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The fourth wave of the coronavirus pandemic is breaking over Europe, with few countries being spared a worrying rise in cases.
Comprehensive vaccination, it turns out, is necessary — but not sufficient — to contain the spread of the virus, which thrives in autumn and winter weather. Countries that had widely relaxed social-distancing restrictions over the summer are now considering re-implementing measures to stem the tide of increasing cases and hospitalizations.
Vaccination “solves part of the problem, but not all of it,” said Hajo Zeeb, professor of epidemiology at the University of Bremen. While vaccination does protect against infection, it’s not fool proof. Just as worrying is that immunity is waning, leading to countries turning to booster shots. “I think even the public are realizing that it’s not all over,” he said.
POLITICO has crunched the numbers on vaccinations, new cases, hospitalizations and deaths across the EU and the U.K. The picture that emerges is mixed and one in which vaccination penetration is the main determinant of whether the pandemic can be successfully contained. A smart approach to measures such as face mask requirements in crowded settings and vaccine “passports” are an important differentiator.
At one end of the spectrum a group of countries has achieved high rates of vaccination of both their adult populations and older schoolchildren. Top of the class is Portugal, which has successfully curbed infections, hospitalizations and deaths at low levels. At the other end are countries facing their worst outbreaks since the onset of the pandemic in spring 2020. With only a fraction of their adult population vaccinated, COVID-19 is spreading like wildfire in Bulgaria and Romania, pushing their health systems towards collapse.
Here is a list of the four groups:
The Overachievers: The success of vaccination campaigns in countries like Portugal, Malta and Spain — where 80 percent or more of the population has been fully vaccinated — translates directly to very low new cases, deaths and hospitalizations.
Could Do Better: Countries like the U.K., Germany and Austria have achieved vaccination rates in the 60- to mid-70 percent range — not enough to stop new cases rising. The relaxation of restrictions in the U.K. has also been a powerful driver of new infections.
Falling Behind: The three Baltic nations and some countries in Central Europe, such as Slovenia, are experiencing some of the highest rates of daily new cases per million people. Vaccination rates in the 50 percent region have left much of their populations unprotected from the virus and hospitalizations and deaths are much higher than their Western neighbors.
The Strugglers: The two countries that lag furthest behind on vaccinations are Bulgaria and Romania. Overburdened health systems have contributed to the perfect storm for the current wave of the virus, which is seeing worryingly high hospitalization levels.
It’s mainly an “epidemic of the unvaccinated” said Zeeb. The figures illustrate this with The Overachievers having very low new cases per million people. The effectiveness in vaccination preventing deaths is highly reassuring. The Strugglers, Romania and Bulgaria, have the lowest share of fully vaccinated people and new daily deaths that far exceed any other country in the EU. These figures are echoed in hospitalization and ICU occupancy. “The best preparation for the fourth wave would have been an effective vaccination campaign,” Ioana Mihăilă, Romania’s former health minister, told POLITICO.
“All of Europe is facing an increase in pressure from the pandemic – in Eastern Europe, where the rate of vaccination is much lower than in the West, the sanitary impact is real and intense,” French Health Minister Olivier Véran told lawmakers on Tuesday. Elsewhere, climatic conditions and the spread of a more infectious sub-type of the Delta variant of the coronavirus were driving infections, he added: “We have every reason to be vigilant.”
Zeeb fears that health systems won’t be able to deal with another wave. He said that the “extraordinary” situation last year can’t be repeated as there are concerns that health systems won’t be able to cope again.
While vaccination isn’t a complete solution — it doesn’t completely block transmission — it’s now clear it can prevent severe illness and death. Data from the U.K., in particular, is reassuring. Britain has seen skyrocketing cases, and while hospitalization rates are increasing, they have not surged as they did in earlier waves. In much of Western Europe, where cases are rising, it’s a little too early to tell whether hospitalizations will trend steeply higher. For now, hospitalizations are lagging new infections.
While new infections may be even higher than they were last autumn and winter, they are “certainly not [higher] on the hospitalization side,” said Zeeb. “Which is the good news, which speaks to the effect of the vaccinations.”
A major driver of new infections has been among youth. Deepti Gurdasani, an epidemiologist at Queen Mary University London, points out that when schools re-opened in the U.K., the high levels of community transmission resulted in “explosive growth” in case numbers.
Among the countries with available data, the countries that have few new cases, such as Portugal and Spain, also have vaccination rates that top 30 percent among those under 18. The Strugglers, Bulgaria and Romania, have rates that don’t top 4 percent. Croatia, Slovenia, Slovakia and Greece, in the Falling Behind category, all have rates under 10 percent and are also facing sharp spikes in infection.
Given the data on cases, deaths and hospitalizations, the overall vaccination rates reinforce how important it is for countries to get to not just decent vaccination levels, but rates that exceed 80 percent. As for what the future could bring, Zeeb sees the coronavirus eventually moving towards an endemic situation in Europe. “Perhaps, when spring comes, which brings down numbers anyway, we’ll more vaccinations [and] have probably moved towards herd immunity in some places, due to both vaccinations plus the infections that have taken place,” he said.
This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.