When during the last months of 2020 the news broke that several of the Covid-19 vaccines were not only ready for use, but also relatively (e.g., the Oxford-AstraZeneca Covid-19 vaccine) to very (e.g., the Pfizer-BioNTech Covid-19 vaccine and the Moderna Covid-19 vaccine) effective, this raised great hope throughout the Western world that by the summer of 2021, most people would be vaccinated, with a prospect that society would start functioning—more or less—normal again.
For the average European, the months of January-March 2021 quickly tempered the initial enthusiasm: It soon appeared that the producers of the Covid-19 vaccines that were ready for use and had (at least temporary) been approved by the regulatory agencies of the Western countries in which they were to be deployed—more precisely (1) the Pfizer-BioNTech Covid-19 vaccine, (2) the Moderna Covid-19 vaccine, (3) the Oxford-AstraZeneca Covid-19 vaccine and, shortly after, (4) the Johnson & Johnson Covid-19 vaccine–, appeared to hardly make any deliveries to the EU member states, while at the same time, in various other countries, such as Israel, the United States, the United Kingdom, the United Arab Emirates and Chile, the vaccination campaigns appeared to make rapid progress.
This difference in treatment between the various countries can be traced back in large part to a completely failed European policy with regard to the procurement of the Covid-19 vaccines during the second half of 2020.
Once again it became clear how much more the EU is committed to the neoliberal principles that determine its functioning, including the classical EU austerity and the respect for public procurement rules (with its basic principle of haggling on prices), rather than looking out for the wellbeing of its citizens. The result of all these bad policy choices was disastrous: while several other Western or Western-oriented countries soon had a prospect of achieving group immunity by the summer of 2021,Footnote 288 the EU was not even at a 15%-vaccination threshold by Easter 2021. This had no cause other than a mismanagement at the top-level of the EU decision-making bodies and of the national governments of the EU member states that had blindly swallowed the EU lead. And EU citizens were once again the victims of the political games that the leading EU elite are so fond of playing.
As Maçães has phrased it:Footnote 289
With the arrival of the vaccines, state competition took a new form, but not a milder one: an ugly global race for enough doses in which the losers are denied a quick path out of the pandemic. Suddenly, the laggards from the previous iteration of the game seemed for the first time to be ahead. The United Kingdom was the first jurisdiction to approve the new vaccine and quickly pulled ahead of other large, advanced economies in the race to vaccinate its population, a rare pandemic success for the country.
The United States followed, with the European Union falling behind, but none could match the success of Israel. In just two weeks in December the state succeeded in vaccinating close to 20% of its citizens, leading the world by a very large measure and drawing on its origins as a tightly knit small nation fighting for survival. The country is now very close to the 70% mark that experts deem enough to put an end to infection growth.
Around the same time, the European vaccination policy was named a “complete fiasco” by none other than European Parliament member and former Belgian Prime Minister Guy Verhofstadt. (Cf., furthermore, Sect. 18.104.22.168) From this, it appeared that while most of the Covid-19 vaccines were produced in Europe, most of this production had been exported to non-European countries, where mass vaccinations had already been carried out, while the European population remained largely unserved. This imbalance between production and distribution was made even more aberrant, when considering that the development of the Covid-19 vaccines had been partly financed by European institutions.
As a result of this huge shortage of vaccines in the EU member states, vaccination campaigns in practically all European countries—except for the United Kingdom—were experiencing immense delays: Only a limited number of at-risk groups (especially the elderly residing in nursing homes), in addition to (some of) the staff of care institutions and (some of) the medical professionals had at the time Guy Verhofstadt formulated his criticism, been served with a Covid-19 vaccine.
The situation was even more perverse in light of the fact that the vaccines destined for export also turned out to be the highest-performing vaccines (notably the Pfizer-BioNtech Covid-19 vaccine and the Moderna Covid-19 vaccine, with an overall effectiveness of 95% and 94.5% respectively), while the EU had for its own use, to a large extent, opted for the much cheaper, but also less effective Oxford-AstraZeneca Covid-19 vaccine, with an (at the time) estimated effectiveness ranging between 60% to 80% according to a variety of sources contradicting each other on this matter.
The foregoing, manifest imbalance between local production and the unavailability for use on the EU market, already in the course of February 2021, inevitably caused fear that the Covid-19 pandemic on the European continent was to last much longer than in other territories, such as Israel, the United States and the United Kingdom. On a practical level, this implied that while some other Western countries were gradually achieving to have a sufficiently large part of their population vaccinated by the summer of 2021, most European countries were likely to lag several months behind.
In the following Sects. 9.4.2, 9.4.3 and 9.4.4, we shall look in more detail at the course of the Covid-19 vaccination campaigns in the United States, the EU and the United Kingdom, with special attention to examining what has gone wrong at the EU level with regard to the procurement of the Covid-19 vaccines.
9.4.2 Vaccination in the United States
22.214.171.124 December 2020: Successful Start of the American Vaccination Campaign (Notwithstanding a Vaccination Mistrust of a Substantial Part of the American Population)
By the end of December 2020, the United States started administering the first Covid-19 vaccines, notwithstanding the fact that misinformation and conspiracy theories pervaded a large part of the general public. Indeed, already in a survey dated October 2020, 25% of the respondents indicated that they would not get a Covid-19 vaccine when it would become available.Footnote 290 According to another source, this percentage may even have amounted to 40%.Footnote 291
Several causes for this vaccination reluctance among a large part of the American population have been suggested.Footnote 292
There is in the first place a large anti-vax community. These people are in principle opposed to vaccination, as in their opinion, no vaccine can ever be safe.Footnote 293
Secondly, there was a faction of the American population that hat started peddling conspiracy theories about the Covid-19 vaccines in particular. According to one such conspiracy theory, the Covid-19 diseased has been caused by 5G cell towers, implying that a vaccine would be useless against it. A second conspiracy theory holds that the vaccines are a plot by the Bill and Melinda Gates Foundation—or alternately, by Elon Musk—aimed at injecting microchips into the American people, and by extension into the world population (in order to gain planet domination, or to eradicate a part of humanity). The latter (absurd) theory even made Bill Gates himself respond.Footnote 294
However, most people in the vaccine hesitancy camp were said to have more rational objections, in most cases being worried enough not to want to be at the head of the line for a new vaccine. One such worry sounded that the vaccines had come about too quickly, raising doubt whether they had been tested in a sufficient manner. A similar concern was about the side effects of the vaccines (e.g., the allergic reaction “anaphylaxis”, or the partial facial paralysis “Bell’s palsy”, or blood clots), notwithstanding the fact that the odds of getting one of these side effects are extremely small.Footnote 295
Even demographics were reported to play a role. As with so much else that is going on in the United States, opinion on Covid-19 vaccination got to a large extent determined by political affiliation.Footnote 296 The Gallup organization which started tracking Covid-19 vaccine attitudes by alignment with a political party since July 2020, e.g., found that Democrats were consistently more willing of getting vaccinated for Covid-19 than Independents or Republicans.Footnote 297 Figure 9.3 presents a schematic representation of Americans’ willingness to be vaccinated for Covid-19 by political assignation, as measured in 2020.
Age also appeared to play a role. With regard to this criterium, it appeared that willingness for receiving a Covid-19 vaccine generally tracked age-determined susceptibility to the Covid-19 disease itself.Footnote 298
But on no other criterium was the difference between willingness and unwillingness to receive a Covid-19 vaccine starker than on race and ethnicity. From one of the polls, it had, e.g., appeared that 83% of the in said poll surveyed Asian-Americans had indicated their intent to receive a Covid-19 vaccine, compared to 63% among those belonging to the Latinx community and 61% among White people. In Black American respondents, the numbers were said to completely “fall off the table”, with just 42% of surveyed Black Americans having declared their intent to be vaccinated.Footnote 299 Figure 9.4 gives a schematic representation of Americans’ willingness to be vaccinated against Covid-19, by subgroup, as measured in 2020.
Notwithstanding these objections of large groups of the American population, the vaccination campaign went ahead as of December 2020, starting with the administration of the at the time two (EUA) approved vaccines, namely the Pfizer-BioNTech and Moderna Covid-19 vaccines.Footnote 300
126.96.36.199 Progress of the Covid-19 Vaccination Campaign in February and March 2021
By February 2021, on average 1.6 million Covid-19 vaccine doses were administered on a daily basis.Footnote 301
Health workers were reported to have handed out 61.2 million doses of a Covid-19 vaccine between 20 January 2021—when Joe Biden had become the new American president—and 1 March 2021. That pace was reported to be high enough to beat Biden’s initial goal of 100 million Covid-19 vaccine shots during his first 100 days in office and was falling just shy of his revised goal of 150 million shots.Footnote 302 It was at the time also reported that the pace would even accelerate with the approval of a third Covid-19 vaccine from Johnson & Johnson.Footnote 303
As of 2 March 2021, the United States reported 28,403,416 Covid-19 cases, with a total of 513,071 Covid-19 related deaths. According to one source, by then, already 54,035,670 people had been given a first dose of a Covid-19 vaccine, which made President Joe Biden start expressing his hopes that the country would reach herd immunity by the summer of 2021.Footnote 304
By 3 March 2021, according to another source, around 80.5 million Covid-19 vaccine doses had been administered, with 15.9% of the population having received at least one dose of a Covid-19 vaccine.Footnote 305 This implied that at least 52.9 million Americans had received at least one dose of the Pfizer-BioNTech or Moderna Covid-19 vaccines. Overall, 27 million, or just under 8% of the American population, had been fully vaccinated. Alaska was in lead of all states, with 14% of its population fully vaccinated, while Utah ranked last with only 6% of its population fully vaccinated.Footnote 306 The vaccination effort was, moreover, reported to prioritize older Americans. As of 3 March 2021, 13.4 million people aged 75 and older, or 60% of everyone in this age group, had received at least a single Covid-19 vaccine dose. Additionally, 6.8 million, or 30% of the age group, had been fully vaccinated.Footnote 307
188.8.131.52 March 2021: President Joe Biden’s Further Vaccination Efforts
While in March 2021, in the Member States of the EU, due to lack of Covid-19 vaccine supplies, the vaccination campaign was suffering huge delays (cf. Sects. 184.108.40.206 and 220.127.116.11), in the United States, after the flying start as of the end of December 2020 and after Joe Biden had taken office as new president on 20 January 2021, the vaccination campaign accelerated even further.
