By MARIANTHI N HATZIGEORGIOU AND MINAKSHI RAJ
As the 2008 economic crisis dominated headlines from late 2007 onward, several countries, including Greece, experienced drastic cuts to public health sector spending.
During the crisis, the IMF reintroduced Structural Adjustment Programs (SAP) and provided emergency funding to many countries with less conditionality than previous iterations of SAPs.
Though these acknowledge the importance of protecting social spending for countries, little action was done to ensure this protection was implemented.
Introduced throughout the EU as an attempt to sustain non-inflationary or minimal inflationary growth, SAP’s carried significant and detrimental global health policy implications as they required countries to “liberate, deregulate, and privatise” economies and reduce involvement in specific economic activities to free the market.
IMF countries remain 3.9 times more likely to make healthcare cuts than other countries.
Since Greece’s own 2008 austerity measures were implemented, the country saw a 20 percent contraction on economic output, a 50 percent reduction in the health budget, 40 percent reduction in hospital spending, and closing and furloughs of neighbourhood and municipal clinics and public health workers.
Additional measures, namely the Memorandum, significantly cut pensions, limiting money available for healthcare spending among elderly citizens and slashed pension entitlements to professionals, including physicians.
The crisis’ resultant brain-drain creates a troubled situation for public health professionals as several reports indicated devastating effects to the country’s public health system.
Given this, public health professionals expected a distressing account of the Hellenic Covid-19 response mirroring that of Spain and Italy.
However, the response from Greece is exemplary and speaks not to the effect of austerity, but rather to the impact and importance of a comprehensive, agile leadership and response plans.
Three key Greek successes
First, they found leadership in science through Dr Sotiris Tsiodras, an Athens-based pathologist and disease specialist, who quickly alerted leaders to the pandemic and was soon thereafter tasked with helping to oversee Covid-19 daily response briefings.
Second, Greece’s response demonstrated unity among its leaders. The collaborative effort of Tsiodras along with national leaders Nikos Hardalias, Kyriakos Mitsotakis, and Vassilis Kikilias has minimised fragmented decisions other countries are observing.
Third, the country was standardised in its implementation of consequences for lockdown violators.
The country acted fast to begin cancelling large gatherings, including carnival celebrations on 20 February, after the country’s third-identified coronavirus case.
Strict and severe penalties including €150 fines were given to individuals who did not follow lockdown measures imposed on 23 March, culminating in about €4.25m in fines collected.
Despite the worry around an efficient public health response given draconian austerity measures, Greece has had notable success in containing spread of the novel coronavirus.
In light of low rates of testing, the small proportion of deaths still demonstrates the impact of extreme social distancing.
On 4 May, Greece introduced thorough reopening efforts to citizens.
Restaurants and hotels are expected to reopen on 1 June, and the country is set to reopen for tourists on 1 July, provided the global epidemic shows signs of decreasing cases.
In a recent interview, prime minister Mitsotakis said he is open to tourists, should a European plan be appropriately “strict and enforceable”, including testing prior to travel and either an antibody or PCR test upon arrival.
While other countries have expedited the reopening of beaches and other tourist destinations to benefit the “local economy”, Greece has demonstrated its sensitivity to individuals’ health and safety.
Given the centrality of tourism to Greece’s economy in addition to the cost of testing on such a scale, Greece’s plan is admirable.
Now for tourism?
History juxtaposed with modernity attracted over 34 million tourists to the Hellenic country in 2019 alone, with earlier 2020 forecasts indicating this would have been another record-breaking year.
Tourism has been central to recovery from the country following the 2008 crisis, with over 20 percent of GDP coming from tourism.
It will remain equally as essential, if not more so, for recovery after Covid-19, but tourism is expected to contract dramatically, possibly to 10 percent of GDP.
Greece will need to strategically consider how to maintain its successful course and balance limiting risk for a rise in incidence while remaining an attractive destination for tourists, especially given the possibility of extended social distancing.
This, as well, should not be a novel concept for the country, as Greece had already announced efforts underway to cap tourists heading to more popular destinations pre-COVID.
This year, however, the efforts will not only concern the local ecology, but also the health of citizens and tourists alike.
Greece has an opportunity here to remain the coronavirus response leader of Europe and prepare for the possibility of delayed entry – or a safe entry – to tourists for the benefit of the nation’s future.
At the same time, Greece will need to be proactive in setting standards for tourists from across the EU as well as from the US and other nations.
They will need to identify screening measures for tourists who are permitted entry by visa from within the EU and simultaneously, become aware of – and reflect on – whether they trust testing measures being conducted in other countries presently.
Although we can anticipate a pause in tourism-related travel, Greece likely will not need to beg for tourists once travellers resume normal livelihood activities.
Additionally, medical practice may also change and require the continued training of healthcare providers who could possibly be called upon by other EU countries for managing responses.
This would present a unique and important opportunity for Greece: promoting inward job creation to provide resources while curtailing the possible brain-drain that could result.
Recent technological advancements with goals beyond healthcare have also supported the region’s progress including in its approach to healthcare.
In Horizon 2020, the EU program for research and technological development, Greece ranked within the top seven countries for technology research and development.
Covid-19 may present an ideal opportunity for Greece to widely implement telemedicine to continue social distancing – in fact, these possibilities are already underway and will benefit Greece in the long term.
Greece should emerge as a leader in the EU for their prompt response following Italy’s outbreak.
The country’s government has been transparent in communicating plans and procedures, resulting in an overwhelming 86 percent approval rating of the partial lockdown and increase of trust towards the government.
Additionally, the government’s distribution of €800 to furloughed employees was critical to deepening this trust.
Lockdown efforts were referenced through the lens of staying safe rather than merely staying home, which have amplified the sentiment of nationalism and pride felt by Greeks.
As such, residents are willing to wait for reopening rather than resisting safety measures and protesting closures for violating their individual freedom.
Recognition should be unconditionally given to a country that has been successful in managing the COVID-19 pandemic has been regarded as surpassing expectations. Their response demonstrates their strength and potential for leadership in their own right. (EUobserver, May 19, 2020)
