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Italy, Germany, and France—Europe’s Big Three—share a groanworthy statistic: nearly three months into their national vaccine campaigns, they’ve managed to vaccinate just 11% of their adult population—about one-third the rate of the United States and Great Britain. There are now real doubts the EU will hit its goal of vaccinating 70% of the population by September.
Supply constraints, political overreach and confusion among the public is mostly to blame. This was on full display on Monday when EU country after EU country, including the Big Three, halted the rollout of AstraZeneca vaccines against the advice of the World Health Organization and the European Medicines Agency (EMA).
The reason: the countries want to study side effects from the AstraZeneca jab, including a puzzling, but statistically tiny, scattering of reported cases of blood clots forming in those who got the shot. One such blood clot incident was reported in Italy’s Piedmont region, causing local officials to seize a batch of the AstraZeneca vaccines.
In response, AstraZeneca has released data showing just how rare such cases are. The drugmaker says it has received notification of 37 reports of either deep vein thrombosis or pulmonary embolism—not that there’s any evidence whatsoever the vaccine has caused these conditions, mind you—in the more than 17 million people who’ve taken the jab across the EU and UK as of March 8.
Even if all 37 cases were a result of the AstraZeneca vaccine—and, to date, there’s no definitive link the jab caused these clots—that would amount to an incident rate of 0.000218%.
“The number of thromboembolic events overall in vaccinated people seems not to be higher than that in the general population,” Emer Cooke, the EMA’s executive director said at a press conference on Tuesday.
Cooke added: “At present there is no indication that the vaccination has caused these conditions.”
Still, the damage is done. In addition to reiterating that the benefits of the AstraZeneca vaccine outweigh any risks, EMA also expressed concerns that the hold-up could sow public distrust in the vaccine rollout campaign.
Meanwhile, the fallout of it all can be felt across Europe, including in Italy, Germany and France.
Italy
Umbria, the central Italian region tucked between Florence and Rome, was among the last regions in the country to get COVID vaccines. And that delay can be seen in its disappointing vaccine rollout rate. Umbria ranks towards the bottom of the country. To close the gap, local officials recently began recruiting any medical professionals—pharmacists, dentists and veterinarians— with expertise in administering shots.
At one vaccination center in the regional capital, Perugia, some 2,000 shots had been administered on March 7—not a world-beating number, but a sign of slow progress. A week later, that optimism was all but dashed following a wave of news reports involving AstraZeneca and the blood clot cases from Italy and abroad.
On Monday, a mere 66 people showed up to the Perugia vaccination center for their appointments to get the AstraZeneca COVID jab. Health officials there had been planning to give out 2,600.
“It was a desert,” one local official told Fortune. Almost nobody came to get their AstraZeneca shots as confusion and fear gripped Italians on whether it was safe to take—or even available.
By mid-day on Monday, national health officials in Italy stepped in and temporarily halted all AstraZeneca vaccinations, a move that will hit hardest Italy’s front-line workers. Thousands of Italy’s school teachers, military and civilian police officers, plus firefighters and its vast ranks of Protezione Civile squadrons were all due to get shots. They are now all on hold. The reason: the most abundant vaccine in the country is that of AstraZeneca’s; the Pfizer-BioNTech jab is earmarked to those 80 and older, and those supplies are running out fast.
Also on Monday, Italy’s biggest cities Milan and Rome went into their most stringent lockdowns since last spring as a third wave of infections tears through the country. Schools are shut as are most restaurants and bars.
There was palpable hope in early January that the vaccine rollout would mean a gradual reopening of the economy. Instead, Italians are once again confined to their homes, and, for now at least, there are fewer vaccines to go around.
France
When French President Emmanuel Macron announced on Monday that he was suspending the AstraZeneca vaccine simply as a temporary “precaution” until the European Medicines Agency determined its safety, his tone was designed to reassure a country that has lived through a year of official bungling and confusion over COVID-19—including a dire shortfall of facial masks and coronavirus tests in the pandemic’s early months, and a painfully slow vaccine roll-out since December.