From a press briefing of 10 March 2021, it appeared that the United States had just received more supplies of the Pfizer-BioNTech and Moderna’s Covid-19 vaccines, good for more than 20 million doses to be sent out to states, tribes, territories, and pharmacies. It was, furthermore, announced that the United States was on the verge of procuring an additional 100 million doses of the Johnson & Johnson Covid-19 vaccine.Footnote 308
By that date, the United States had purchased enough Covid-19 vaccine doses for serving every adult living in the country. In addition, approximately 75% of the Covid-19 vaccines that had already been distributed to states, had effectively been administered.Footnote 309 By the same date, more than 90 million Americans had received one or two jabs of a Covid-19 vaccine, with an estimated 61 million Americans having received at least one dose and an estimated 32 million Americans having been fully vaccinated.Footnote 310 The White House also reported that in the period between June 2020 and January 20, 2021, there had been a seven-day average of 890,000 Covid-19 vaccine shots per day. By 20 March 2021, the United States averaged above 2 million shots per day.Footnote 311
On the day President Joe Biden entered office, 8% of the American people over 65 had been inoculated for Covid-19. By 10 March 2021, that percentage had already risen to 60.Footnote 312 It was even reported that on 9 March 2021, Alaska became the first state to make the Covid-19 vaccines available to all people over the age of 16.Footnote 313
On Monday, 8 March 2021, the CDC for the first time issued guidance on social activities that fully vaccinated people would be able to safely resume, with limited risks for themselves and others. E.g., fully vaccinated people were allowed to meet other fully vaccinated people in small groups, without having to wear a face mask or without having to distance themselves from one another physically. Fully vaccinated people were also given permission to start visiting unvaccinated people belonging to another household, without wearing face masks or having to physically distance themselves, as long as no one in the unvaccinated household was at high risk of serious illness from Covid. Finally, fully vaccinated people did no longer need to be quarantined or tested after contact with a Covid-19 contaminated person, as long as the fully vaccinated person himself remained asymptotic after such a contact had taken place.Footnote 314
On 11 March 2021, President Joe Biden declared that he would urge states to make a Covid-19 vaccine available to all American adults by no later than 1 May 2021. The Biden administration had already previously indicated that the United States had acquired enough of the Covid-19 vaccines to inoculate every adult American citizen by the end of May 2021. By that time, the Biden administration had committed nearly USD 20 billion to the Covid-19 vaccine rollout programme, as part of the USD 1.9 trillion Covid-19 rescue package that the Biden administration had proposed in January 2021 and that had been signed into law by President Biden on 11 March 2021.Footnote 315
By 19 March 2021, more than 115 million doses of a Covid-19 vaccine had been administered throughout the United States, while the United States had managed to distribute more than 151 million Covid-19 vaccine doses.Footnote 316
On 23 March 2020, the rollout of the American Covid-19 vaccination campaign even gained further momentum. There were then, on average, more than 2 million doses of a Covid-19 vaccine administered on a daily basis. This was in part due to the increased supply of Covid-19 vaccines, resulting from the EUA that had been granted to the Johnson & Johnson Covid-19 vaccine, which helped accelerate the rollout on the basis of three EUA approved vaccines instead of two.Footnote 317 In the meantime, states remained the ones responsible for making the practical decisions about vaccine implementation, with most of them having defined eligibility to first include frontline laborers, such as those employed by the healthcare industry, and people aged 65 and over. A handful of states had already expanded eligibility to include people belonging to even younger age groupsFootnote 318
18.104.22.168 25 March 2021: New Vaccination Targets
On 25 March 2021, Joe Biden held his first official press conference as President of the United States.Footnote 319
During the press conference, President Biden announced his additional efforts to (1) further accelerate the US Covid-19 vaccination campaign, (2) ensure that all American individuals and communities would obtain access to a Covid-19 vaccine, and (3) especially expand access to the Covid-19 vaccines to the most affected and at-risk communities throughout the country. It was, furthermore, announced that, with funding largely provided under the American Rescue Plan (cf. Sect. 4.4.3), the US Department of Health and Human Services (HHS) would invest nearly USD 10 billion for increasing access to the Covid-19 vaccines and for ensuring a better distribution of the vaccines among communities of colour, rural areas, low-income populations and other underserved communities, as part of the federal Covid-19 response policy.Footnote 320
President Biden also highlighted that “equity”Footnote 321 was one of his top policy priorities. This included the setting up of federally run community-based Covid-19 vaccination centres in the most affected areas of the United States, sending Covid-19 vaccines directly to local pharmacies and community health centres that had to serve vulnerable population groups in a disproportionate manner, launching hundreds of mobile clinics in order to reach people where they are, and creating the “Covid-19 Health Equity Task Force”.Footnote 322
The announcements of 25 March 2021 included:Footnote 323
A USD 6 billion investment in community health centres for expanding access to the Covid-19 vaccines among underserved communities.
Extending eligibility for the Covid-19 vaccines to people served by community health centres.
An investment of USD 3 billion to build confidence in the Covid-19 vaccines.
The launching of a partnership for the Covid-19 vaccination of dialysis patients.
An investment of USD 330 million in community health workers.
As of 7 April 2021, a total of 225,294,435 Covid-19 vaccines had been delivered to the United States, of which 171,476,655 had been effectively administered. Table 9.3 provides an overview of the status of the Covid-19 vaccinations at that date.Footnote 324
By 2 May 2021, according to information provided by the CDC, the number of Americans fully vaccinated against Covid-19 exceeded 101 million. More than 43% of Americans had by then received at least one dose of a Covid-19 vaccine.Footnote 325
22.214.171.124 Biden’s Approval Rating in Mid-April 2021
By mid-April 2021, the rapid roll-out of the Covid-19 vaccination programme, together with the USD 1.9 billion Coronavirus relief programme (cf. Sect. 4.4.3), helped assure President Biden a high approval rating as he was approaching his 100th day in presidential office.Footnote 326
This appeared from a poll that had been organized by the Pew Research Center.
For its research, the Pew Research Center had surveyed 5109 American adults throughout April 2021. These were all members of the Pew Research Center’s American Trends Panel (ATP) and had been recruited to be representative of the general population by gender, race, ethnicity, party affiliation, education and other categories.Footnote 327
It resulted from this survey that President Joe Biden received the support of 59% of the people surveyed in the Pew study. The Pew Research Center also made a comparison of Joe Biden’s performance to that of other recent presidents with regard to their first days in the White House. From this comparison, it appeared that after 100 days in office of his first and only term as president, Donald Trump had an approval rating of just 39%. In contrast, twice-elected President Barack Obama had a 61% approval rating in the month of April after his first term instalment, while Obama’s immediate predecessor, President George W. Bush, was at 55%. Ronald Reagan had been the one with the highest approval rating at the same stage, more precisely at 67%.Footnote 328
According to the Pew study, while a new immigrant crisis on the US southern border manifested itself as a nearly test of Biden’s determination, the issue of illegal immigration had overtaken Covid-19 as the issue Americans considered “a very big problem”.Footnote 329
In the April 2021 Pew survey, a clear majority—more precisely consisting of 72% of the surveyed respondents—had rated the Biden administration’s Covid-19 vaccine rollout as “good” (43%) or “excellent” (29%). A majority of 67% of the surveyed respondents had, moreover, given their approval to Biden’s coronavirus aid programme, including 36% who had indicated it as “very good”.Footnote 330 Remarkably, the 72% presidential approval rating with regard to the federal Covid-19 vaccination programme included a majority of Republicans and Republican-leaning voters at age 55.Footnote 331 Still, deep partisan divisions remained over Biden’s ratings on a variety of other policy issues. A total of 81% of the Republicans, or those who lean Republican, generally disapproved of Biden’s overall presidency, while 93% of the Democrats or those who lean Democratic, generally approved. According to the Pew Research Center, this pointed to a wide partisan divide within the American society.Footnote 332
126.96.36.199 Vaccination of the US Health Sector
According to another survey,Footnote 333 released on 6 April 2021, at the beginning of March 2021, only just over half (52%) of the American frontline healthcare laborers indicated that they had been administered at least one dose of a Covid-19 vaccine, amongst which 42% who had received both doses. This implied that no less than 48% of the frontline laborers employed in the healthcare sector in the United States had not yet received a single dose of a Covid-19 vaccine. These numbers were considered astounding to the extent that healthcare laborers who had to deal with patients, including patients suffering from Covid-19, were among the highest priority groups for access to the Covid-19 vaccines.Footnote 334
According to the same survey, the majority of healthcare professionals employed in hospitals (66%) and outpatient clinics (64%) indicated that they had been administered a Covid-19 vaccine. These relatively high figures were in contrast to the far lower figures concerning healthcare laborers employed elsewhere. The percentages of healthcare laborers having been administered a Covid-19 vaccine employed elsewhere amounted to 52% for those working in doctors’ surgeries, to 50% for those employed in long-term nursing homes or assisted living facilities, and to only 26% for home healthcare laborers. Similarly, around seven in ten (68%) of healthcare laborers involved in everyday diagnosing and treating patients, such as (general-practice) physicians or nurses, indicated that they had been administered a Covid-19 vaccine, compared to only around four in ten of healthcare laborers involved in administrative tasks (44%) or in assisting with more practical patient care, such as bathing, feeding, cleaning, exercise, and housekeeping (37%).Footnote 335
There again appeared to be huge differences based upon race. Only 39% of black and 44% of Hispanic frontline healthcare laborers had indicated that they themselves had been administered a Covid-19 vaccine, compared to 57% of the white healthcare laborers. These figures were said to reflect the similar disparities in vaccine uptake rates based upon race among the national adult population of the United States.Footnote 336 (Cf. Sect. 188.8.131.52.)
