The European Centre for Disease Prevention and Control (ECDC) warns in a risk assessment today that there is a risk of a very high COVID-19 burden this Winter unless public health measures are applied urgently.
In a previous risk assessment in September, ECDC warned that countries that have not yet achieved high enough COVID-19 vaccination coverage in their total populations run a high risk of experiencing a significant surge of cases, hospitalisations and mortality from then until the end of November. This is in fact what has happened according to the new risk assessment.
In the past, ECDC has issued join reports with the European Medicines Agency (EMA) but not this time. However, Marco Cavaleri, Head of Biological Health Threats and Vaccines Strategy at EMA, participated at a technical briefing (24 November) and agreed with ECDC’s assessment of the situation and its recommendations.
The ECDC Director, Andrea Ammon, explained at the briefing the reasons for the risk assessment. The current overall epidemiological situation in the EU/EEA is characterised by a steep and rapidly increasing overall case notification rate (daily infection rates). The death rate is still lower than in the past but is slowly increasing.
The epidemiological situation has deteriorated in most EU/EEA countries in recent weeks. Overall, countries with lower vaccination coverage and with a slower pace of vaccine rollout tend to be those with a more concerning situation.
Contact rates and vaccination rates influence the risks but countries can manage them by reducing contacts and increasing vaccinations. Without changes in contact rates, countries with more than 80% vaccination coverage are at increased risk, while those at vaccination coverage levels of less than 80% are at high risk.
A map presented by ECDC at the briefing shows that a number of EU member states were of high concern in the first week of November: Belgium, the Netherlands, Estonia, Poland, Czech Republic, Hungary, Croatia, Bulgaria and Greece.
To date, 65.4% of the total population and 76.5% of the adult population in the EU/EEA have been fully vaccinated against COVID-19, according to ECDC. However, the overall pace of weekly increase in vaccine uptake in the EU/EEA is slowing down and is mostly driven by the rollout in younger age groups.
This leaves a large vaccination gap that cannot be bridged rapidly and gives ample room for the virus to spread.
“There are still sub-populations and age groups in which coverage remains lower than desired, even in countries that have achieved good overall vaccination coverage,” the ECDC Director said. “There are still too many individuals at risk of severe COVID-19 infection whom we need to protect as soon as possible.”
The current overall level of vaccination uptake in the EU/EEA will therefore be insufficient to limit the burden of COVID-19 cases and hospitalisations over the winter months (December and January), and countries with lower levels of vaccination are at higher risk.
Because vaccines offer high protection against severe outcomes of COVID-19 infection, the forecasts are showing that a large number of new COVID-19 hospital admissions will be unvaccinated individuals, in particular unvaccinated individuals in risk groups.
On the positive side, vaccination continues to successfully avert deaths, reduce hospitalisations and transmission in the EU/EEA, despite the emergence and continued dominance of the Delta variant, which is up to 60% more transmissible than the previously dominant variant.
Available evidence emerging from Israel and the UK shows a significant increase in protection against infection and severe disease following a booster dose in all age groups in the short term.
For the first time, ECDC reports that all EU/EEA countries have begun administration of additional dose vaccination to better protect individuals who mount inadequate immune responses to the primary schedule and ‘booster’ vaccinations to improve protection in individuals for whom immunity may wane over time since completing the primary schedule.
If ECDC and EMA have been reluctant in recent months to recommend booster vaccination to the whole adult population, the message at the briefing today was clearly in favour of third vaccine shots. Waiting too long time with booster vaccination will lead to higher caseloads, overwhelm hospitals and force countries to put into place restrictions and lockdowns.
“It’s booster time,” said Marco Cavaleri from EMA. “Filling the vaccination gaps and carrying on with non-pharmaceutical measures (masks, social distancing etc) are top priorities. It is important to use all tools.”
“Countries should urgently consider a booster dose for those 40 years and over and could also consider a booster dose for all adults 18 years and older at least 6 months after completing their primary series. This is to increase protection against infection due to waning immunity which could potentially reduce the transmission in the population and prevent additional hospitalisations and deaths.”
WHO/Europe issued also a statement yesterday (23 November) saying that evidence on waning vaccine-derived immunity against infection suggests very low levels of protection 30 weeks after vaccination.
The booster dose is recommended by EMA six months after completing the primary schedule at the earliest but countries have some flexibility and can decide on a different period. For those still sceptical to the need of a booster, Ammon referred to Israeli findings showing that it strengthens the immunity defence.
Back in September, the prevailing opinion was that there was not yet enough scientific evidence to justify booster vaccination. Why did it take ECDC and EMA so much time to consider the issue and recommend booster vaccination?
Only in the last 10 – 14 days did ECDC receive evidence which made it conclude that booster vaccination for the adult population is justified, Ammon explained. “In September the evidence wasn’t that clear.” She assured that the availability of booster doses in the EU member states was not an issue. They have also been preparing for booster vaccination and put a logistical infrastructure in place.
“We need to urgently focus on closing the immunity gap, offer booster doses to all adults, and reintroduce non-pharmaceutical measures (masks, social distancing etc),” she summarised the recommendations. The recommendations are valid for all countries, she added, although countries with low vaccination rates should focus on increasing the rate.
She admitted that the long-term duration of the booster effect, while positive, is not yet known because it has not been observed that long and will have to be monitored. Asked about making vaccination mandatory, she replied that it raises the vaccination rate but it can also have a polarising effect and drive people to reject vaccination.
M. Apelblat
The Brussels Times
