Why Europe Is Falling Behind on Vaccines

Spring in the European Union is going to be dismal. The bloc faces a vaccine supply shortage of its own making, which will delay member states from reopening and weigh on their economic recovery into the summer. Rather than taking responsibility, Brussels tried to deflect attention from its mistakes by launching a public spat with pharmaceutical firm AstraZeneca, imposing export controls on vaccine makers and causing a minor diplomatic crisis with the United Kingdom.

Finger-pointing and export bans are not substitutes for common sense public health policy. Instead, Europe must make the most of a bad situation. It should focus on vaccinating as many high-risk people as possible, as efficiently as possible, with the limited supply of Pfizer and Moderna vaccines available. It should (but will probably not) act collectively to support its most vulnerable member states. And it should act now to confront the anti-vaccine challenge, which if left unchecked could derail the entire reopening effort.

As COVID-19 cases rose in October 2020, most EU member states waited too long to respond. By November, with intensive care units rapidly approaching full capacity, they slammed on the breaks by reimposing some of the world’s strictest lockdowns. Since then, cases, hospitalizations, and deaths have come down considerably, but policy has remained tight. The highly contagious U.K. variant is spreading on the continent, so governments are wary about opening up before their high-risk populations have been vaccinated.

This is a large ask because the EU has a lot of high-risk people. Not only is the bloc’s population larger than the United States’ and United Kingdom’s combined (the EU’s 446 million people compared to the U.S. and U.K.’s joint 395 million people), but the demographics also skew older. More than 20 percent of Europeans are older than 65 compared to only 16 percent in the United States. The region has 105 million high-risk people, which we define as health care workers plus the over-65s. Just to fully vaccinate them before reopening the economy, the bloc would need to deliver around 210 million doses. (Pfizer and Moderna require a two-dose regimen.) So far, EU member states have administered only 17 million doses. The United States has administered 42 million and the United Kingdom 12 million.

At first, the lag was all the regulators’ fault. The European Medicines Agency (EMA) took until Dec. 21, 2020 to approve Pfizer’s COVID-19 vaccine, nearly three weeks after the U.K. had approved the same application. The EMA did not approve Moderna until early January, and AstraZeneca until late January. Once the vaccines got the green light, the EU’s campaigns didn’t have a bad start. In the first few weeks of rollout, Germany, Italy, and Spain were keeping pace with the United States and United Kingdom. France lagged behind.

But it looks increasingly unlikely that Europe can keep up. In late January, all three vaccine manufacturers that are approved in the EU announced delays to their delivery schedules. Pfizer said it can make up the missed deliveries by late February. But AstraZeneca will only deliver 40 million doses by March 31—half of the originally promised amount. Now, European Commission president Ursula von der Leyen said she expects that the EU will only receive around 100 million doses in the first three months of 2021—and that “this will certainly happen over and over again.” In other words, it’s not just teething issues. Something in EU’s vaccine procurement strategy has gone deeply, structurally wrong.

Brussels wanted to blame the manufacturers. In truth, it is largely the European Commission that botched it. The two vaccine makers that have performed best in clinical trials and are best prepared to update their vaccine formulas to target new variants are Pfizer and Moderna. Yet those two companies will deliver at most 430 million doses to Europe before September 2021, enough for about half of the EU’s adult population.

The European Commission does have contracts, including provisional purchase agreements, from five other vaccine makers, including Novavax, CureVac, Johnson & Johnson, and Sanofi/GlaxoSmithKline. But Brussels cannot catch up by swiftly approving and distributing these alternative formulations. Johnson & Johnson released clinical data on Jan. 29, but its 66 percent headline efficacy figure—the lowest reported yet from a Western vaccine maker—means that regulators might not approve it for use on the high-risk. The EMA has approved AstraZeneca for use on all adults, but the German government is refusing to give it to people over 65 years old, and the Italian government is cautioning against using it on people over 55 years old. Other member states, such as Poland, are also following this cautious line. Johnson & Johnson is unlikely to get wider use than this.

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Most of the EU’s other prospective vaccine suppliers are nowhere near approval. CureVac is still in clinical trials. Sanofi/GSK is so far behind that it has agreed to turn over part of its manufacturing facilities to supply extra Pfizer doses. But even so, distribution of the extra doses is very unlikely to happen until at least the summer. Novavax reported results of its Phase 3 trial in late January. But, as of December 2020, the EU had only just concluded “exploratory” talks with the U.S. company. Moreover, Novavax’s clinical data shows that, while its formulation is 90 percent effective against the original COVID-19 strain, it is only 60 percent effective against the new South African variant. Even if the EU moves quickly to secure Novavax doses in the coming weeks, it will likely continue to lean heavily on Pfizer and Moderna’s supplies to vaccinate its high-risk population.

All this means that the EU’s vaccine rollout program will likely not  accelerate the way the United States’ and United Kingdom’s did. It is now unlikely that the EU’s high-risk population will receive at least one vaccine dose before April 2021. This will delay the EU’s reopening by at least a month compared to the others—and potentially by significantly longer.

The union’s resulting macroeconomic outlook is, in one word, lousy. The bloc’s largest economies are also its oldest and most policy-cautious. Germany and Italy, as we have noted, are effectively restricting their highest-risk residents to Pfizer and Moderna. France needs to use the highest-efficacy vaccines it can find because uptake levels will be low. As many as 60 percent of French adults say they are disinclined to get a COVID-19 vaccine, according to a recent Ipsos poll. If that figure holds, the country will struggle to get to herd immunity.

The longer Europe takes to get its vaccination house in order, the more the downside risks will multiply. If governments lift their lockdowns (or people stop respecting them) before vaccination is widespread, a new wave of cases is likely, making it easier for vaccine-resistant variants of the virus to take hold. If international tourism does not recover by the summer, Italy, Spain, Portugal, and Greece will suffer another devastating economic blow. By its own standards, Europe has already enacted historic levels of fiscal stimulus, but this is only a fraction of what the U.S. has done—and an extension of Next Generation EU, the $903 billion EU-level fiscal support package on which fiscally strapped member states are relying on is unlikely in 2021.

The only solution for Europe is to buckle down and push ahead on every front. The Next Generation EU fiscal package and the European Central Banks’ asset-purchase program have bolstered vulnerable member states’ spending capacity, but if the lockdowns stretch well into the spring, they will need to use some of the additional fiscal resources for more emergency support. The EU should also ramp up investment in testing and genomic sequencing to track new strains and slow their spread, as well as making a concentrated effort to push back against anti-vaccine sentiment. Europe’s COVID-19 woes are the result of policy failures, not the fault of vaccine makers.