate manufacturing, inequitable distribution and cost barriers,” he said.

“To address this, and with backing from the Greek Prime Minister, I have suggested that EU member states, the G20 or a similar body buys patent rights for Covid-19 related medical technologies that are proven to be effective, so that manufacturing can be scaled up and they can be equitably distributed to those in need - turning them into global public goods,” he said.

But for many aid organisations, proposals like this don’t go far enough – NGOs such as Oxfam want explicit support for compulsory licensing, where nations can manufacture drugs without the consent of the IP (intellectual property) owner when there is an overriding public health interest.

This, however, is a solution that Prof Mossialos believes has “significant” disadvantages, because it may “discourage private investment into R&D in the long-term”.

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