How should Europe deal with the COVID-19 pandemic in the future? Which strategies should be pursued and what specific risks should be considered? To answer these questions, researchers from the Max Planck Institute for Dynamics and Self-Organisation brought together more than two dozen experts from all over Europe – including Prof. Rudi Balling, director of the Luxembourg Centre for Systems Biomedicine (LCSB), and Assistant Prof. Enrico Glab, head of the Biomedical Data Science group at the LCSB – and jointly prepared a detailed situation analysis for the coming months and years. The results have recently been published in the renowned journals The Lancet and The Lancet Regional Health – Europe.
A European perspective
Following a significant decline in COVID-19 incidence across Europe in spring, many countries have relaxed or even completely lifted their containment measures. However, in combination with the spread of the new delta variant, this led to a renewed increase in case numbers and recent research data suggest that this variant is significantly more infectious than the previous ones. In addition, even though the vaccination itself is very effective in protecting against a severe course of infection, people who have already been vaccinated could still transmit the virus. Increased travel, the planned opening of schools after the summer vacation and increased transmission of the virus in the upcoming wet and cold season emphasise the need for a cross-national strategy. “It was very important that we develop such a European perspective,” says Viola Priesemann from the Max Planck Institute for Dynamics and Self-Organisation, who coordinated the publications. “In every European country, the situation is slightly different. Nevertheless, we need a common strategy because the virus doesn’t stop at borders.”
To this end, the authors used current data to produce a comprehensive analysis of the situation, which was published at the end of July 2021. They derived various possible scenarios for the future and explained what conditions would have to precede each of them. In a The Lancet, the authors now point out how maintaining a low incidence could have a beneficial impact on the pandemic.
Analysing two opposing strategies
In their second publication, the authors have considered two opposing strategies. In the first one, countries continue to rapidly lift restrictions, assuming the combination of past natural exposure and current vaccination coverage would allow a high incidence, without overburdening healthcare systems. In the second one, countries only lift restrictions at the pace of vaccination progress, with the core aim to keep incidence low, and efficiently controls the pandemic via test-trace-isolate programs.
The scientists explain that the first strategy could lead to an incidence of several hundred per 100,000 people and per week, whereas the second would require an incidence of well below one hundred. Without a common strategy, such a discrepancy could cause considerable friction between European member states, hampering cooperation, economy and international exchange: Indeed, high incidence in one country puts the low-incidence strategy in a neighbouring country at risk. “Either strategy can only work effectively if Europe agrees on a common approach,” emphasises Enrico Glaab. “We know very well that no country will be able to stop the pandemic on its own, so it is high time for a coordinated response.”
Favouring low incidence
The researchers also highlight the many advantages of the low incidence strategy, including reduced mortality, morbidity and long COVID-19, and lower risk of new variants of concern emerging and spreading. This strategy also ensures solidarity with those not yet protected, reduces the impact on the workforce and would allow schools and childcare to remain open during the coming autumn-winter season.
In contrast, a high incidence might still overwhelm hospitals and intensive care units in some countries. The insufficient vaccination coverage in many European countries, uncertainties regarding child vaccination and the time required for full immunisation of adolescents are additional factors to be considered.
Taking all this into account, the authors recommend that all European countries act together to achieve low incidence, at least until everyone has had the opportunity to get vaccinated. “A high incidence in one country challenges the pandemic response for others, in Europe and across the world,” explain Rudi Balling and the two dozen experts who collaborated for this article. Maintaining low incidence represents an act of solidarity and becomes easier with the increasing vaccination coverage.
COVID certificate and travel
The European Union’s Digital Covid Certificate for vaccinated people was introduced to facilitate cross-border travel despite the current situation. However, the researchers advise that its implementation must be accompanied by a systematic evaluation regarding its contribution to the spread of variants of concern, which will also require the development of a European strategy for testing travellers and commuters on a routine basis.
Need for a common European strategy
The lack of a coherent pandemic response and communication strategy is one of the challenges Europe has to tackle in the near future. The researchers conclude: “We have yet to overcome the pandemic but an end is conceivable: Restrictions can be lifted when high vaccination coverage is reached, and if vaccines remain highly effective against new variants of the virus. Until then, a common European strategy should be implemented to minimise economic and societal costs for Europe and the world as much as possible. And public trust must be maintained through timely, consistent and persistent communications.”
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References:
- Emil Nafis Iftekhar, Viola Priesemann, Rudi Balling, Simon Bauer, Philippe Beutels, André Calero Valdez, Sarah Cuschieri, Thomas Czypionka, Uga Dumpis, Enrico Glaab, Eva Grill, Claudia Hanson, Pirta Hotulainen, Peter Klimek, Mirjam Kretzschmar, Tyll Krüger, Jenny Krutzinna, Nicola Low, Helena Machado, Carlos Martins, Martin McKee, Sebastian Bernd Mohr, Armin Nassehi, Matjaž Perc, Elena Petelos, Martyn Pickersgill, Barbara Prainsack, Joacim Rocklöv, Eva Schernhammer, Anthony Staines, Ewa Szczurek, Sotirios Tsiodras, Steven Van Gucht, Peter Willeit, A look into the future of the COVID-19 pandemic in Europe: an expert consultation, The Lancet Regional Health – Europe, 2021.
- Viola Priesemann, Rudi Balling, Simon Bauer, Philippe Beutels, André Calero Valdez, Sarah Cuschieri, Thomas Czypionka, Uga Dumpis, Enrico Glaab, Eva Grill, Pirta Hotulainen, Emil N Iftekhar, Jenny Krutzinna, Christos Lionis, Helena Machado, Carlos Martins, Martin McKee, George N Pavlakis, Matjaž Perc, Elena Petelos, Martyn Pickersgill, Barbara Prainsack, Joacim Rocklöv, Eva Schernhammer, Ewa Szczurek, Sotirios Tsiodras, Steven Van Gucht, Peter Willeit, Towards a European strategy to address the COVID-19 pandemic, The Lancet, 2021.