Describing the possibility of a massive fourth wave of COVID-19, the World Health Organization’s Europe director Hans Kluge estimated on Thursday that by February there could be about 500,000 more deaths from the coronavirus in the 53 countries that make up the WHO European region, which stretches from Britain to Central Asia.

In the WHO’s latest daily statistics, Europe accounted for 65% of the world’s confirmed COVID cases over the last 24 hours, and 56% of deaths.

“We are, once again, at the epicenter,” Kluge said at a press conference on Thursday. “The current situation and alarming short-term projections should trigger us to act.”

Tale of two realities

All that sounds like devastating news, and in some countries, it most certainly is.

But in fact this is a tale of two very different realities. Central European countries like Bulgaria, Estonia, Slovenia, Russia, and Romania are experiencing record levels of infection and severely overstretched health facilities. Meanwhile, the powerhouse economies of Western Europe—France, Italy, the U.K., Germany, and Spain—all appear vastly better prepared to face another COVID-19 wave than they were when the cold weather hit a year ago.

“The rebound is quite moderate” in France, epidemiologist Antoine Flahault told the network LCI on Thursday after the WHO’s warning. More than 118,000 people have died of COVID-19 in France since the pandemic began, but now, Flahault says, “France is in a much better position to tackle this winter, like Spain, Portugal, or Italy.”

There is one big difference between this winter and the last one: vaccines—which became available in late December 2020—and the vaccine mandates that governments in France, Italy, and elsewhere have instituted in recent months.

The results of those programs are evident, according to the WHO. Kluge told reporters on Thursday that the fourth wave was hitting with vastly different force in different parts of Europe. “Where vaccine uptake is low…hospital admission rates are high,” he said. “Most people hospitalized and dying from COVID-19 today are not fully vaccinated.”

Italy, which suffered a devastating number of deaths early in the pandemic, last month began requiring negative COVID-19 tests or full vaccination for all employees, in one of the strictest mandates in the world. France instituted vaccine mandates in September for millions of health workers and civil servants, and proof of full vaccination or a negative COVID-19 test is required to enter restaurants, department stores, and other public places.

These vaccine mandates helped spur vaccination rates: More than 50 million people in France are now fully vaccinated, about 86.6% of those over 12; in Italy, the national figure is about 74.8%, rising to about 90% in the northern city of Bergamo, which was the global epicenter of COVID-19 early in the pandemic.

That is in stark contract to Russia, where 36.9% of people are fully vaccinated, and which is experiencing record COVID-19 infection rates of about 194 cases per 100,000 people over the past seven days. Similarly, in Ukraine, where only about 20.9% of people are fully vaccinated, infections have rocketed with the arrival of the Delta variant. There were an average of 348 infections per 100,000 people over the past week—close to the country’s record.

As COVID-19 hit a grim milestone of 5 million deaths this week, Russia had the region’s biggest toll, with 8,162 deaths over the past seven days. Ukraine’s weekly death toll was 3,819, and Romania’s was 3,100.

Regional differences

Even within rich countries, the disparities can be stark. German Health Minister Jens Spahn told reporters on Wednesday that the fourth wave of COVID-19 in his country—the European Union’s biggest economy and largest population—was largely “a pandemic of the unvaccinated.”

In the eastern state of Saxony, for example, hard-core anti-vaccine sentiment has complicated the vaccine rollout; about 56% of people in the state are fully vaccinated, according to the Robert Koch Institute. That’s about 10% lower than the national average, and COVID-19 cases have risen sharply. Saxony’s seven-day infection rate is 386 per 100,000 people, compared to Germany’s overall number of 170.

Local officials blame the rise in infections on the right-wing party Alternative für Deutschland, or AfD. The party came out top in Saxony in Germany’s election in October, and for months it has pushed vaccine skepticism. “The AfD significantly influences a large part of the electorate that we cannot convince to get vaccinated,” the regional health minister, Petra Köpping, told Le Monde newspaper on Thursday. “That is a problem.”

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