Possible scenarios

To this end, the authors use current data to produce a comprehensive analysis of the situation, which was published at the end of July 2021. From this, they derived various possible scenarios for the future and explain what conditions would have to precede each of them. The content of this experts’ view is presented below:

“We have considered two opposing strategies: 1) 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; or 2) lift restrictions at the pace of vaccination progress with the core aim to keep incidence low, given this effectively and efficiently controls the pandemic via test-trace-isolate (TTI) programs.

Given current immunization levels (August 2021), the first strategy can 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. Such a discrepancy of incidence poses considerable friction to European cooperation, economy and society: high incidence in one country puts the low-incidence strategy in a neighboring country at risk. Because of this conflict of interest, some countries impose testing and quarantine requirements, hampering international exchange. Thus, either strategy can only work effectively if European agree on a common strategy. It’s about time for this, as no country is able to stop the pandemic on its own.

To nonetheless facilitate cross-border travel, the European Union’s Digital Covid Certificate for vaccinated people was introduced. However, no vaccine is yet completely effective at preventing virus transmission. Therefore, the implementation of the certificate must be accompanied by systematic evaluation regarding its contribution to the spread of present and future variants of concern. This also requires the development of a European strategy for testing travelers and commuters on a routine basis.

The advantages of a low incidence are known and include:

• Reduced mortality, morbidity and Long COVID-19,
• Solidarity with those not yet protected, 
• Lower risk of new VOCs emerging and spreading, 
• Increased feasibility of comprehensive TTI, 
• Less workforce in quarantine and isolation, including those in healthcare, 
• Ensuring schools and childcare 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 immunization of adolescents are additional factors to be considered in this. Thus, we 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. Maintaining low incidence represents an act of solidarity and becomes easier with the increasing vaccination coverage.

Challenges

• To improve measure effectiveness, three further challenges must be overcome:
• Vaccination availability, access, and hesitancy;
• The widespread misconception that freedom would be maximized when ignoring high incidence. However, it has been recognized that low incidence facilitates containment and safeguards the freedom of all, including the most vulnerable people;
• The lack of a coherent pandemic response and communication strategy. The perceived risk, the motivation and health literacy are important predictors of the people’s health-seeking behavior and adherence to measures. Public trust must be maintained through timely, consistent and persistent communications, including systematically developed dissent for misinformation.”