From the survey, it appeared that worries about the safety and efficacy of the Covid-19 vaccines had been among the main factors for explaining why a lot of the American, frontline healthcare laborers had indicated not yet taking a Covid-19 vaccine. Of the 48% of healthcare laborers who had indicated not yet taking a Covid-19 vaccine, 82% had said that they were concerned about potential side effects of the vaccines. 81% had indicated that they considered that the Covid-19 vaccines were too new and that they wanted to wait and see how the vaccines would work for other people. In addition, about two-thirds (i.e., 65%) had indicated that they did not trust the American government for ensuring the safety and efficacy of the vaccines. It was thereby pointed out that these concerns of the unvaccinated healthcare laborers again mirrored those living among the general American population.Footnote 337
184.108.40.206 Prognosis on Herd Immunity
Notwithstanding the huge success of the US vaccination campaign in the period between December 2020 and April 2021, many scientists and experts, already soon after the US vaccination campaign had started, had issued warnings that the United States was not likely to reach group immunity in 2021, or perhaps not even in 2022. This was due to many reasons, including the high levels of vaccine hesitancy in the country, besides the fact that the Covid-19 virus was still globally widespread, which led to new variants (and to a fear that there would follow others).Footnote 338
According to Glenza, herd immunity rates change based on (1) how contagious a given virus is, (2) the efficacy of available vaccines, (3) the number of people who receive the vaccine, and (4) the propensity of the virus to evolve, (5) among other factors.Footnote 339
The virus that causes Covid-19 (or “Sars-CoV-2”), is subject to the same pressures as e.g., measles, albeit having a serious of elements playing in its advantage. First, a worldwide and ongoing circulation of the Covid-19 virus gives it millions of opportunities to mutate, evolve and eventually evade vaccine conferred immunity. Very high vaccination rates have been able to prevent this phenomenon in measles. That is why experts refer to the Covid-19 immunization campaign as “a race between vaccines and variants”, implying that the Covid-19 vaccines must be distributed and administered quickly enough in order to tamp down on variants. Otherwise, as explained by Glenza, a vaccine may become nothing more than a static solution to a moving target.Footnote 340
Further, the Covid-19 virus is still a novel virus. Unlike measles, scientists are uncertain how long immunity (provided by either earlier contamination or a Covid-19 vaccine) will last, though for natural immunity it could be as short as a few months. Therefore, already early 2021, many experts started believing that already vaccinated people will continue to need either boosters, or variant-specific vaccines, in the future.Footnote 341 (Cf. Sect. 220.127.116.11.)
A third factor is that even before more contagious “escape variants” of the Covid-19 virus were identified, such as the B.117 variant first discovered in the United Kingdom (cf. Sect. 1.1.2), the United States was still facing a very difficult task in achieving herd immunity, due to the fact that when the vaccination campaign had started, there was not yet a vaccine available for roughly 20% of the American population—notably children.Footnote 342 That is precisely why in May 2021, both Pfizer-BioNTech and Moderna applied for a EUA that would allow their vaccines to be used on children (cf. Sect. 18.104.22.168).
High levels of vaccine hesitancy and continued inequities in how the vaccines are distributed, could, furthermore, continue to contribute to localized outbreaks of the Covid-19 virus, especially in areas where inoculation rates are lower.Footnote 343
Health inequality was expected to amplify the impacts of vaccine hesitancy even more. Some conservative regions with the highest rates of vaccine hesitancy tended to have worse overall health, weaker public health infrastructure and higher overall levels of poverty and poor housing, which could make Covid-19 spread in this region even worse.Footnote 344 (On the further impact of these determinants of health inequality, cf., furthermore, Chap. 10.)
By May 2021, it was feared that the “new normal” was going to depend on where a person lives and how local officials would decide to implement or ignore public health measures.Footnote 345
9.4.3 The EU’s (initially) Failed Vaccination Strategy
22.214.171.124 A Wrong Sense of Solidarity as the Starting Point of the EU’s Failed Vaccination Strategy
Already in March 2020, the EU had reached the decision in principle to base the vaccination strategy of its Member States on a vague principle of (European) solidarity.
However, it would soon appear that the EU Commission’s strategy of joint vaccine procurement turned out to be disastrous, with national leaders of EU Member States soon afterwards starting to accuse the EU of having been too bureaucratic, too limiting to its members and simply too slow in procuring Covid-19 vaccines,Footnote 346 as a result of which, at a moment when several other Western countries were starting, at high speed, to vaccinate their respective populations, the EU Member States did not yet have access to a supply of the Covid-19 vaccines that would have allowed for the vaccination of only their risks groups. Hence, while from January to March 2021, several other countries, such as Israel, the United States, the United Kingdom, Saudi-Arabia and Chile, were very successful in deploying their vaccination strategies, in EU countries, the population remained confronted with continued severe lockdown measures due to a third wave of the Covid-19 pandemic (cf. Sect. 2.4.3), besides with a shortage of vaccines.
As already mentioned before (cf. Sect. 9.4.1), this even made none other than European Parliament member Guy Verhofstadt, at the end of February 2021, sound the alarm bell through an emotional outcry which he shared in a video posted on his Facebook page. According to the information that Guy Verhofstadt shared, while (about) 75% of the world’s production of vaccines against the Covid-19 virus took place in Europe, only 4% to 6% of European citizens had received their first shot of a Covid-19 vaccination. It appeared that, even though Europe was the world leader in the production of the Covid-19 vaccines, there was an acute shortage of vaccines in almost every European country (the United Kingdom that had just before left the EU, excepted), resulting in a huge vaccination backlog. By contrast, several non-European countries had mass access to the most performing Covid-19 vaccines. E.g., according to press reports, by the end of February 2021, Israel had already been administering a Covid-19 vaccine to large parts of its adult population. In the United States, around 20% of the population had already been vaccinated, and in the United Kingdom almost 30%. In the United States, the Covid-19 vaccination coverage achieved was, moreover, (almost) entirely based on the two (at the time) best performing vaccines, namely the Pfizer-BioNTech and Moderna Covid-19 vaccines. On 26 February 2021, the US press even reported that, on a single day, no less than 2.2 million vaccinations had been administered throughout the United States.Footnote 347
Hence, as so many of the EU’s neoliberal policies (such as, before in history, the liberalization of the banking market and the energy market in the 1990s, which had turned out to be advantageous for big market players, but disastrous for the general consumer’s interestsFootnote 348), also its Covid-19 vaccination strategy turned out to be a disaster. More specifically, the EUs decisions to (1) prioritize process and price over reasonable progress, and to (2) put a purported form of “solidarity” between EU countries ahead of giving individual governments sufficient room to manoeuvre, would turn out to hold back an adequate Covid-19 response throughout the EU’s Member States during the first months of 2021. As a result, the EU vaccination strategy that was supposed to be a powerful demonstration of European solidarity, an affirmation of the EU single market’s purchasing power and an ethical stand against the by US President Donald initiated “vaccine nationalism”, soon resulted in a rollout that would leave the EU lagging far behind more successful countries such as Israel, Saudi-Arabia, the United Kingdom and the United States,Footnote 349 and that would be described by even some of the EU’s leading politicians themselves as an utter fiasco.
As a result of a number of poor EU policy decisions regarding the procurement of the Covid-19 vaccines, EU countries thus simply stood by when, already at the end of December 2020, the United States and the United Kingdom bought, approved, and started injecting Covid-19 vaccines at a high tempo. Under the rhetoric of having agreed upon on lower prices and a purported higher accountability for drug makers, next to ensuring shots for the whole of the EU, European delays in delivery only caused tensions among EU member countries resentful about the trade-offs, while the European population was throughout Q1 2021 completely left in the dark on the questions if and when they would ever get access to a Covid-19 vaccine jab.Footnote 350
The emergence of this—in the words of Guy Verhofstadt—“disastrous” take off of the European vaccination strategy as of the end of December 2020, moreover, came hardly as a surprise. On the contrary, during the entire first year of the global Covid-19 vaccine race, the EU had continuously been one or more steps behind: its move to start securing vaccine Covid-19 vaccine doses for itself came only after warnings that the United States had already started monopolizing production output. Its deliberative approaches to regulatory approval would leave EU citizens lagging behind the United States and the United Kingdom when it came to getting access to the Covid-19 vaccines—at a moment when delays were counting in lost lives.Footnote 351 As the EU shamefully discovered, wielding the market power and moral authority of 27 sovereign nations—with different budgets and perspectives on risk—, while at the same time complying with neoliberal policy principles (such as “austerity”) and technical procedures (such as the “public procurement” procedure), implied moving far more slowly than the one-and-done competition.Footnote 352
126.96.36.199 March-May 2020: Choosing Prestige Over Common Sense and Efficiency
The EU’s decision of deploying a joint vaccine procurement strategy, purportedly, started when the EU leadership began realizing that then US President Donald Trump and his coronavirus task force were already in March 2020 sitting together with a group of pharmaceutical executives in order to secure US access to the Covid-19 vaccine candidates which, at the time, were not even ready yet.Footnote 353
This would result in a new policy deployed by the EU Commission to start working together to inoculate not just citizens in every EU country, but the entire world.Footnote 354 Solidarity was thereby not only expected of EU member states regarding one another, but towards the entire world. This was a noble vision, but in light of the monopoly positions of the vaccine-producing enterprises rather naïve. This would, moreover, but a year later prove to be yet one more lost gamble with the lives of the European population.
As a result of the foregoing, instead on starting to secure Covid-19 vaccine candidates in progress, shortly after US President Donald Trump had announced a freeze on the US funding of the WHO, the Commission von der Leyen instead hosted a big fundraiser campaign. This campaign took place on the initiative of the EU, together with the UN and other big philanthropy players, on 4 May 2020, and would ultimately garner almost USD 8 billion, loosely earmarked for research on treatments and tests of Covid-19 vaccine candidates.Footnote 355 However, the USD 8 billion would be spent without any guarantee that the EU itself would benefit from its generosity in getting priority access to the Covid-19 vaccines, when ready.
This policy approach, not hindered by much insight on how the private pharmaceutical market in practice functions, regretfully implied that, rather than taking the immediate health interests of the European population at heart, the EU Commission purportedly noble goals in the end would prove to be fatal for getting quick access to the Covid-19 vaccines, when ready.
The United States itself wisely abstained from participating in the prestigious event. Instead, on 15 May 2020, President Trump formally launched his USD 10 billion “Operation Warp Speed”. The goal of this programme of the Trump administration was to invest in experimental Covid-19 vaccine candidates and to make their development speedily enough in order to be able to deliver 300 million doses to the American people by January 2021.Footnote 356 This strategy of the Trump administration would less than a year later prove highly beneficial for Trump’s successor, President Joe Biden who, as a result, immediately after entering the presidential office in January 2021, could continue the by then already initiated American vaccination program by having a seemingly monopolized access to the two most performant Covid-19 vaccines, namely the Pfizer-BioNTech and the Moderna Covid-19 vaccines which were by then ready for use. (Cf. Sect. 188.8.131.52.)
184.108.40.206 June 2020: The EU’s New Vaccine Strategy—Choosing Stinginess Over Human Lives and Economic Sense
In May 2020, the vaccination race was just beginningFootnote 357 and it should have been clear already then that, as far as a speedy access to the Covid-19 vaccines was concerned, the bets were far more on Trump’s business-driven sense of reality, than on von der Leyen’s idealistic yet unworldly attitude.
