Greece’s vaccination policy for the undocumented: Confused

Athens, Greece: On the 26th of September 2021, the Minister of Health, Thanos Plevris, announced in a morning broadcast, the decision to grant a Temporary Health Certificate (PAMKA) to third-country (undocumented) nationals residing in Greece for the purpose of vaccination.

Ten years earlier, as an MP for the Popular Orthodox Rally party (Laikós Orthódoxos Synagermós), Plevris, himself stated that migrants arriving in Greece should not be entitled access to food, water, and health care.

The COVID-19 pandemic vaccination strategies highlighted inequalities in national health systems across Europe. It also revealed a striking contradiction at the political level, as Eva Constantaras, data editor at Lighthouse Reports, told Solomon in an interview on the occasion of a recent investigation published by the Netherlands-based investigative outlet.

The contradiction refers to the realization by many governments that although anti-migration policy can play well on the national level, it actually is in their interest to integrate migrants and refugees into their health systems, especially in times of global pandemic.

The cross-border, month-long, open-sourcing survey, Vaccinating Europe’s Undocumented: A Policy Scorecard, focused on the vaccination policies regarding undocumented people, adopted by 18 European countries, including Greece. Constantaras, research manager of the investigation, spoke to Solomon about the challenges of the data collection, the methodology followed and the comparative analysis mainly focused on Greece.

Greece’s overall score: “confused”

According to the scorecard by LR, Greece is among the countries that have been characterized as “confused”. Greece’s policies appear vague and until recently, the language in official documents was unclear, referring to the general population and prioritizing vulnerable groups such as specific age groups, people with underlying diseases, and health workers.

Moreover, although vaccinations of individuals from refugee and migrant populations residing in detention facilities on the islands and the mainland have been initiated, the national vaccination policy did not explicitly include nor exclude undocumented people from the vaccination plan.

As for the budget for the national vaccination campaign, although it is available publicly and online, there is no additional information on whether there is going to be a specific amount for the vaccination of undocumented people. According to media reports, the vaccination plan for undocumented people will be included in the ratification of the Donation Agreement between the “Stavros S. Niarchos Public Benefit Foundation” regarding the COVID-19 pandemic, which was approved by the Hellenic Parliament on October 1, 2021.

The country also had a weak confidence score which is driven by the lack of information on marginalized communities including undocumented people. According to the World Data and the official government data of Greece, as of the 28th of December 2020 and by the 13th of December 2021 the number of fully vaccinated people stood at 6,774,449. However, no data has been recorded regarding the number of vaccines given to migrants or asylum seekers, nor morbidity and mortality data regarding these groups. In addition, in Greece, no systematic effort to record the number of undocumented people has been published, causing a problem of underreporting.

For over two years, coronavirus has impoverished the living conditions of refugee and migrant communities in Greece, many of which live in crowded and dire conditions. Now, the government’s vaccine “amnesty” –only for the date of the appointment– is designed to encourage those without legal status to get vaccinated for public health. Pre-existing limited trust in the authorities, would however,  most likely prevent undocumented people from getting their jab and/or accessing treatment.

The Interview

What inspired you and Lighthouse Reports to take a closer look at the national vaccination policies of undocumented people in Europe?

One of the very first themes that Lighthouse Reports ever investigated was migration. Part of the idea was building a network of migration reporters across newsrooms who have done a lot of non-data-related stories. For example, investigations on illegal farm labor. When I came on as data editor, the migration newsroom wanted to do a data investigation.

But a data investigation about an undocumented population is pretty tricky. There’s no good data on the number of undocumented people in each country. For example, there’s no data on how many undocumented people have become sick with coronavirus, how many have died, how many have been vaccinated; those are all of the obvious things to measure in order to figure out whether or not undocumented people are receiving health care.

Politicians realize that sort of being “anti-migrant” is good politics. It plays really well, on the national level, but it’s actually a very bad policy. And that was our starting point. This weird contradiction when politicians are saying that they’re “anti-migrant” and that they’re strengthening their borders, but in reality, they’re kind of starting to realize that the best thing to do for the country is to integrate those populations into their health care systems and educational programs.

Who did you work with and how did you collaborate?

What we did was controlled crowdsourcing. We worked with people who were either in the Lighthouse Reports network or in the larger data journalism community.

We also worked with data journalism students from Birmingham University -Paul Bradshaw, who ran Help Me Investigate, has a lot of experience working with students doing crowdsourcing projects.

It’s quite a lot of work because you have to get all of the volunteer researchers trained on where to find all these policy documents and statements, you have to review everything they’ve gathered, and make sure it’s comprehensive. And then what surprised us most was that the sorting process took a very long time because we had to verify and standardize the way data were interpreted.

What were your sources of information? As a data journalist, how do you collect data where there is none?

We did a policy review. We only used official documents, such as official national vaccine policies, and official statements made either in press releases or to the media. We tried to figure out both on paper and in their discourse, what politicians were saying about what their official vaccine strategy was.

First, we thought we were going to focus specifically on what they’re saying about vaccinated undocumented people. But we realized most of them were saying nothing. We had to expand the scorecard to measure how we could use other ways to figure out what are the proxies that they’re using to say whether or not they cover undocumented people and so to measure how hostile or welcoming a country was. For example, we measured how inclusive they are of people without internet access, because a lot of undocumented people don’t have internet access.

Lots of countries’ policies are vague on purpose. In some cases, we suspect they’re not saying anything, because they actually are vaccinating undocumented people, but they don’t want to be public about it, because they don’t want the populist backlash.