The French leader’s calm “I got this” tone did not go down well.
It came only days after his government had reassured this nation of 66 million that the AstraZeneca vaccine was safe and effective. The cover of the left-leaning Liberation newspaper, bathed in fire-alarm red on Tuesday, said the official about-turn “would further erode the trust of the public.”
Top aides scrambled to refine their message in TV and radio interviews on Tuesday morning, attempting to reassure the French that the government had the situation under control. “The vaccinations are here, and will continue no matter what, through the other vaccines available,” the head of France’s vaccine program Alain Fischer said on France Inter radio. “Trust begins with transparency,” he said, explaining why the government had felt compelled to suspend the AstraZeneca vaccine. “Everything that is known is said.”
Fischer’s confidence seems at odds, however, with the experience of many in France, where appointments to get the vaccine jab have been exceedingly difficult to secure, and where the far scarcer—and, according to trial data, more effective—Pfizer-BioNtech vaccine has been reserved for people over 75. With a severe shortage of doses, the government has depended on AstraZeneca to try boost its vaccination program. From this week, the country’s pharmacists are authorized to administer vaccines—but only AstraZeneca has been available to them.
Much—though not all—of that delay can be explained by the tentative approach of the European Medicines Agency, the regulatory body for the European Union’s 27 nations, which was slower to approve vaccines than the U.S. or the U.K., and then ordered too few for the E.U.’s 450 million people.
But in France, there is plenty of blame being leveled against the country’s top-heavy bureaucracy, and its labyrinthine health system. “Whether it is masks, tests, or vaccines, every step of the response to the epidemic has turned into a wreck for the French bureaucracy,” the news magazine L’Express said on Tuesday, which said he had interviewed about 30 top officials for its article. It says the French Ministry of Health has “Kafkaesque foundations and ultra-rigid procedures,” and quotes an unnamed minister who said that the country has “suffered a bitter failure on the health plan.”
That is a failure Macron can hardly afford, just one year before he faces a reelection campaign for a second five-year term in office; recent polls shows him fighting a tough contest against far-right leader Marine Le Pen. For that reason, many wondered whether his decision to suspend the AstraZeneca vaccine was more influenced by political concerns, than health risks. An ardent supporter of the E.U., the French president has been careful to act in concert with other European leaders.
“This decision is purely political!” Yves Buisson, president of the coronavirus group at France’s National Academic of Medicine, told “Le Parisien” newspaper on Tuesday. The paper called Macron’s decision to suspend AstraZeneca “a sledgehammer that would leave its mark.”
Germany
In Germany, many doctors are livid at the government’s decision to halt the AstraZeneca rollout, particularly given the statistically tiny nature of the adverse effects that are being examined. Other European countries such as Denmark and Austria had already made the same call last week, but it was the German government’s decision on Monday that quickly saw fellow big beasts France and Italy fall in line.
“I think it’s dangerous, but nobody asks us,” says Katrin Ludwig, a general practitioner in the Schöneberg neighborhood of Berlin. “I don’t have all the data, but from the data we can look up, it’s not rational.”
Germany’s health minister, Jens Spahn, said Monday that the decision to pause the AstraZeneca vaccine was a “professional rather than political” one. He said the aim was to “maintain confidence in the vaccine,” but Ludwig expects quite the opposite effect—particularly given the government’s previous flip-flopping over the issue of the vaccine’s suitability for over-65s.
“I think that people are very confused about it,” she says. “Many people will not like to get the vaccine now that they hear it is paused. We already had the discussions before, and I think it will not get better.”
If the doctor is right, and the minister is wrong, this episode could further dent the image of Spahn’s Christian Democratic Union (CDU). In two state-level elections that took place Sunday, the CDU received its worst-ever results, and that was largely down to negative public perceptions over its handling of the pandemic.
There are still another four such elections on Germany’s political schedule this year, plus the federal election in late September. If the CDU-led federal government does not make good on its promise to offer all German adults vaccination by the end of the summer, the party could find itself out of power for the first time in 16 years.