Already before, when it came down to securing medical supplies during the early months of the Covid-19 pandemic, the EU had not acquired a great track record. On the contrary, during the early days of the Covid-19 crisis, EU countries had unilaterally closed their borders and accused each other of hoarding precious personal protective equipment (PPE), so that it did not reach the places where it was most needed. (Cf. Sects. 2.3 and 2.4) Brussels’ response had been the deployment of a system meant to wield the purchasing power of 37 countries—the EU27 and 10 of their neighbours—for buying face masks and ventilators, besides a variety of medical equipment, which in part helps explain why these remained unavailable for the common European during the entire first months of the Covid-19 pandemic (except for buying face masks themselves on the private market at extremely high prices).Footnote 358 One of the main problems in all of this had been EU bureaucracy itself. E.g., before it could place an order, the EU Commission had to wait for each EU country to sign the purchasing agreement. Some countries, fed up with the endless back and forth, thus simply went ahead and purchased medical items on their own.Footnote 359
The same strategy was initially deployed as part of the EU’s vaccination program, which turned out to be just as disastrous.Footnote 360
What the EU especially underestimated was that its bureaucratic logic was no match for the working principles of the private, pharmaceutical market (although the neoliberal set-up of the latter had, to a large extent, been made possible thanks to the free market reforms of the EU itself; cf. Sect. 9.2). Thus, vaccine procurement presented a formidable challenge, with EU bureaucracy having to deal with a bewildering array of Covid-19 vaccine producing candidates, including pharmaceutical enterprises—all driven by the pursuit of profits, and none of which had yet produced a deliverable end product.Footnote 361
Meanwhile, some EU countries had decided to stop waiting for the EU Commission to strike a deal. E.g., France and Germany initiated talks with Moderna separately. By mid-April 2020, Paris and Berlin were even reported working together on a bilateral basis for buying Covid-19 vaccines.Footnote 362
Eventually, after having regrouped the EU27 Member States, the EU27 health ministers signed off on a EU Commission plan to buy the Covid-19 vaccines on their behalf, on 12 June 2020.Footnote 363
In parallel, the separate Franco-German initiative continued to make progress and had invited both The Netherlands and Italy to join its select buyers’ club. This initiative proved relatively successful, as by 13 June 2020 the “quartet”—also known as the “Inclusive Vaccine Alliance”—announced that it had reached an agreement for 300–400 million doses of the Oxford-AstraZeneca Covid-19 vaccine.Footnote 364 However, some small EU countries saw this elect initiative as a threat.Footnote 365 E.g., the then Belgian Health Minister Maggie De Block denounced the deal between the Vaccine Alliance and Oxford-AstraZeneca as the result of an “unreasonable” decision that would hurt everyone.Footnote 366
Shortly before, on 1 June 2020, Health Commissioner Stella Kyriakides had presented what could be called the “new EU vaccine plan”. Rather than continuing negotiations with vaccine producers by going back and forth to get approvals from each individual EU country, the European Commission came up with the idea of reusing a mechanism called the “Emergency Support Instrument”. This concerned a very rarely used tool that would allow Brussels to buy Covid-19 vaccines directly and without a further need of signatures from the individual EU Member States, for an initial amount of EUR 2.1 billion. Once approved by the central EU authorities, the Covid-19 vaccines would then be distributed among the EU countries in accordance with the size of their population.Footnote 367 In addition, the von der Leyen Commission also strengthened the firepower of “DG SANTE”, an until then relatively low-profile EU procurement service that had little real authority, but that would be granted the responsibility for the actual negotiations with drug and vaccine producing enterprises.Footnote 368
After the plan was approved by all 27 EU member countries, the four countries belonging to the Vaccine Alliance decided to close shop, allowing the European Commission to resume its own exclusive negotiations with “Johnson & Johnson” and “Oxford-AstraZeneca”, two producers of Covid-19 vaccines that would ultimately prove less effective than the Pfizer-BioNTech and Moderna Covid-19 vaccines that the European Commission initially neglected, but on which the United States was focusing.Footnote 369
The strategy for implementing the new Covid-19 vaccine plan was that, rather than one drug producing enterprise negotiating with 27 governments, the EU would wield its full market power, leaving drug producers in the dark about what terms were being agreed to with their competitors.Footnote 370 This new strategy, as conceived by the EU Commission, was even made public in a “Communication from the Commission” of 17 June 2020. This communication was named “EU Strategy for COVID-19 vaccines” (COM/2020/245 final)Footnote 371 and stressed the importance of a both global and European solidarity:
This is not only a European challenge, it is also a global one. All regions of the world are affected. The spread of the virus has shown that no region is safe until the virus is under control everywhere. In addition to it being in their clear self-interest to do so, high-income countries have a responsibility to accelerate the development and production of a safe and effective vaccine and make it accessible for all the regions of the world. The EU recognises this task as its responsibility.
To this end, the EU is leading the global effort for universal testing, treatment and vaccination by mobilising resources through international pledging and by joining forces with countries and global health organisations through the Access to Covid-19 Tools (ACT) Accelerator collaborative framework. The Commission will continue to support this global mobilisation and collaboration.
As part of the effort to help protect people everywhere and EU citizens in particular, the Commission is proposing an EU strategy to accelerate the development, manufacturing, and deployment of vaccines against COVID-19.
The strategy has the following objectives:
Ensuring the quality, safety and efficacy of vaccines.
Securing timely access to vaccines for Member States and their population while leading the global solidarity effort.
Ensuring equitable access for all in the EU to an affordable vaccine as early as possible.
The strategy rests on two pillars:
Securing sufficient production of vaccines in the EU and thereby sufficient supplies for its Member States through Advance Purchase Agreements (APAs) with vaccine producers via the Emergency Support Instrument (ESI). Additional financing and other forms of support can be made available on top of such agreements.
Adapting the EU’s regulatory framework to the current urgency and making use of existing regulatory flexibility to accelerate the development, authorisation and availability of vaccines while maintaining the standards for vaccine quality, safety and efficacy.
With regard to the joint purchasing strategy, the EU Commission’s approach was made crystal-clear:Footnote 372
Joint action at EU level is the surest, quickest and most efficient way of achieving that objective. No Member State on its own has the capacity to secure the investment in developing and producing a sufficient number of vaccines. A common strategy allows better hedging of bets, sharing of risks and pooling investments to achieve economies of scale, scope and speed.
An important step towards joint action between Member States has already been taken in the formation of an inclusive vaccine Alliance by France, Germany, Italy, and the Netherlands. This alliance was formed to pool the national resources of those countries and secure fair access to vaccine supplies for the European population. The current proposal builds on the important groundwork undertaken by that Alliance.
In order to scale this approach up to cover the whole EU, the Commission proposes to run a central procurement process, which creates a number of important advantages. In particular, all EU Member States will be able to benefit from an option to purchase vaccines via a single procurement action. This process also offers vaccine producers a significantly simplified negotiation process with a single point of contact, thus reducing costs for all. Centralising vaccine procurement at EU level has the merit of speed and efficiency by comparison with 27 separate processes. A truly European approach would avoid competition between Member States. It creates solidarity between all Member States, irrespective of the size of their population and their purchasing power. A pan-EU approach will increase the EU’s leverage when negotiating with industry. It will also enable us to combine the scientific and regulatory expertise of the Commission and the Member States.
A common EU approach will always respect the principle of subsidiarity and Member States’ competences in health policy: vaccination policies remain in the hands of Member States.
In other words, at a moment in time when US President Donald Trump, as befitting to a conniving businessman, had already concluded far-reaching agreements with several of the Covid-19 vaccine candidate developing enterprises, the EU itself was still mainly in its usual rhetoric phase, without yet any concrete action to improve the health and safety of its citizens.
All of the above would prove not to be of much help in securing a fast access to the Covid-19 vaccines, rather on the contrary, although the importance of proceeding fast had at the same time been explicitly recognized in the Commission communication of 17 June 2020, which stated:Footnote 373
Against that background, it is essential that all 27 EU Member States have access to a vaccine as early as possible. The same applies to the Member States of the European Economic Area (EEA).
The practical leadership of the EU-wide Covid-19 vaccine purchases was then entrusted to EU director-general for health policy Sandra Gallina, a former Italian translator.Footnote 374 In the Covid-19 vaccine negotiations on behalf of the EU, EU bureaucrat Gallina and her team would soon start putting great importance on three things: (1) a wide selection of potential vaccines, (2) low prices per dose, and (3) the principle that drug makers would bear legal responsibility if anything went wrong.Footnote 375 This approach was, moreover, in line with the guidelines that the EU Commission itself had put forward in its June 17, 2020 communication:Footnote 376
The aim of the negotiations is to conclude Advance Purchase Agreements with individual companies under the best possible conditions. These APAs will specify a number of details with respect to expected payments (such as payment amounts, schedule and financial structure), delivery details of the vaccine if and when successful (such as price per person vaccinated, quantity of vaccines and delivery timeline after approval) and any other relevant conditions (such as production capacity in the EU, possible availability of production facilities for the manufacturing of other vaccines or medicines in case of failure, or liability arrangements).
A speedy conclusion of procurement contracts was not the top priority of the Gallina task force; neither was securing quick delivery of the Covid-19 vaccines as of the respective dates on which they would, eventually, be ready. This, notwithstanding the communication of the EU commission of 17 June 2020 had explicitly mentioned otherwise.Footnote 377
The EU, moreover, mainly went after the cheaper vaccines, notably the Oxford-AstraZeneca and Johnson & Johnson Covid-19 vaccines, as opposed to the more expensive mRNA vaccines developed by BioNTEch-Pfizer and Moderna, and this notwithstanding the fact that the latter had a much higher effectiveness.Footnote 378
Precisely this stinginess later motivated the pharmaceutical enterprises to give priority to countries that had been willing to pay a higher price for the (more performant) mRNA vaccines (such as Israel and the United States). Perhaps even more ironic has been the fact that, while the EU had announced that its procurement policy emphasized concerns about vaccine quality and safety, including related liabilities to be granted by the Covid-19 vaccine producers, the EU would, ultimately, bet mostly on purchasing the two Covid-19 vaccines—notably the Oxford-AstraZeneca and Johnson & Johnson ones—that would cause the most problems with side effects, e.g., due to blood clots, from March 2021 on. (Cf. Sect. 220.127.116.11) In fact, when the latter problems surfaced in March-April 2021, the EMA would consistently downsize these problems, proclaiming that the risks posed by the Oxford-AstraZeneca and Johnson & Johnson Covid-19 vaccines did not outweigh the benefits of their continued use in the EU vaccination campaign. There was, in other words, by April 2021, not much left of the earlier concerns about product liabilities, unless in the form of meaningless EMA recommendations that the possibility of side effects should be mentioned on the package inserts of both vaccines. These were of course hardly read by anyone, to the extent that most of the vaccinations in EU Member States were administered by doctors or nurses, either in hospitals, home practices or vaccination centres, of course without the administrators of the vaccines making their packaging available to the vaccinees, let alone offering the rows of vaccinees standing in line to get a jab, the opportunity to first attentively read said package inserts.
