Mandatory vaccination for the age group of sixty and over in Greece

—Fereniki Panagopoulou, Assistant Professor, Panteion University (Greece)

The vaccination programme in Greece, notwithstanding the fact that it was impeccably organized, did not bring about the desired results. It did not convince a large part of the population and, consequently, it did not lead to the attainment of a wall of immunity. In this context, the Greek government announced that vaccination will be mandatory for persons over the age of sixty, whereas it also imposed a corresponding monthly fine of EUR 100. Only those infected within a hundred and eighty days from the above announcement, as well as persons who cannot receive the vaccine due to documented health reasons, are exempt from this obligation.

In light of the above, it is reasonable to wonder whether this measure actually constitutes a form of indirect compulsion, which stands in violation to our right to determine what shall be done with our own body.[1]

Is this limitation imposed on such a large part of the population in compliance with the principle of proportionality?[2] The answer to this question must be determined based on the acceptance of the premise that the freedom to exercise our constitutional rights does not entail the freedom to transmit the virus.[3] We shall examine, as a first step, whether making vaccination mandatory for this particular age group is a measure that can be deemed appropriate. Without a doubt, the answer to this question is in the affirmative. If our fellow citizens, who are over the age of sixty, get vaccinated, then our health system will be able to take a much needed respite, as the instances of hospitalizations in this age group will be reduced. Medical data in Greece speak for themselves:[4] a) nine out of ten deaths due to the coronavirus concern citizens who are over sixty years of age; b) seven out of ten  patients who are intubated are over the age of sixty; c) eight out of ten patients who are intubated are not vaccinated; d) in countries such as Portugal and Denmark, where the vaccination rate in this particular age group has reached 99%, the pressure on the health system and the loss of human lives is up to ten times lower compared to the situation in Greece. Therefore, making vaccination mandatory for this age group is anticipated to have a positive effect on the operation of the long-suffering national health system.

On a second level, the question whether this measure is necessary must be assessed. In this context, it is examined whether other milder, but equally effective measures, are available, such as information campaigns on vaccination. Establishing mandatory vaccination requires the exhaustion of the effort to persuade people about vaccination.. An information campaign did take place, however it did not reach its goal. Is there a milder measure than imposing a monetary penalty? The conversations currently taking place about banning unvaccinated persons from Intensive Care Units can, in no way, be regarded as a milder measure. Likewise, imposing a form of lockdown for those not vaccinated could, arguably, prove to be more effective, but it would also make the situation even more suffocating for them. And what if our fellow citizens were to voluntarily and self-willingly choose not to expose themselves to other people and confine themselves?[5] This approach would be milder but not as effective, as it would not be possible to guarantee that this vulnerable age group would never be exposed to the virus.

What appears to be more challenging is the examination of proportionality in a narrow sense. At this point, what needs to be considered is whether the intervention to our right to determine what shall be done with our own body takes place in harmonious balance with the need to protect public health. In this respect, it is crucial to opt for the solution which, in the context of the in concreto balancing exercise, takes into consideration the entire sum of the possible or concurrently conflicting interests, while, at the same time as serving the remaining public interests, preserves the core of the right to the protection of health intact.^[6] Under ordinary circumstances, mandatory vaccination conflicts with the right to self-determination.^[7] A person cannot be subjected to something that may bring about (even entirely isolated) side-effects. The rule is that vaccination is recommended, and in some cases strongly so, but it is not imposed; therefore, non-vaccination should not be linked to adverse consequences.^[8] Nevertheless, should vaccination be deemed medically required for the immediate protection of public health, it may be made mandatory in exceptional circumstances, particularly in relation to specific population groups rather than against the entire population at large. Our fellow citizens who are over the age of sixty constitute a targeted population group. This is the case as, in view of scientific evidence, they constitute a vulnerable group that requires the attention of a considerable part of our health system’s resources. Nevertheless, such an imposition cannot be absolute. One must provide for exemptions from mandatory vaccination, based on purely medical reasons, for persons for whom vaccination is not recommended. Furthermore, the application of a monetary fine across the board has also been put under scrutiny. The monthly penalty of EUR 100 has a different value depending on each person’s financial circumstances: for someone who is unemployed it is overwhelming, whereas for a person who is well off it almost seems negligible.[9] Nevertheless, administrative penalties cannot, by their very nature, be proportionate. Violating a red light carries a fine that is the same for everyone, irrespective of whether they are rich or poor. Another aspect that has been challenged is the fact that the age group for which mandatory vaccination has been imposed is possibly one less likely to transmit the virus, in comparison with younger persons, for example.[10] The argument against this view is that it is primarily cases of persons of a more advanced age that have led to Intensive Care Unit congestion and, thus, it is for this reason that it is imperative that they should get vaccinated. Lastly, the age discrimination related to the imposition of mandatory vaccination for our fellow citizens who are over the age of sixty[11] is seen as one that does not violate the principle of equality,[12] as it is based on scientific data. Those aged sixty years or over are statistically at a higher risk of developing serious illness due to COVID-19 than younger persons.

Something had to be done – and it was right that it was done, as the health system had genuinely reached its limits. It seems to be working, too, as vaccination appointments in this age group soared right from the first day when it was announced.[13] To be able to have health and self-determination, you have to be alive.[14]

Suggested citation: Fereniki Panagopoulou, Mandatory vaccination for the age group of sixty and over in Greece , Int’l J. Const. L. Blog, Dec. 16, 2021, at: http://www.iconnectblog.com/2021/12/mandatory-vaccination-for-the-age-group-of-sixty-and-over-in-greece/

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[1] See Kostas Chrysogonos, Mandatory vaccination is in contravention to the Constitution, CNN Greece, 30.11.2021, available at: https://www.cnn.gr/ellada/story/291502/xrysogonos-sto-cnn-greece-syntagmatiko-provlima-logo-tis-ypoxreotikotitas-ton-emvoliasmon.

