*The Greek Vaccination Plan*

The Greek Vaccination Pan, named "Freedom" (Eleftheria) (Greek Government 2021), was launched in December 2020 and initially put in implementation in January 2021. The national booking system operates through a specific website<sup>8</sup> and a mobile application. To register, one needs AMKA and a VAT number (AFM). The site is available in Greek and English and refers only and explicitly to the population group of "citizens". Information in other languages than Greek and English is only provided by the webpage of the UNHCR (2021b).

The Greek vaccination plan consists of three phases with specific identification of the eligible social categories:

1st phase:


2nd phase:


According to the Greek Vaccination Plan, and as also revealed by the FRA (2021) report, in Greece persons without legal status or with insecure legal status did not constitute a

priority group for vaccination in the national vaccination strategy. Additionally, in the same FRA report, it is mentioned that migrants and refugees living in 'hotspots' on the Greek islands have not been prioritized for vaccination. Indeed, only six months after the launch of the National Vaccination Plan in Greece, refugees and asylum-seekers living in camps and reception centers started to receive vaccination. Analytically, for the first months of the vaccination plan, only the AMKA holders could be vaccinated. However, the dysfunctional AMKA delivery system blocked access to vaccines and self-tests for tens of thousands of migrants and refugees. In March 2021, Law 4782/2021 provided for the supporting documents and the steps the person without AMKA or PAYPA should follow in order to apply for a temporary AMKA, called PAMKA. The application for PAMKA started to operate in June 2021. It is evident, therefore, that the addition of PAMKA to the state vaccination plan has been invented and implemented only when it was realized that the vaccination rate of Greek citizens was lower than initially anticipated and, therefore, vaccine redundancy was sufficient to cover those previously and mostly excluded (Emmanouilidou 2021). We may detect to this auxiliary vaccination policy the recruitment of an exploitation plan of migrant and refugee populations in order for the much desired 'immunity wall' to be built nationwide.

In practice, the issue of PAMKA requires that a person should have, in addition to the passport, some other identification documents double-crossed by registers kept at public sector bodies. Should the application which a migrant-refugee person has submitted be accepted, s/he receives PAMKA and then s/he could ask for a vaccination appointment. PAMKA is serving solely for arranging a vaccination appointment and the issuance of a vaccination certificate and it does not provide for any other access to the healthcare system for migrant-refugee populations. In May 2021, the Joint Ministerial Decision 2981/2021 (Government Gazette B'2197/26.05.2021) defined more specific categories of beneficiaries of PAMKA issuance, i.e., asylum seekers and unaccompanied minors without PAYPA as well as detained third-country nationals. Receiving access to vaccination becomes, as a result, a very complicated procedure that does not ensure the issue at stake, namely, the creation of an immunity wall and, ultimately, the defense of public health. Thousands of people without legal status are automatically excluded from the vaccination process. This, in turn, implies a direct negative impact on the course of the pandemic. Although there are places with a large concentration of land workers (i.e., the case of Manolada (Generation 2.0 2019)), or cases of places where thousands of undocumented migrants/refugees are living and working, they are not eligible for vaccination even under the conditions of the said current plan (Generation 2.0 2021). Therefore, those without AMKA, PAYPA, PAMKA, or any document from the Greek Authorities do not have access to vaccination. In other words, an administrative issue such as the acquisition of a permanent or a temporary Social Security Number constitutes the insurmountable obstacle to vaccination that excludes migrants/refugees from a core measure of protection against the coronavirus pandemic.

In addition, irrespectively from access to any kind of Social Security Number, migrant/refugees populations kept in camps have remained and still remain unvaccinated. Greek Authorities have justified their non-prioritization by stating that camps do not address "coronavirus morbidity or spread", so staff and residents will be vaccinated "in turn, according to their age cohort according to the regulations applied for the general population"9. However, the analysis derived from the public surveillance data indicates that "*compared to the general population the risk of COVID-19 infection among refugees and asylum seekers in reception facilities was 2.5 to 3 times higher (p-value < 0.001). The risk of acquiring COVID-19 infection was higher among refugee and asylum seeker populations in RSs on the Greek mainland (IP ratio: 2.45; 95% CI: 2.25\_2.68) but higher still among refugee and asylum seeker populations in RICs in the Greek islands and the land border with Turkey (IP ratio: 2.86; 95% CI: 2.64\_3.10), where living conditions are particularly poor. We identified high levels of COVID-19 transmission among refugees and asylum seekers in reception facilities in Greece. The risk of COVID-19 infection among these enclosed population groups has been significantly higher than the general population of Greece, and risk increases as living conditions deteriorate*" (Kondilis et al. 2021). On the other hand, the official rhetoric avoids the issue of why the first lockdown in Greece (March–May 2020) ended a couple of months later for the migrant/refugee populations residing in camps (Fouskas 2020). By taking into account these controversial accounts, it seems that new exclusionary tactics against the migrant/refugee populations are at stake. In fact, as the Greek case also testifies, institutional policies have not only left out marginalized third-country nationals from the national vaccination plan, in practice, but they have also imposed harsher mobility restrictions against them, highlighting pre-existing inequalities and politics of exclusion, as it is the case elsewhere (Brown 2020; Evershed 2020).

From June 2021 onwards, Greece announced that the National Public Health Organization (EODY) will vaccinate residents in 34 reception centers, 6 Reception and Identification Centers and 8 pre-removal centers (EASO 2021). The vaccines made available in the camps were only selected according to the availability of the three officially approved vaccine brands10. However, contrary to the opportunities and choices offered to the Greek citizens, people from third countries who live in precarious conditions are not in a position to decide upon the vaccine brand they wish. In addition, the local authorities of the Lesvos Island have mentioned that "*as the vaccines cannot be left out of the refrigerator for a long time, the vaccinations will be given to a certain number of people, only by appointment and always inside the KYT (the Reception Centre) so as not to burden the vaccination lines of the local community*"11. In July 2021, there were no official data for the vaccination progress of those residing in official State camps, but it is estimated that less than 1000 persons have been vaccinated in 3 reception and identification centers at the island's hotspots and 3 host facilities on the mainland12. This is not surprising, as the vaccination plan for the camps provides for availability only twice a week13, and those who have received a second-degree asylum rejection decision are excluded from vaccination (Aggelidis 2021). What is most striking is the highly symbolic gesture of the Greek Authorities that the unused vaccines are to be administered to prisoners and migrant-refugee populations who live in closed facilities (Gakis 2021).

All the above depict not only aspects of discrimination and exclusion but also aspects of migrant and refugee populations' degrading legal status and health conditions. Such procedures reinforce the pre-existing stigma attached to the above populations as if they possess a lower social status. This stigma further affects the already existing and evidenced negative attitudes towards migrants/refugees (Dixon et al. 2019)14. Thus, a contradicting social situation emerges which is signifying a *paradox*. On the one hand, those who are perceived as a danger to public health are eligible only to 'leftovers', that is, without sufficient health protection, while, on the other, they are perceived as a danger to public health due to the insufficient protection they receive. This *paradox* serves the perpetuation of the vicious cycle of migrants/refugees' stigmatization, a cycle reinforced by perceptions emanating from the public health field which operates as an additive component to crimmigration. Thus, administrative procedures establish a concrete negative screening and a practice of official controls which disproportionately affect migrant populations and intensify the trajectories of crimmigration. Currently, the health field affected by COVID-19 contributes to the advancement of the crimmigration regime and at the same time to a dangerous cul-de-sac. In addition, the official social controls imposed to combat the COVD-19 health crisis contribute to crimmigration through the intensification of the dangerization of mixed migration flows.