In the period January-April 2021, delivery problems with the cheaper Oxford-AstraZeneca and Johnsons & Johnson Covid-19 vaccines, would result into immense delays of the EU vaccination campaign, even to the extent that the EU was afterwards forced to initiate court proceedings against AstraZeneca for breach of contract with regard to the performance of its delivery obligations. (Cf. Sect. 18.104.22.168.)
The failure of European bureaucracy in swiftly procuring enough Covid-19 vaccines would thus appear from two main levels, on the one hand, from a complete unfamiliarity with the working methods of the pharmaceutical sector and, on the other, from a very naive view on how the economy functions by assuming that small savings on the price of the (cheap) Covid-19 vaccines would ever be able to outweigh the damages that the European economy continued to suffer due to the delays in vaccinations.Footnote 379
Be this as it may, the EU Commission’s negotiations with the producers of the more efficient mRNA vaccines kept dragging on. Apparently, Covid-19—and the many lives it costs, next to the detrimental economic impact of the continued lockdown measures throughout the EU—did not lend any sense of urgency to the negotiation talks of the EU bureaucrats who, moreover, felt no need of making sure that the EU would have sufficient access to the more efficient mRNA vaccines as well. All negotiation talks were, furthermore, held virtually, adding an intangible complication to the whole ordeal.Footnote 380
Because of these factors, talks with Pfizer-BioNTech and Moderna, proved especially thornyFootnote 381 (as a result of which, by January 2021, the mRNA vaccines would hardly be accessible in the EU countries who, since then, saw it necessary to try and explain to their population that the much cheaper Oxford-AstraZeneca and Johnson & Johnson-vaccines were more than good enough for European use, notwithstanding a wide variety of concerns about their safety and side-effects).Footnote 382
22.214.171.124 Being the Last in Entering Into Contracts with the mRNA-Vaccine Producers, But Still Being Proud of It
When BioNTech-Pfizer had reported efficacy results of their Covid-19 vaccine higher than 90 percent on 9 November 2020 (cf. Sect. 126.96.36.199), and, moreover, promised to soon send their available testing and trial data to the European regulators, the EU Commission projected calm. Next, Moderna had reported efficacy rates higher than 90 percent on 16 November 2020 (cf. Sect. 188.8.131.52). In response, the United Kingdom made a deal with Moderna on that same day. But again, the EU Commission’s Gallina task force showed no urgency to speed up its negotiation processes.Footnote 383
On 17 November 2020, it seems that the US biotech company Moderna had lost its patience, when it had deemed it necessary to warn the EU countries that further dragging out negotiations to purchase its very promising Covid-19 vaccine, would ultimately slow down deliveries, and that, to the extent that several other countries had already signed deals, the latter were (obviously) bound to get priority. At the time, Moderna had just announced that its experimental mRNA Covid-19 vaccine promised to be almost 95% effective in protecting people from Covid-19, thus further boosting hopes of an end to the Covid-19 pandemic, only shortly after Pfizer-BioNTech had released similar promising findings about their own Covid-19 vaccine a while before (cf. Sect. 184.108.40.206). Moderna, furthermore, explained that while already since the summer of 2020, it had engaged in fierce discussions with the EU Commission about the EU buying 80 million doses of its Covid-19 vaccine, still no contract had been signed by 17 November 2020. In the meantime, Moderna had already signed agreements to provide its Covid-19 vaccine to Canada, Japan, Israel, Qatar and the United Kingdom. Moderna thereby pointed out that there was a lot of red tape involved in getting a deal with the EU, while, by contrast, it took just two weeks to cement a deal on providing the vaccine to Canada from the time the two sides had started talks to the signing of a contract.Footnote 384 Already then, it became clear that the EU would not be among the first to receive the Moderna Covid-19 vaccine deliveries when it would ultimately be ready, after having obtained the necessary regulatory approvals).Footnote 385
At the same time, also the United States had been showing far more eagerness to make a deal with Moderna. As explained before (cf. Sect. 220.127.116.11), already on 2 March 2020, Moderna and other Big Pharma executives had been meeting in The White House with (then) US President Donald Trump. By April 2020, the United States had already paid USD 500 million to bankroll Moderna’s clinical trials. Moderna received, on the whole, USD 2.5 billion in US government financial support under the notorious “Operation Warp Speed”, the initiative that the Trump administration had unveiled on 15 May 2020, to establish a close cooperation between the US federal government and the vaccine industry for developing a vaccine that would put a stop the Covid-19 pandemic. While for Moderna, Operation Warp Speed had proven to be one of the most efficient forms of support in the development of its Covid-19 vaccine, the EU from its side had merely committed to a lot of idle talk.Footnote 386
The result of all this was that, the United States would be able to start using the Moderna Covid-19 vaccine by the end of 2020, while the EU had not yet shown a concrete willingness to place an order.Footnote 387
Eventually, the purchase agreement between the EU and Moderna would get signed on 25 November 2020.Footnote 388 At that moment, most of the other (non-EU) Western countries had already weeks before signed their own Moderna purchasing contracts. As Moderna had already pointed out on 17 November 2020, the consequence of this would be that the EU would be the last to receive Moderna-deliveries, which helps to explain the slow start of the Covid-19 vaccinations in the EU member countries as of January 2020, while in many other Western countries, millions of doses of the Covid-19 vaccines had been administered already.
Moreover, the EU was similarly late in purchasing the BioNTech-Pfizer Covid-19 vaccine which was also purchased in November 2020. Again, the United Kingdom had acted more quickly, having bought its BioNTech-Pfizer Covid-19 vaccine supplies already in July 2020. Pfizer had offered the EU 500 million doses in the same month, but Brussels had simply turned the proposal down, deeming it too expensive.Footnote 389
As a result of all this, the United Kingdom had also reached a basic “deal in principle” with AstraZeneca 3 months earlier than the EU, and its later purchasing contract itself came with sharper teeth, although the EU would later keep stressing that it had signed its actual purchasing agreement a bit earlier than the United Kingdom (namely on 27 August 2020, while the UK’s actual purchasing agreement with AstraZeneca was dated on 28 August 2020—one day after the EU agreement).Footnote 390
The EU, hence, took in some cases months longer than the United Kingdom and the United States to sign purchasing agreements with the Covid-19 vaccine producers. Making matters even worse, the EMA, a body by definition particularly receptive to the precautionary principle that plays such a dominant role in EU policy-making, would later also take its time to approve the first vaccines. Its first approval bioNTEch-Pfizer Covid-19 vaccine came some weeks after the one granted by the United Kingdom, and ten days after the one granted by the United States.Footnote 391
According to Nicolas Bouzou, head of a Paris-based advisory firm called “Asterès”, the EU had simply made its orders too late and only focused on price, seemingly considering that getting access to the Covid-19 vaccines was not a priority. For Bruno Maçães, a political scientist at Washington DC’s Hudson Institute and former Portuguese secretary of European affairs, there was in the summer of 2020 simply “no sense of urgency” at the side the EU.Footnote 392
Maçães expressed this concern as follows:Footnote 393
There is a lot that went wrong with the European Commission’s vaccination strategy. But before everything else, there was complacency. Back in the summer, the predominant feeling in Brussels and many European capitals was that the virus could be controlled through savvy policy measures. The contrast with the health calamity in the United States made European officials forget that the pandemic was in fact a state of emergency requiring a decisive approach to vaccination. Instead, most believed that vaccines would eventually be needed to root out the problem, but the process could be conducted against the background of a waning pandemic, at least in Europe. There was no urgency in signing the necessary contracts with the most promising manufacturers, with protracted haggling over prices further delaying the process.
We now know that time was of critical importance and that the sooner procedures could be tested and perfected, the sooner a high yield of vaccine doses could be expected. The lack of urgency was also reflected in the attempt to bring a number of exogenous considerations into the process. For many months the European Union seemed more interested in scoring political points on solidarity, market power and negotiating clout than in focusing laser-like on the task at hand: getting as many vaccines as fast as possible into the arms of its citizens. It was easy to see all these problems coming. They were like bad omens and they kept piling up.
During a pandemic, it makes a vital difference whether vaccines are available now or in two months’ time, both in terms of saving lives and resuscitating the economy.
This was never understood in Brussels, with the Commission insisting it had secured billions of doses but forgetting to consider when these doses would be available. Even in normal times, being able to lead in key technological areas will sooner or later be translated into more visible forms of global power.
Surprisingly, EU bureaucrats themselves would continue to perceive their actions as a huge success. They kept on showing great confidence that the terms of the EU Commission’s procurement contracts were robust in best serving the interest of the European consumers and their pocketbooks. European bureaucrats were particularly proud that they had managed to drive down prices for the Covid-19 vaccines lower than their counterparts in Washington.Footnote 394
There could have hardly been a more alienated way of reasoning at the EU policy level, since as a result of this completely unworldly stance, the vaccination campaign in EU countries would run into months-long delays, as of January 2021.Footnote 395
18.104.22.168 Lack of Awareness That, Ultimately, the European Population Would Have to Pay the Price for the EU’s Many Mistakes in Procuring the Covid-19 Vaccines
In our opinion, the EU purchasing strategy was a severe debacle. It was deeply callous of the EU to reason that savings of a few million euros could ever weigh up against the loss of lives that every delay in starting the vaccination campaign implied. Moral objections aside, it was also mind-bogglingly naive to strike a bargain which would be immediately wiped out by the massive, economic losses from the continuation of the lockdowns (cf. Sect. 2.4.3), at a time when countries such as Israel and the United States already would be able to start functioning relatively normally again.
