Even five weeks ago, as we wrote at the time, it was easy to see that “spring will be bleak in Europe”. The perfect storm of under-procurement, overzealous regulators, and anti-vaccine populations prepared the continent for months of extremely tight lockdowns. But the situation is now even worse than we predicted. On Monday, the governments of Germany, France and Spain stopped administering AstraZeneca’s vaccine over scattered and unscientific allegations that it could cause blood clots. Today they threatened to block exports of vaccines to countries that do not export their own production to the European Union. Such a move is unlikely to materially change the timing of the bloc’s reopening, but it will certainly increase tensions with neighbors, particularly the UK. Even if AstraZeneca’s temporary suspension is reversed, Europe will continue to lag behind. European leaders must now decide: stay imprisoned until early summer when Americans and British return to their normal lives or surrender and tolerate a brutal surge in cases and hospital stays. The latter path now seems more likely.
A month ago, the European Union was just a few weeks behind the US and the UK in introducing vaccines. Now it’s back over a month and keeps slipping. Only 7.9 percent of Europeans received at least one dose, compared with 21.7 percent of Americans and 37.2 percent of British. European regulators took a few weeks longer to approve the main vaccines compared to their UK and US counterparts. But the slow start from the gate no longer explains the divergence. The real culprit is an ugly combination of supply shortages and widespread vaccination skepticism. Because of this, the United States and the United Kingdom have continued to rapidly increase daily dose administrations, while European countries have not.
The biggest problem is the lack of care. Europe was buying far too few cans of Moderna, Pfizer and AstraZeneca when the companies took their first orders last summer and instead preferred less promising European companies. Realizing its mistake, Brussels has now used all the tricks in the book to cross the border, including banning Europeans from exporting cans that they are contractually obliged to deliver to foreign customers. (“We reject the first-come-first-serve logic,” said Stella Kyriakides, EU Commissioner for Food and Health Safety, in January.) Pfizer and AstraZeneca made small concessions to this print campaign, adding a few million additional doses and one dose offered slightly faster delivery schedule. But these companies also have obligations to other governments and there is only so much they can do to do Europe justice.
It seemed for a while that Johnson & Johnson would be Europe’s rescue grace. His vaccine is moderately good at preventing symptomatic COVID-19 and doing very well at reducing severe cases, hospitalizations and deaths. And the formulation only requires a single dose, which makes administration much quicker and easier. On March 11, the European Medicines Agency approved the shot, but the company now says it may not be able to meet its target of delivering 55 million doses in the second quarter. In any case, deliveries will start in mid-April at the earliest.
EU member states are now so desperate for vaccines that some are negotiating with Russia and China outside of the EU’s aegis. European regulators are currently reviewing an application for Russia’s Sputnik V and are likely to approve it based on published clinical data. However, Russia has already signed a contract for the supply of cans to other countries and it is unlikely that approval and delivery will come early enough to affect the schedule for reopening Europe. In the meantime, European nations are very unlikely to approve vaccines made in China, as developers suspiciously refused to publish their Phase 3 data.
The final nail in the coffin came this week when several EU countries including Germany, Italy, France, Spain and the Netherlands stopped giving AstraZeneca vaccines, citing isolated reports of blood clots in people who had received the vaccine . As of March 17, European regulators had received a total of 30 reports of blood clots from 5 million people vaccinated with AstraZeneca.
This decision is unscientific. “There is currently no evidence that vaccination caused these conditions,” concluded the European Medicines Agency, the supreme regulator, last week. Blood clots are very common: in the United States, they kill 60,000 to 100,000 people each year, out of about 2.8 million deaths each year. And if you’re scared of blood clots, COVID-19 is the worst risk factor you can imagine. Ten percent of COVID-19 patients in the non-intensive care unit in the hospital are diagnosed with venous thromboembolism, a blood clotting disorder. Of the COVID-19 patients admitted to the intensive care unit, 28 percent get blood clots. The potential risk of the AstraZeneca vaccine is extremely low in comparison. In short, if you live in Europe and you are afraid of blood clots, then you should hurry to get the AstraZeneca vaccine.
But European leaders have done it for the company since it first announced delays in its delivery schedule for the EU. For example, at the end of January, French President Emmanuel Macron falsely claimed that the AstraZeneca vaccine was “virtually ineffective” for people over 65 years of age. (In clinical trials, the AstraZeneca vaccine was 100 percent effective in preventing severe cases of COVID-19. New studies show it is ineffective against the “South African” B1351 variant, but few cases of this variant have been identified in Europe .) Although the health authority of the country Macron flatly contradicted in February, the Europeans heed his words; Even before the news this week, many Europeans had refused to be vaccinated with AstraZeneca. Even if governments resume administration of AstraZeneca next week, much of the damage has already been done. Even a slight spike in anti-vaccine sentiment in the high-risk population is terrible news. If the lockdowns end before the virus is all but eradicated, a new wave of hospitalizations and deaths will follow.
What does all this mean for Europe on the way out of the lockdown? The answer is clear: without AstraZeneca, Europe won’t have enough doses until mid-June to fully vaccinate its high-risk population. Even if they are resumed immediately, making up for lost time and delivering each future AstraZeneca dose on arrival in an older arm, Europe’s most vulnerable patients will not be until mid-to-late May 14 days after receiving an initial vaccine dose.
Do the European people have the willpower to wait that long? Probably not. Europeans are currently living under the strictest locks in the world, measured by the “stringency index” of the Blavatnik School of Government in Oxford. Italy is now in its strictest lockdown since last spring.
And even these are not good enough. Cases, hospitalizations and deaths are increasing across the continent. In Italy, daily cases have doubled in the past 30 days. In Eastern Europe, where lockdowns are not as severe, the Czech Republic suffers the world’s highest rate of daily deaths per capita. Poland and Hungary are close behind. However, Germany and other countries have started easing restrictions in the face of negative data as popular pressure to reopen is overwhelming.
The culprit for the increase in cases is the B117 variant (also known as the “UK variant”), which is now widespread across the continent. This strain is both 70 percent more contagious and 60 to 70 percent more deadly. This is the reason the UK continues to be nationally blocked even though almost the entire high-risk population is more than two weeks after the first dose. When the country eased its lockdown in November 2020, cases and hospital stays skyrocketed and within five weeks the hospital system was overwhelmed. Epidemiological models suggest that if the UK reopened tomorrow, the same thing would happen again. If European countries end their own bans early, they should expect a similar outcome.
In short, Europe is sabotaging itself again. If governments followed sensible public health policies, the unscientific decision to stop AstraZeneca vaccine delivery would mean the lockdowns would have to be extended accordingly. But elected officials may not hold your nerve if the weather warms up. If European governments give in to public pressure and lift restrictions too soon, the result will be another massive wave. For US and UK citizens celebrating the newfound freedom brought about by vaccination relatively quickly, it is likely too early to book your summer vacation in Portugal or France. For Europeans, the message is grimmer: either stole yourself for a summer indoors or at an increased risk of unnecessary death.