[2] See the analysis by Fereniki Panagopoulou, Making vaccination for the those in the age group of sixty and over mandatory, Syntagma Watch, 1.12.2021, available at: https://www.syntagmawatch.gr/trending-issues/h-ypoxrewtikothta-tou-emvoliasmou-sthn-hlikiakh-omada-anw-twn-ekshnta-etwn-apopsi-i/.

[3] See Andreas Dimitropoulos, In the context of emergency healthcare requirements, rights undergo institutional adjustment, Vice, 1.12.2021, available at: https://www.vice.com/el/article/7kbb7y/tesseris-syntagmatologoi-miloyn-sto-vice-gia-ton-ypoxrewtiko-emboliasmo-politwn-anw-twn-60-etwn?fbclid=IwAR0a_2Fhd9eUwgwtW4NiiBEuRJ2heLylpq44umML19UujH62oGGhpaQrqiQ.

[4] See the Introductory remarks of the Prime Minister, Kyriakos Mitsotakis, to the meeting of the Council of Ministers, available at: https://primeminister.gr/2021/11/30/28073.

[5] See Yiannis Tasopoulos, Mandatory vaccination and intermediary control of proportionality, Syntagma Watch, 2.12.2021, available at:https://www.syntagmawatch.gr/trending-issues/ypoxrewtikos-emvoliasmos-kai-endiamesos-elegxos-ths-analogikothtas-apopsi-i/ ∙Yiannis Drosos, Sputniknews, 30.11.2021, available at:https://sputniknews.gr/20211130/ypohreotikos-emvoliasmos-stoys-60-ki-ano-i-syntagmatikotita-oi-asteriskoi-kai-to-politiko-kostos-20813599.html.

[6] See Dimitra Kontogeorga-Theoharopoulou, Aspects on the study of the principle of proportionality, with reference to decision no. 2112/1984 of the Council of State, in “Offering”, Works in honour of Georgios M. Papachatzis: Public Administration and Administrative Justice, Athens-Komotini 1989, p. 889 et seq. The Principle of proportionality (Substantive issues and questions), in Substantive issues in public law, Dimitra Kontogeorga-Theoharopoulou/Evangelia Koutoupa-Regatou, (eds.), P. Sakkoulas Publications, Athens -Thessaloniki, Greece, 2005, p. 59 et seq.(82).

[7] See National Bioethics Committee, Recommendation on the Vaccination of Children, 26.5.2015, available at: http://www.bioethics.gr/images/pdf/GNOMES/ RECOMMENDATION_Immunization_In_Children_Final_GR.pdf.

[8] See Vassiliki Molaki, The vaccination of children: autonomy or protection of public health? Issues in bioethics and recommendations of the National Bioethics Committee, in: Μaria Kanellopoulou-Botti/Fereniki Panagopoulou-Koutnatzi, (eds.), Bioethical quandaries III, The Child; Papazisis Publications: Athens, Greece, 2018, p. 349 et seq.(359, et seq.).

[9] See George Dellis, The weakest aspect of the measure is the horizontal amount of the fine, Vice, 1.12.2021, available at:https://www.vice.com/el/article/7kbb7y/tesseris-syntagmatologoi-miloyn-sto-vice-gia-ton-ypoxrewtiko-emboliasmo-politwn-anw-twn-60-etwn?fbclid=IwAR0a_2Fhd9eUwgwtW4NiiBEuRJ2heLylpq44umML19UujH62oGGhpaQrqiQ.

[10] See Xenophon Kontiadis/Alkmini Fotiadou, Mandatory vaccination and administrative fines based on an age criterion, Syntagma Watch, 1.12.2021, available at:https://www.syntagmawatch.gr/trending-issues/ypoxrewtikothta-tou-emvoliou-kai-dioikhtika-prostima-me-hlikiako-krithrio-apopsi-ii/.

[11] Cf. Xenophon Kontiadis/Alkmini Fotiadou, Mandatory vaccination and administrative fines based on an age criterion, Syntagma Watch, 1.12.2021, available at: https://www.syntagmawatch.gr/trending-issues/ypoxrewtikothta-tou-emvoliou-kai-dioikhtika-prostima-me-hlikiako-krithrio-apopsi-ii/.

^[11] Source: https://www.thetoc.gr/koinwnia/article/emboliasmoi-sxedon-triplasiastikan-ta-rantebou-apo-tous-ano-ton-60-meta-tis-anakoinoseis-mitsotaki/, which raises questions on the age and social discrimination involved.

[12] Cf. Xenophon Kontiadis/Alkmini Fotiadou, Mandatory vaccination and administrative fines based on an age criterion, Syntagma Watch, 1.12.2021, available at: https://www.syntagmawatch.gr/trending-issues/ypoxrewtikothta-tou-emvoliou-kai-dioikhtika-prostima-me-hlikiako-krithrio-apopsi-ii/.

[13] Source: https://www.thetoc.gr/koinwnia/article/emboliasmoi-sxedon-triplasiastikan-ta-rantebou-apo-tous-ano-ton-60-meta-tis-anakoinoseis-mitsotaki/.

[14] See Stavroula Tsinorema, Ιnterview with Marina Rigou, OW, 7.12.2021, available at: https://www.ow.gr/ygeia/ipoxreotikos-emvoliasmos-poso-sintagmatikos-einai/?fbclid=IwAR07aN4k-lGdq8uUdo6E8vaByttqsgd5NNyRBaRE5r_RjE8jP4QlRc3wn7U.