Even Europe’s anti-vaxxers have to admit: Vaccine mandates really work

August 24, 2021, 3:56 PM UTC

This week marks the beginning of France’s so-called rentrée, when the French slouch home after their sacred (and long) summer break, and when street protests and political infighting typically hit a high point. But this year, there is a twist to the usual pattern: The biggest complaint against President Emmanuel Macron—his hard-line COVID-19 vaccine mandates—is falling flat, as most French seem to have concluded that the tough approach is a stunning success.

Across Europe, a series of sticks of varying severity has led to a pronounced rise in vaccine uptake, pushing the European Union further ahead of the U.S. in a process Washington once led. Today, 63.6% of the EU population has had at least one shot, compared with 60.4% in the U.S., and that gap is growing.

This mandate-inspired uptick is having profound effects both in terms of health outcomes and the economy.

The seven-day rolling average of COVID deaths per million people is 3.02 in the U.S., almost four times the EU figure of 0.77. And in the COVID-sensitive travel sector, European regional airline capacity has risen to around two-thirds of 2019 levels, while discount carrier Ryanair has said it expects to post a profit this quarter and is opening 250 new routes for the winter, Bloomberg reports. In the U.S., however, a summer passenger surge to 80% of pre-pandemic levels has faded, and Southwest Airlines has said it may return to losses after a profit last quarter.

Europe now provides a clear example of how vaccine mandates can work—offering lessons for the U.S., where Republican governors have blocked attempts to impose similar rules. Much like in Europe, more than two-thirds of Americans now appear to support vaccine mandates, according to a poll out last week—leaving the Republicans to defend a minority opinion.

France

Macron’s reputation as an arrogant know-it-all was on full display on July 12, when he went on television and told people to get vaccinated, or face the consequences. His new rules were sweeping, and nonnegotiable. Since Aug.9, anyone over 18 wanting to go to a cinema, a sports match, or a museum, or eat in a restaurant or even shop in a mall, has had to show a QR code at the door to prove they are fully vaccinated; from Sept. 15, all health workers will need to be fully vaccinated, or, Macron vows, face losing their jobs.

Now, lines of customers outside shopping centers wait to show their vaccine proof, phones outstretched, and on Sunday, Fortune’s Paris-based correspondent narrowly missed a tennis date when the security guard at the gym found her cell phone QR code too blurry to scan.

Both right-wing and far-left opposition groups have seized on the “health pass” as a campaign issue with which to bash Macron, who faces a reelection battle next April, for a second five-year presidential term. Weekly demonstrations have accused the government of trampling on their cherished constitutional rights. “You are killing our liberties,” read one poster in a demo on Saturday against the vaccine mandates.

“We have a movement that is anti-vax and anti–health pass that is very, very politicized,” Jérôme Marty, head of France’s National Union of Independent Doctors, tells Fortune. Marty believes it would have been “more effective” if Macron had met with labor unions and health professionals before imposing the vaccine mandates. Even so, he says the impact has been striking. “The great majority of those in ICUs are not vaccinated,” he says. “There has been a strong acceleration of vaccines.”

More than 10 million more French have rushed to be vaccinated since Macron’s declaration on July 12. As of Monday, more than 41 million people in France have been fully immunized—more than 61% of the population, according to the French Health Ministry. That’s far above the U.S., where 51.3% of people are fully vaccinated.

At this rate, France could hit 70% full vaccination by late September, according to Reuters’ COVID-19 tracker, a sharp increase from early this year, when the country struggled to launch its vaccine program with a labyrinthine vaccination program and severe shortage of doses.

Like other countries, France is suffering a fourth COVID-19 wave from the Delta variant, with about 93 deaths per day, up from about 24 daily deaths in late July. Virtually all severe cases have been among the unvaccinated, according to the government.

Those unvaccinated people are decreasing rapidly. Roger Fontaine, head of the French Red Cross in the Paris suburb of Seine-Saint-Denis, tells Fortune the new rules brought immediate results. “From the moment the President spoke we saw the change,” says Fontaine, whose organization runs mobile coronavirus vaccination units. “We exceeded 10,000 vaccines in the past month.” The area, the poorest district in France, was hard-hit by the pandemic, with hospitals strained to capacity.