At the beginning of 2020, the European population could start to see for themselves how badly they fared under the policy choices the EU had made. The (at the time prevailing) prospect that most of the EU population would, at best, only have access to the less effective Oxford-AstraZeneca Covid-19 vaccine (where it remained for a long time unclear whether this vaccine was still sufficiently effective from a certain age threshold, next to protecting against certain mutations/variants of the Covid-19 virusFootnote 396) caused a great concern among a large part of the EU population, with even those first summoned to receive the Oxford-AstraZeneca jab refusing to show up. Incidentally, among those who refused the Oxford-AstraZeneca Covid-19 vaccine, was a large proportion of healthcare workers themselves.Footnote 397
The EU and the national authorities of several of the EU Member States responded to this hesitancy with regard to the Oxford-AstraZeneca Covid-19 vaccine by means of a campaign of persuasion (worthy of a dictatorial regime), increasingly—and against all facts—advocating that the Oxford-AstraZeneca Covid-19 vaccine, in reality, did not exhibit any of the flaws reported previously, which, of course, has been but another factor of distrust for many.
As phrased by FranklinFootnote 398:
The European Union is now waking up to what it needlessly missed out on. Worried EU governments are now desperately reassuring their populations that the Oxford AZ vaccine is safe and effective. The French have just relaxed the restriction on the vaccine’s use among the over 65s. The Germans are likely to follow suit. Thomas Mertens, head of Germany’s expert panel on vaccine use, has promised an “update” to the current regulations. He was at pains to point out that the existing restriction were never about safety concerns and added that “somehow the whole thing went kind of badly wrong.” Yeah, “somehow”.
In Flanders (Belgium), public policy was during some time even such that people who refused the Oxford-AstraZeneca Covid-19 vaccine would not be given any other choice (i.e., a “take it or leave it”-principle),Footnote 399 with the Flemish government not even appearing to have questioned how such an approach related to some of the fundamental rights guaranteed by the ECHR, which imply a minimum protection with regard to the right to integrity of the human body, in addition to an elementary right to a full and adequate medical treatment.Footnote 400
22.214.171.124 Further Comparison with the Approach of the United Kingdom and the United States
How delusional can policymakers and bureaucrats get?
Convinced that by, supposedly, having negotiated with the Covid-19 vaccine manufacturers in a “hard”, rather than a swift and efficient manner, they had done the EU citizen (and by extension the European economy) a huge favour (notably by having obtained the lowest possible prices for the Covid-19 vaccines), European policymakers and bureaucrats then also tried to get the ((Br)exiting) United Kingdom behind the EU vaccination policy choices. The European Commission thus offered the United Kingdom the chance to join its disastrous Covid-19 vaccine procurement programme, but London—already having to deal with the harsh reality of Brexit—wisely turned down the offer. Instead, the United Kingdom simply signed its own purchasing agreements. In addition to purchasing the Oxford-AstraZeneca developed Covid-19 vaccine, the UK government also signed deals for procuring the Covid-19 vaccines developed by BioNTech-Pfizer and—shortly after the release of the preliminary trial data—from Moderna as well.Footnote 401
But where the United Kingdom would really get ahead of the EU in the Covid-19 vaccination race was in approving the actual deployment of the several Covid-19 vaccines.
By 20 November 2020, BioNTech-Pfizer had already submitted its request to obtaining an EUA to the US FDA.Footnote 402 (Cf. Sect. 126.96.36.199) Given the EU’s own apparent complete lack of interest in making the mRNA Covid-19 vaccines available within the EU as soon as possible, BioNTech-Pfizer waited until 1 December 2020 to submit a similar application to the EMA (short for the “European Medicines Agency”).Footnote 403 However, the United Kingdom wisely chose to pre-empt both the US and EU supervisory agencies, thus becoming the first Western country to give a formal green light to a Covid-19 vaccine, by dispensing some of the requirements under the formal application procedure. More in particular, the UK Medicines and Healthcare products Regulatory Agency, already on 2 December 2020, gave a temporary approval to the BioNTech-Pfizer Covid-19 vaccine, based simply on the report about the Phase III trial data with regard to this vaccine it had earlier received.Footnote 404 A few days later, a first dose of the BioNTech-Pfizer Covid-19 vaccine, outside the scope of trial testing, was administered in the United Kingdom (cf. Sect. 9.4.4). It was for many observers clear that this would have been impossible without Brexit, which according to some also indicated a differences in priorities that prevailed on the two different sides of the Channel.Footnote 405
At about the same time, the US FDA—11 days ahead of the EU EMA—also rushed to give a EUA to the BioNTech-Pfizer Covid-19 vaccine.Footnote 406 Eleven days would under normal circumstances be considered an insignificant delay in the land of drugs regulation. However, against the background of a raging global pandemic, lost days very likely equalled thousands of lost lives,Footnote 407 as well as huge economic damage.Footnote 408
Being one of the United States’ biggest pharmaceutical enterprises, Pfizer itself had not received any form of financial support under the Trump administration’s Operation Warp Speed. However its partner (and actual developer of the BioNTech-Pfizer Covid-19 vaccine), BioNTech, had itself received a loan from the EIB, besides actual financial support from the German government. One could have thus expected that BioNTech-Pfizer would first have turned to the EU for getting a regulatory approval on the use of their vaccine. However, most probably in the light of Pfizer’s own bad experiences in its contract negotiations with the EU, the New York-based enterprise Pfizer wisely chose to coordinate the clinical trials needed for getting regulatory approval in close cooperation with the US supervisory agency FDA—rather than with the EU supervisory agency EMA—as well as with Germany’s own vaccine regulator, the Paul Ehrlich Institute.Footnote 409 This at the same time helps explaining why the request for (temporary) approval of the BioNTech-Pfizer Covid-19 vaccine was first made in the United States. In the end, the US FDA granted an EUA for the BioNTech-Pfizer Covid-19 vaccine on 11 December 2020, which was just three weeks after the two enterprises had submitted their application. The EMA granted a similar temporary permission some 10 days later. (Cf. Sect. 188.8.131.52.)
Notwithstanding the fact that it took the EMA one day less than the FDA to make its decision between the date of the formal application and the ultimate decision, it was clear that, by then, the EU had not only lost the Covid-19 vaccination race with regard to the procurement of the Covid-19 vaccines, but also with regard to granting the necessary regulatory approvals, adding a further cause to the fact that the Covid-19 vaccines, by early 2021, were much less available in the EU than in the United States, besides a variety of other countries that had all been much quicker in responding to the challenges posed by the ongoing Covid-19 pandemic itself in relation to the rapid development of functional Covid-19 vaccines.Footnote 410
184.108.40.206 Late Start of the Vaccination Campaign in the EU and Problems with Supply Shortages
In early 2021, political leaders across the European continent began to protest about the delays of the EU vaccination campaigns.Footnote 411 Worse still, it appeared that EU citizens were mostly denied access to the most effective Covid-19 mRNA vaccines that could slow the epidemic on the continent and save their lives.Footnote 412
Vaccinations within the EU slowly began on 26 December 2020, when three EU countries—Hungary, Germany and Slovakia—had rushed to accept the European Commission mission’s invitation to begin inoculating people as of 27 December 2020).Footnote 413 This was almost 2 weeks after the first Covid-19 vaccinations had been administered in the United States and almost three weeks after pictures of the first woman being vaccinated with the BioNTech-Pfizer Covid-19 vaccine by the UK National Health Service had been released to the world’s media.Footnote 414 (Cf., furthermore, Sect. 220.127.116.11.)
Notwithstanding the delays and clearly not in the least embarrassed about the many mistakes that had been made during the negotiations and the procurement process for acquiring the Covid-19 vaccines, European Commission’s mission chairwoman, Urusla von der Leyen, was surprisingly quick to call the coordinated deployment a “true European success story”, although many other politicians, let alone the EU citizens themselves, did not share this over-enthusiastic assessment.Footnote 415
Given the terms of the agreed upon purchase agreements, and even though the initial EU order for doses of the BioNTech-Pfizer Covid-19 vaccine had been double that of the United States, it soon got clear that the cooperating vaccine producers had planned to deliver the purchased doses of their Covid-19 vaccine at a much faster rate to the United States than to the EU itself. Pfizer thus explicitly committed to deliver 200 million doses of the BioNTech-Pfizer Covid-19 vaccine to the United States by the end of July 2021, for which Pfizer would resort to the production that it accomplished through its American factories, while the EU itself was not even guaranteed that it would receive this same number by the end of September 2021.Footnote 416 Moreover, at the beginning of 2021, supply disruptions started to occur which BioNTech and Pfizer completely passed on the EU, while deliveries to the United States largely continued as agreed upon. When on 15 January 2021 Pfizer-BioNTech thus announced that they would have to reduce supplies of the vaccine to some countries for a few weeks in order to upgrade their plants to be able to produce doses more quickly, it was mainly the EU that was affected by this measure, while the vaccination campaign in the United States itself could go ahead as planned.Footnote 417
Deliveries to the EU by Moderna were even worse, as Moderna itself had already warned around the middle of November 2020. Moderna’s Covid-19 vaccine had ultimately been approved on a temporary basis by the EU EMA on 6 January 2021, several weeks after the US FDA had granted the Moderna Covid-19 vaccine a EUA for use within the United States.Footnote 418 Most probably due to the experiences that Moderna had endured during its negotiations with the EU, Moderna from the outset announced a limited supply to the EU throughout 2021, committing only 10 million doses of its Covid-19 vaccine for delivery to the EU throughout Q1 2021.Footnote 419
When, on 22 January 2021, AstraZeneca as well announced that deliveries of its Covid-19 vaccine to the EU would not be a top priority, the European vaccination campaign was down and out before it even began, and would remain so until the end of April 2021.Footnote 420
At the same time, it appeared from preliminary customs data that millions of Covid-19 vaccines produced on EU soil, had simply been exported from the EU to Britain, Canada, Israel and China. Britain, Israel and Canada all declared that they received their doses of the BioNTech-Pfizer Covid-19 vaccine exclusively from EU countries. Britain also declared that it received doses of the Oxford-AstraZeneca Covid-19 vaccine from the EU, notwithstanding the fact that AstraZeneca had two operational production plants on British soil.Footnote 421 So, while, on the receiving end, the EU was facing huge delivery problems with regard to all three main Covid-19 vaccines—bearing in mind that the Johnson & Johnson Covid-19 vaccine was at the time not yet ready—it nevertheless allowed a massive export of Covid-19 vaccines produced within the EU itself to other territories, in this manner denying its own citizens access to the life-saving product.
The afore-mentioned drastic announcements by the three main Covid-19 vaccine-suppliers the EU had been counting on, would eventually force health ministries all over the European continent to completely rewrite their vaccination plans throughout Q1 2021 and the month of April 2021,Footnote 422 with a single EU Member State, notably Hungary, even starting to look at Russia and China for deliveries of their own Covid-19 vaccines.