According to the scorecard, Belgium is one of these countries; the confusing countries in the middle. But then there are other countries that we think don’t have a good system. For example, Germany has a very inflexible system towards undocumented migrants, because you need a national health care number to pay for any health care service. So even if they were to say they will vaccinate undocumented migrants, as soon as the undocumented migrant tries to pay for it, they’re going to hit a wall.

Another characterization is closed-door countries. We have open and accessible countries, and then we have confusing countries. So I think that we didn’t realize that so many countries would be so unclear on their policies. And that’s why in the end, we brought the expert interviews into explaining. Everywhere we could find we had an expert in migration healthcare issues, trying to sort of reality check.

What tools and methodologies did you use to measure the data into categories? 

We consulted with PICUM, the Platform for International Cooperation on Undocumented Migrants. They put us in touch with many grassroots organizations, and we talked to them about what we should measure in terms of barriers. So they’re the ones that brought up issues like privacy guarantees.

But we had to restructure or even eliminate some of our questions. For example, if there was a question that most researchers answered as “unknown”, we had to eliminate the question because we didn’t have enough data to answer that question. So, a lot of things that we would have liked to know, we just weren’t able to find the answers to.

What does your scorecard measure?

I think it’s very important to say what it doesn’t measure. It doesn’t try to measure any concrete information about how many undocumented people have been vaccinated, how many are hospitalized or died. We were not able to find any metrics, specifically about the concrete healthcare impacts of the pandemic on undocumented people.

What does it measure? It looks at how open vaccine policies are towards undocumented people.

The first category is “policy transparency” which evaluates government efforts to make national vaccine policies available to the public. Is the national strategy online? Have the politicians talked about their policies online and what the rollout looks like?

The most important category, which was weighted the highest is “undocumented access”. Do official written documents say that they’re going to vaccinate undocumented people? Do they have the same choice of the vaccine as other people or do they prioritize in the same vulnerable categories as other people?

Those are the questions we wanted to get to, but in most cases, there were no answers. In most cases, the policies did not mention specifically whether undocumented people could get it for free, whether they could get it without an identification. I think that was the most frustrating because there was just a lack of transparency.

The next category, “marginalized access”, attempts to evaluate how a country is accommodating the needs of other vulnerable groups. It looks at people living in housing insecurity, or detention centers, or people with no internet access. Are those policies addressing misinformation? Are they providing services in different languages? So, looking bigger than just undocumented.

And then, our last category is pretty crucial: What are the privacy guarantees? Are there assurances provided that data collected before and during vaccination will not be shared outside health authorities?

We used those categories to try to figure out holistically, how friendly a country’s COVID-19 vaccine policy is towards undocumented people.

What were some of the challenges you have encountered during the data collection process, especially considering that some countries have different regional systems?

I think our biggest limitation was countries that have completely decentralized systems, for example, Italy and Spain. It’s a big mystery for those countries that don’t have national-level policies, what’s happening there. We consulted with a lot of grassroots organizations in the design of the program. We were relying a lot on those organizations to figure out where we should be doing country-level investigations.

In Belgium, for example, they said that Brussels and some of the major cities are doing a very aggressive and very good job of vaccinating undocumented people. And since that’s where most of them live, it almost becomes a moot point that the national policy is not very good. So we were looking specifically for these examples where we should investigate where the policy and what’s really happening might not match up. That’s then where we try to engage a local migration reporter to go and explain what’s happening there.

Also, when we looked at Cyprus or Luxembourg, we did a calculation for our confidence score, which was basically the number of unknowns divided by the total number of questions. And so we had three countries that fell below like 66%. And so, over a third of the answers were unknowns. Finally, we decided to eliminate those because we weren’t feeling confident enough about the results.

What were some of the surprises you encountered during the investigation? 

The poor performers were not that big of a surprise. Countries like Poland, the Czech Republic, Slovakia. But, in Prague, we had a journalist saying that they’re doing a pretty good job of trying to vaccinate undocumented people, which, again, was a surprise to us considering the hostility at the national level. And then sort of at the other extreme, Portugal, which was our top performer. People in Portugal said that the policy looks good on paper. But in reality, it’s not nearly as organized as the policy makes it look. So there’s kind of a parallel system.

Also, you would think Greece would be under pressure to be much more transparent, just because of how many undocumented people it has and how many there are on the public stage. So, for me, it was notable that Greece got away with having so little information available about undocumented health care access. That kind of lines up with the current political situation in Greece. Because if they’re not actually going to vaccinate undocumented people, it’s almost a moot point if the privacy guarantees are fine.

What are some questions that remain unanswered?

Most of our investigations started with FOI-ing the governments to figure out the numbers of people. For example, in Portugal and Greece where the undocumented have a temporary security number, you can FOI how many people have applied for that number. So far, we have not gotten a lot of answers to those FOI requests.

Another thing I would love to do, but it depends on the interest of our migration reporters, is to update the scorecard. Most of this data was collected based on documents ending in July. In many countries, there have been a lot of policy developments and a lot of policy documents have changed since July, some, sort of in response to criticism.

Like Greece which has now issued this new law. Or Ireland which is also carrying out a regular liquidation process that affects the scores. The UK has a very progressive policy, but there were some issues with GP registering undocumented people. Those are the places where it would be nice to be able to do the update.

What is the impact that you aim to have on the findings?

We aimed for the record to exist. That somebody is paying attention across the EU to how countries are addressing the health care needs of undocumented people. This is the one moment in time that somebody went and bothered to check how the policies compare to each other.

We think it’s important that it exists to inform, whether it’s academic research or policy research.

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This interview is published in the context of Solomon’s in-depth series of reports on “Migrant workers in Greece in the time of COVID-19” and is supported by the Rosa Luxemburg Stiftung Office in Greece.