France health pass
A tourist is tested for COVID-19 at a temporary site on the Rue de Rivoli in Paris.
Kiran Ridley—Getty Images

Germany

Germany is starting to adopt French-style rules.

On Monday, all of the country’s 16 states introduced a uniform rule forcing people to prove vaccination, recovery, or lack of infection if they want to enter restaurants, gyms, and indoor events. From Oct. 11, unvaccinated people will also have to pay for rapid coronavirus tests that have thus far been free.

These measures are, as in France, largely designed to push the undecided toward vaccination. Germany’s vaccination rate is undoubtedly slowing—after an early-June peak of 1.4 million doses being administered in one day, the daily figure is now around 320,000. According to the government’s official figures, only 59% of the population is now fully vaccinated, with 64.1% having received at least one dose.

However, there has recently been some uncertainty over how many Germans have already had the jab.

Earlier this month, the Robert Koch Institute (RKI)—the government’s top biomedicine adviser—said it was likely that the government had been undercounting the numbers of vaccinated people, particularly those in the 18 to 59 age group.

While the government believed 59% of this group had received a first dose, an RKI survey had the figure at 79%. It suggested the discrepancy was largely the result of local doctors not reporting vaccinations in the government’s centralized system, and incorrectly recording the single-dose J&J vaccine as a second shot, not a first.

Italy

Since Aug. 6, Italians have needed a special pass to do the things Italians hold most dear: dine indoors at a Michelin-starred restaurant or at a modest roadside trattoria, go to the gym, visit Florence’s Uffizi Gallery or any other museum in the country, or go to the stadium to watch a soccer match.

The “green pass,” as it’s called, is a nationwide certificate from the Ministry of Health declaring you’ve either been vaccinated, have recently tested negative for COVID-19, or that you’ve recently recovered from the virus. Businesses and patrons who try to flout the rules are hit with steep fines.

Even before it launched, a small but vocal group protested. Some vowed to leave one-star reviews on Tripadvisor for those restaurants that follow the rules. Others called for boycotts. If the howls of protest accomplished anything, it was to further divide Italy’s no-vax movement. “Madness,” is how one prominent “green pass” opponent condemned the movement to punish businesses for following the law.

Since then, the green pass controversy has mostly faded. Restaurateurs and bar owners are reporting a banner August, and the usual queues for the morning cappuccino or after-lunch espresso are as long as ever. More important, health officials saw a steady rise in vaccinations prior to the green pass launch, particularly among the young. More than 60% of Italian teens between 16 and 19 have now had at least one vaccine dose, encouraging public health officials and educators with a few weeks to go before the start of the new school year.

Italy green pass
As of the first Friday in August, the height of the holiday summer season, Italians were required to present a “green pass” showing they had been vaccinated, or had recently tested negative for the coronavirus.
Giuliano Berti—Bloomberg via Getty Images

Spain

Spain has been an outlier in Europe’s push to increase vaccine uptake.

After facing a brutal first wave of the pandemic with one of the world’s most restrictive lockdowns, Madrid has been reluctant to impose heavy restrictions or mandates. In recent days, Spain’s Supreme Court has supported regional courts that overturned a requirement for vaccine passports or negative PCR tests to enter nightclubs in Andalusia, and another to require regular COVID testing for nursing home workers in Castilla-La Mancha.

At the same time, Spain has not suffered from the vaccine hesitancy seen in countries such as France. Spain leads large EU countries in vaccine uptake, with 67.3% of the population fully vaccinated and 76.3% with at least one dose. There has been high uptake among the young, with 70.5% of those ages 20 to 29 having received at least one dose.

“The governments haven’t had to push or pull. From the very beginning of [COVID] vaccines, surveys indicated 90% wanted it,” says Rafael Bengoa, a former WHO director and health minister of the Basque region.

Bengoa points to Spain’s high adoption levels for other vaccines, which expose people to vaccine conversations with their doctors, as well as the country’s national single-payer public health system, which connects each person with a primary health care team that can easily contact them.

“The administration of vaccines in Spain in the last 30 years has been carried out by primary care nurses, a group [who] have…looked at it as one of their main tasks,” says Fernando Rodríguez Artalejo, an epidemiologist at the Autonomous University of Madrid.

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