18.104.22.168 Criticism on the EU’s Stinginess
While throughout the months January-April 2021, panic over Covid-19 vaccine shortages in all EU member states mounted, many started questioning the EU Commission’s policy of having pursued low prices to the detriment of fast deliveries.Footnote 423
Israel, which at the time was taking the lead in inoculating its population, made no attempt at hiding the fact that its “whatever-it-takes approach” for acquiring the Covid-19 vaccines had involved shelling out more,Footnote 424 a strategy which had proven highly effective, to the extent that Israel soon became the country most likely to reach herd immunity because of its vaccination strategy.Footnote 425
The United Kingdom and the United States had, in a similar manner, also been willing to pay more per dose of the Covid-19 vaccines than the EU. Published figures about the prices paid for the Covid-19 vaccines indicate that the EU had been willing to pay less than USD 2 per dose of the Oxford-AstraZeneca Covid-19 vaccine, while the United States had been willing to pay around USD 4. When considering these figures, one has to bear in mind that the United States did not rely on the Oxford-AstraZeneca vaccine in their own campaign (nor did it intend to), while for the EU, the Oxford-AstraZeneca Covid-19 vaccine had at the time been indicated as the central piece of the EU vaccination campaigns. The United States had, phrased differently, been willing to pay the double for something it did not consider all that important. From the aforementioned data, it also appeared that the United States had negotiated a USD 20 price tag per dose for acquiring the BioNTech-Pfizer Covid-19 vaccine, and Israel even a price tag of more than USD 40 per dose. In contrast, the price that the EU had been willing to pay for a dose of the BioNTech-Pfizer Covid-19 vaccine only amounted to USD 15, which presents a further insight in the value the EU warrants to the lives of its citizens in comparison to less stingy countries.Footnote 426
On January 23, 2021, in a column named “Our worst policy error”, Wolfgang Münchau, the then-head of the London-based “Eurointelligence” think tank and a frequent critic of Brussels initiatives, gave the following assessment of the EU’s stinginess, in which he severely criticized the EU’s wrongheaded policy choice of prioritizing price over delivery.Footnote 427 Considering this opinion being so right on the money, it is hereafter quoted completely:Footnote 428
It looks like I might have been a bit premature when I predicted that austerity would go down as the EU’s worst policy error during my lifetime. In one sense this prediction from the time of the eurozone crisis will probably turn out to be correct.
Austerity triggered economic divergence that will be hard to reverse.
But the EU vaccine’s policy must be a close contender for that title. As of January 22, the EU had vaccinated only 1.89% of its population, whereas the UK vaccinated 9.32%. Moreover, the daily rate of increase is faster in the UK. UK vaccinations not only started earlier, but the gap is also still widening.
You can’t blame logistical errors. What happened is that the EU did not secure enough vaccines. That, in turn, slowed down the pass-through. The Commission’s headline numbers are not deliveries. Already in November, the head of Moderna warned that the EU was dragging out negotiations. AstraZeneca, which is distributing the Oxford vaccine, said deliveries to the EU will take longer than previously anticipated. Pfizer, which distributes the German BioNTech vaccine, is now warning the EU of supply bottlenecks because of problems with a production site in Belgium.
What happened here is that the EU did a Brexit trade deal with the pharma industry: it tried to lock in a perceived short-term price advantage at the expense of everything else. Instead of prioritizing the speed and security of supplies at any price, the EU prioritized the price. The EU paid 24% less for the Pfizer vaccine than the US, for example. For the Oxford/AstraZeneca vaccine, the price gap is 45%. The UK almost certainly paid a lot more. It is no wonder that the manufacturers are prioritizing orders on a first-come, first-serve basis, and from countries that pay the full price. The price difference is macroeconomically irrelevant. But if vaccine shortages lead to longer lockdowns, the indirect effect of that short-sighted policy will be massive.
At one point, the cost of this policy error will also be measurable in terms of human lives. This is not possible now because we don’t know the future spread of the virus. We know that the UK mutant has arrived on the continent but has not yet unleashed its full pandemic force. In the most benign scenario, the current lockdown might prevent the worst. In the worst-case scenario, the vaccination delay would be a calamity that could costs tens of thousands of lives.
So why did EU governments shift responsibility for vaccination procurement to the EU in the first place? Angela Merkel reasoned that it would have strained EU cohesion if Germany had procured privileged supplies of the BioNTech vaccine. What she did not consider is that the EU is ill-equipped for this task. To this day, the EU’s DNA is that of a producers’ cartel. Its priority is not to secure supplies but reduce costs and achieve some balance between French and German interests. Triangulation is what Brussels does for a living. Whatever-it-takes is not part of its culture.
On a broader perspective, the vaccine disaster is the culmination of a trend that started with the Maastricht Treaty. Until then, the EU did only a few things well: the customs union, the Schengen travel zone, and to a lesser extent, the single market. The EU’s competencies have progressively widened since, but the results are mostly disappointing. In the early 2000s, the EU obsessed about the Lisbon Agenda for structural reforms, which brought few concrete benefits. Nor did the Juncker investment programme a decade later. The vaccination disaster differs in only one respect: it will be blamed for the loss of human lives.
There will undoubtedly be calls for resignations. But for me, the more important issue is the conclusions EU citizens will draw from it. For starters, the EU has just provided a hindsight argument in favor of Brexit. The UK would not have proceeded with vaccinations as quickly if it had subjected itself to the same policy. The last thing the EU ever wants to do is give people a rational, non-ideological reason for Euroscepticism.
In a similar manner, albeit a bit shorter, on the same date, Guntram Wolff, director of the Bruegel think tank in Brussels, tweeted the followingFootnote 429:
The EU spends less per vaccine shot than other industrial countries. This stingy approach cost lives. It’s incomprehensible, why budget line for vaccine purchases was so limited while lockdowns cost hundreds of billions. More financial incentives needed to boost production now.
To the extent that the EU Commission sacrificed speed for stinginess and solidarity, while at the same time trying to reach an understanding with the Covid-19 vaccine providers concerning possible liabilities, it remains an open question whether it got what it wanted.Footnote 430 For a supranational institution that prides itself on consistently prioritizing both economic interests and principles, this approach demonstrated a clear lack of insight into the basic dynamics of capitalist economies: when negotiating the purchase of Covid-19 vaccines, the EU was not on a buyer’s market. Speed was of the essence, as countries from all over the world vied for priority access in the vaccine queue, while it was also clear that production and supply of the Covid-19 vaccines would not be able to meet demand.Footnote 431 Also, the heavy-handed treatment of, e.g., manufacturer Moderna—cf. the public statement of the latter of 17 November 2020, quoted before at Sect. 22.214.171.124—apparently testified to little insight from the part of the EU on how to deal with suppliers of a scarce and vital product.
There has also been strong criticism regarding the poor quality of the EU vaccines purchasing task force itself which has been considered not being up to the task. Wheeldon has in this regard pointed out that, while the EU Commission is very good at negotiating things like trade deals, it traditionally did not have any competence whatsoever in matters as vaccines and vaccine contract negotiations which had in the past always been left to the Member States themselves. For some, the EU Commission, had mistakenly aggrandized its competence, although it was clearly not up to the job, lacking both the competent people and the experience for such an undertaking. By contrast, the United Kingdom had put a successful venture capitalist specialised in biosciences, notably Mrs Kate Bingham, at the head of its Covid-19 vaccine acquisition program. Bingham’s specific professional expertise was in purchasing vaccines and drugs, as well as in drawing up purchasing agreements with pharmaceutical enterprises, while none of that was the competence of Ursula von der Leyen or anyone within the Gallina task force.Footnote 432 (Cf. Sect. 126.96.36.199)
The policy choice of deploying an unqualified task force, which then moreover prioritized price above speed, caused great delays by December 2020. Further policy choices and austerity measures doomed all other attempts at a truly equal approach to the vaccination process,Footnote 433 both in terms of the relationship between the EU member states, as between individual European citizens.
Be this as it may, on 19 January 2021, when just over 5 million Covid-19 vaccines had been administered throughout the EU, the EU Commission still deemed it fit to announce targets according to which at least 80% of EU health laborers and the elderly above the age of 80 would be served with a Covid-19 vaccine by March 2021, and 70% of the EU adult population by the end of the summer of 2021. Moreover, while at the time hardly having received deliveries of the Covid-19 vaccines for itself, the EU announced that it would start donating excess doses of the Covid-19 vaccines to poorer countries.Footnote 434
There is little room for denying that, while, during the months of January and February 2021, the variety and the available numbers of Covid-19 vaccines in the United Kingdom were not as wide and big as they were across the Atlantic Ocean, but at the same time, no European country had vaccinated more people than the United Kingdom. If the United Kingdom had then still been a member of the EU, already on 22 January 2021, it would have been the only country on track to achieve the EU Commission’s goal of vaccinating 70% of the adult population by the summer of 2021 (and, hence, for once being among the best students of the EU class).Footnote 435 What is as clear is that the EU’s prioritizing price over speed has cost not only precious time, but also precious lives.
As Maçães has phrased it:Footnote 436
I now fear that the European Union will find itself in the impossible situation of having to prolong some of the existing restrictions beyond the summer, while both Britain and the United States start to normalize. That is the cost of the vaccine delays: a very high cost in lives, prestige and further economic losses. The current crisis has the potential to spiral out of control. The imperative was to reduce the risks of that happening, no matter what the immediate financial cost.
As the EU vaccine procurements came under increasing attack from all possible sides during the second half of January 2020, EU bureaucrats, Gallina in the lead, were still particularly notable for the fervour with which they continued to defend the EU’s strategic choices. In clear denial of all contradictory facts, Gallina said that she was still convinced that the EU was better off than Israel, the United Kingdom and the United States, pointing out that the EU had managed to “reserve” many different Covid-19 vaccines and had also managed to negotiate the best prices.Footnote 437 Gallina, in addition, argued that the EU was in the “top league” of Covid-19 immunization process worldwide, while denying that the Covid-19 vaccines rollout was hobbled by delays arising from the contracts with the vaccine producing pharmaceutical enterprises.Footnote 438 Gallina, furthermore, argued that, by the end of January 2021, the EU had already vaccinated more than 12 million people and that unfavourable comparisons with more successful countries such as Israel, at the time the world leader in Covid-19 inoculation, were not at all helpful.Footnote 439
However, the EU bureaucrats remained unable to answer the real questions regarding the extreme slowness of Covid-19 vaccine deliveries to the EU, throughout Q1 2021 and deep into April 2021.
