Why Is Europe So Late With COVID Vaccination?
The slow pace of COVID-19 vaccinations in the EU is causing loss of life and well-being, as well as harm to the economy now and for the future. And it has become difficult for EU citizens to swallow, given the comparison with the US and the UK. The latter have pushed on the accelerator and have successfully vaccinated a proportionally much larger chunk of their population.
Since vaccines have been positioned vis-à-vis public opinion as the only feasible antidote to lifting COVID restrictions, the pressure on governments is enormous. To be sure, loosening the restrictions won’t happen solely on the basis of domestic vaccination as it will need to take into account what other countries are doing. The risk of importing the virus again, including more aggressive variants, forces the issue of vaccination to be a truly international effort. Nonetheless, the perception that the EU could have done much better on securing enough vaccine supplies is, once again, damaging its reputation, while the lack of a united, robust strategy addressing this crucial phase of the pandemic is scratching off the varnish of EU leaders — whether they sit in Brussels or in their respective capitals.
The pace of vaccination is driven primarily by four factors: 1) the availability of vaccines, 2) the distribution of vaccines, 3) the administration to the population, and 4) the willingness of individuals to be vaccinated. So far, it appears that, worldwide, only Israel, the US, and the UK have managed to apply a combination of most of these criteria in the most optimal manner.
Availability and distribution of vaccines
The US pursued vaccine procurement through Operation Warp Speed, a public-private partnership announced by the Trump administration in May 2020 funded with 10 billion USD upfront. Operation Warp Speed didn’t worry about the cost of the vaccines and, in fact, heavily subsidized vaccine development, testing, and manufacturing. In contrast, the EU opted to handle negotiations through the European Commission, assisted by Member State representatives, using the so-called Emergency Support Instrument, worth 2.7 billion EUR. The Europeans focused on getting a low price for the vaccines and making sure the vaccine companies could be sued if the vaccines caused problems. Both the US and the UK bought a very large number of doses of various vaccine candidates last summer before knowing which ones would be approved. Based on available information, both countries’ contractual strategies with the vaccine manufacturers were more aggressive than the one pursued by the EU.
While regulatory approval processes differed in the EU, post-Brexit UK, and the US, the respective regulatory agencies all claimed to have use fast-track procedures. The US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA) were a little faster than the European Medicines Agency (EMA). The UK approved the Pfizer/BioNTech vaccine on December 2, followed, a week later by the FDA, while the EMA did not give approval for the same vaccine until December 21. The AstraZeneca vaccine was approved in the UK in December but wasn’t cleared by EMA until the end of January this year.
In July, the US ordered 600 million doses of the Pfizer vaccine. The EU put in its order three months later — for half as many doses. Once the vaccines received approval, the EU realized that it had bought too few doses and went to buy an additional 300 million Pfizer vaccines only in January this year. The UK signed the final agreement with AstraZeneca on August 28, one day after the European Commission, but had reached a pre-agreement in May which, according to various sources, established “the development of a dedicated supply chain for the UK”. Around that time the US was closing an agreement with a third vaccine manufacturer, Moderna, which the European Commission only contracted in November.
When vaccine makers in Europe had manufacturing issues in late January, the EU was penalized. Meanwhile, the UK government was shifting its policy and decided to prioritize the first doses — a strategy called “First Doses First”.
Administering vaccines to the population
All kinds of dysfunctions caused additional delays in each Member State’s organization of the inoculations. From issues in the Netherlands related to the storage of Pfizer vaccine to France requiring pre-vaccination consultations to patients, to Italy facing issues with setting up an efficient booking system in some of its regions — the list goes on.
In February, the influential Bild Zeitung published the headline “Dear Britons, We Envy You!”. Indeed Britain, which has poured £11.7 billion into their vaccine effort, has so far covered a huge share of the adult population (close to 43% as of writing) with at least one dose, with the government aiming to cover the rest before summer. The “First Doses First” strategy was risky but is paying off, with coronavirus-driven deaths falling much faster for vaccinated groups compared with unvaccinated groups. The UK appears to have put in place a much better logistics plan, using family doctors to pre-register patients (who are then contacted with information on when and where to go to get inoculated) and even sponsoring Uber rides for those unable to reach the vaccination center by their own means. Last but not least, the UK did not join several EU Member States’ decision to temporarily halt the administration of the AstraZeneca vaccine for a few days following reports in March that it could lead to potentially dangerous blood clots.
85.5 million Americans have received at least one dose of a vaccine — more than a third of the adult population. In February, the Pentagon approved the deployment of more than 1,000 troops across the country including nurses, vaccinators, and clinical staff. President Biden had promised to administer 100 million vaccines by his 100th day in office and surpassed that goal on March 19, his 59th day. Several US states have started giving vaccines to everyone over 16. Governors in most states have said they expect to meet or beat Biden’s May 1 deadline for vaccinating all adults.
Managing public opinion
Nobody expected that coordination of public health messaging across EU’s 27 Member States would be easy, but the truth is, until now such coordination has not even been an objective. The large anti-vaccine sentiment among EU population should have pushed the European Commission to set up a large, coordinated public communication effort. In Italy and France, the medical community has flocked TV shows, giving all kinds of opinions and details about the pros and cons of different vaccines to confused public opinions.
In any crisis, let alone one of this proportion, communication must be centrally controlled. Europeans often mock US-style press briefings, but in times of emergency and given the overwhelming online and offline flow of scattered information (coming from local, national, and international bodies and experts), daily updates coming from a single, official source in each country are simply indispensable. People have opinions, and they should be free to express them, but non-stop discussions about what should be done in this period of huge uncertainty equate to shooting a smoke bomb into a panicking crowd. Arguably, the UK’s and the US’ ability to speak with a single voice has been beneficial in translating the sense of urgency into a fairly well-organized campaign on the ground.
In the next weeks and months additional vaccines will become available but maximizing supplies requires that the infrastructure and the willingness of people to get vaccinated are fixed in advance. All political leaders are, willingly or not, betting their political future on the vaccine campaign. But only those who go all-in, impose a clearly articulated emergency mindset, and forcefully rally adequate resources to back that up can hope to come out well.
The EU’s allergy to top-down approaches is very welcome in ordinary times but is simply ineffective now. Failure to do what’s needed will be a huge gift to Brexit and to the many critics waiting for the EU to collapse. The EU is “‘a tanker,’ not ‘a speedboat’” said European Commission President Ursula von der Leyen recently. Rather than a tanker, right now the EU looks like a canoe with too many people onboard — all rowing in different directions.
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