In early February 2021, EU Commission President Ursula von der Leyen herself acknowledged that, when negotiating and signing the Covid-19 procurement agreements, the EU had been too optimistic about the rapid production and delivery of the Covid-19 vaccines, but also continued to emphasize that the joint purchase by Brussels had been the right strategy.Footnote 440 von der Leyen, furthermore, came up with the remarkable argument that “the battle against the virus is a marathon, not a sprint”.Footnote 441
This desperate defence of the EU’s strategic choices by both Von der Leyden and the chair of the vaccine procurement task force, however, had no impact whatsoever on the failure of the deliveries—and, hence, of the vaccine administrations—themselves.
As Franklin has assessed this attitude of the EU leadershipFootnote 442:
As an institution, the EU displays a pattern of behavior that in an individual would be diagnosed as petty narcissism. We all know the type of person: the character flaw isn’t obvious at first, but they soon give themselves away. In place of the usual give-and-take of a healthy human relationship, they think they’re doing you a favor just by allowing you to interact with them. Furthermore, you will be expected to pay for the privilege. This means abiding by their rules; having to guess what they want without being told; prioritizing your relationship with them above any other attachment. Resist their nonsense and you’ll be accused of being the unreasonable one.
188.8.131.52 In Between-Conclusions Regarding the EU’s Failed Covid-19 Vaccines Procurement Policy
In light of the foregoing, the EU policy of dealing with Covid-19 has failed in many ways and on many occasions.
Especially since the enactment of the 1992 Maastricht Treaty, the EU has committed itself heavily to implementing neoliberal doctrine. Already before the creation of the EMU, the emphasis on the interests of the trade, financial and industrial sectors have been high on the European Communities’ agenda, at the expense of other possible interests within the socio-economic sphere, such as care for the environmentFootnote 443 and public health (of which, incidentally, hardly any trace can be found in the European treaties), and certainly not in case these other socio-economic interests would collide with economic interests themselves.
As has been demonstrated throughout the previous Chapters of this book, the European neoliberal political agenda has during the past three to four decades increasingly, and on a wide variety of policy topics, determined the policy of the EU member states as well. The combined effect of submitting EU policy and the policy of the EU Member States to the doctrines of economic neoliberalism, has in times of Covid-19 proven to be especially detrimental.
Let us briefly summarize some of the findings of the previous Chapters about what this has implied for the European policy responses to Covid-19.
First, in full accordance with neoliberal logic, most EU Member States have during the past decades increasingly pursued an austerity policy in the field of healthcare. (Cf. Chap. 5) As a result, when Covid-19 hit Europe as of January 2021, little was left of any preventive health policy in most EU Member States, nor was there much to be seen thereof at the EU level itself, to the extent that the EU had no significant competences in this area. The combination of these two elements—a far-reaching austerity policy at the level of the EU Member States and the absence of significant competence, or even interest, regarding public health matters at the EU level itself—implied that, when Covid-19 reached the European territory in January 2020, both the EU itself, as its Member States, could only stand by and watch. There were, e.g., no EU institutions mandated to cope with a pandemic. Nor were there any stocks of protective or other medical equipment needed to combat such a health crisis available anywhere. This dearth of equipment ranged from ordinary facemasks for general use, to more advanced medical protection gear or equipment needed for the treatment of Covid-19 patients (such as, e.g., respirators). The leaders of certain European Member States would even bluntly lie to the public, explaining that face masks offered no protection against the Covid-19 virus anyhow, even while Asian countries, far more experienced in such health crises, generally relied on facemask wearing to combat coronavirus outbreaks. In addition, in many European countries, after decades of neoliberal austerity policy decisions in the field of healthcare, the capacity of the hospital sector turned out to be unable to cope with the large wave of Covid-19 contamination cases. In many EU Member States, this led to the most dramatic situations, including the systematic refusal of admitting members of the elderly population (in particular long-term nursing home residents) to hospitals, implying that they were left to die in their retirement home, or even at home, under the most appalling conditions. (Cf. Chap. 6) There was, furthermore, a complete lack of knowledge on how to respond to the Covid-19 pandemic, which resulted in completely wrong advice to the general public—such as statements that the Covid-19 outbreak was no worse than a seasonal flu or that face masks did not offer any protection whatsoever -, as well as in terms of failing to work out sound policy measures for several months after the outbreak of the pandemic. In the meantime, throughout the months of February and early-March 2021, the Covid-19 pandemic spread wildly throughout Europe, resulting in astronomical death rates, while in various Asian countries—but also in some countries of Oceania –, thanks to much more efficient government response, the Covid-19 pandemic was in many cases contained far more quickly. (Cf. Sect. 184.108.40.206) It is in this regard most significant that, even at a time after the WHO had already issued clear warnings about the seriousness of the situation, and after several cases of Covid-19 had already been identified on the European continent (by the end of January 2020), the EU would still continue for the next one and a half month to give absolute priority to all kinds of economic matters, in addition to the migrant problem and the EU relationship with Turkey, but did not deign itself to any significant action to combat Covid-19. As a result of this completely lax attitude on the part of the EU (in addition to numerous EU Member States), the Covid-19 virus had all this time free rein to spread across the entire European continent (besides Great Britain). The consequences have been correspondingly dire: already by the end of March 2020, the EU had the dubious status of being the Covid-19 pandemic’s centre of gravity.
Those who think that, after having learned these painful lessons, the EU would have been inclined to correct its past mistakes by embracing the quickly developed Covid-19 vaccines (cf. Sect. 9.3.1) and by aiming at acquiring them as quickly and efficiently as possible, would find himself again mistaken.Footnote 444
Faced with the negotiators of the Covid-19 vaccine producers who mainly envision a profit-making goal (cf. Sect. 9.2), EU officials tried to drive a hard bargain, as neoliberal doctrine equally teaches that every cent spent on the common good, e.g., on public health, is a waste of resources. Precisely this attitude is the reason why the EU negotiators would later proudly declare that they had managed to negotiate the lowest possible prices for the Covid-19 vaccines. (Cf. Sects. 220.127.116.11 and 18.104.22.168)
The combination of these elements has ensured that the EU, next to the EU Member States themselves (which had submitted to an unworldly principle of European solidarity on the subject of vaccine negotiations, apparently under the guise that the bulk purchaser would be able to negotiate a lower price) were among the last in the Western world to secure their contracts with the Covid-19 vaccine manufacturers, albeit at the lowest price. At least one of the vaccine producers, namely Moderna, explicitly warned that the actual vaccine deliveries would be based on a “first come, first served” logic (cf. Sect. 22.214.171.124), which should have led the EU to suspect that the actual deliveries would turn out to be problematic.Footnote 445
As Andreas Kluth wrote:
(…) the Eurocrats have unwittingly staged something like a parody of Brussels.
The EU was slow to strike deals and timid in the haggling. Its regulators took too long to approve vaccines that came on the market, including home-grown ones. Brussels then reacted badly to production shortfalls.
And thus, it happened.
When three of the most promising Covid-19 vaccines became available for distribution by the end of 2020, the EU (and with it, the EU Member States) could but observe how various other countries were getting off to a flying start with vaccinating their population, while the EU itself was barely receiving any deliveries. This also gave immediately rise to the suspicion that this situation would only come to an end after the entire population of the “first-in-line countries” would be vaccinated, with as result that, as the calendar year 2021 progressed, all hope that the entire European population would still be vaccinated in that same year, gradually diminished.
A far-reaching neoliberal policy has disrupted the population of the European continent on two levels: (1) On the one hand, by having to live under a regime that was completely unprepared for the arrival of a pandemic and, (2) on the other hand, by reaching the painful conclusion that even a health crisis of the size of a global pandemic, has, regretfully, not been able to motivate EU leadership to abandon the subordination of public healthcare to neoliberal economic principles.
Even Paul Krugman saw himself, on 18 March 2021, compelled to comment on the EU vaccination failure, in an opinion piece that appeared in The New York Times, in which Krugman wrote the following:Footnote 446
(…) at this crucial moment in the Covid-19 saga, when new vaccines finally offer a realistic prospect of returning to normal life, policy in the European Union has been marked by one bungle after another. Jabs in arms got off to a slow start: Adjusted for population, Britain and the U.S. have administered around three times as many doses as France or Germany. And the E.U. countries are still lagging, administering vaccines less than half as rapidly as we are.
Europe’s vaccination debacle will almost surely end up causing thousands of unnecessary deaths. And the thing is, the continent’s policy bungles don’t look like isolated instances, a few bad decisions made by a few bad leaders. Instead, the failures seem to reflect fundamental flaws in the continent’s institutions and attitudes — including the same bureaucratic and intellectual rigidity that made the euro crisis a decade ago far worse than it should have been.
The details of the European failure are complex. But the common thread seems to be that European officials were not just risk averse, but averse to the wrong risks. They seemed deeply worried about the possibility that they might end up paying drug companies too much, or discover that they had laid out money for vaccines that either proved ineffective or turned out to have dangerous side effects.
So they minimized these risks by delaying the procurement process, haggling over prices and refusing to grant liability waivers. They seemed far less worried about the risk that many Europeans might get sick or die because the vaccine rollout was too slow.
126.96.36.199.1 March 2021: Searching for a Scapegoat
According to information provided by the European Centre for Disease Prevention and Control, as of December 2020, all EU/EEA countries started to develop strategies or plans for the roll-out of the available Covid-19 vaccines. The majority of said countries thereby aimed at launching their national Covid-19 vaccination campaigns at the end of December 2020, shortly after the delivery of the first batches of the Comirnaty vaccine, i.e., the name for the Covid-19 vaccine developed by BioNTech-Pfizer. By February 2021, all EU/EEA countries also started administering the Moderna Covid-19 vaccine and the Oxford-AstraZeneca Covid-19 vaccine.Footnote 447
Vaccinations in the EU/EEA countries were to be rolled out in phases, with all EU/EEA countries starting with the inoculation of certain priority groups that had been selected based on their higher risk for developing severe Covid-19 disease. This mainly concerned the elderly and the residents of long-term nursing facilities. A second priority group were the healthcare laborers and certain other frontline workers.Footnote 448
At that time, ECDC and the WHO Regional Office for Europe jointly established a tracking system for collecting information on the roll-out of the Covid-19 vaccines in Europe, including data on the precise number of doses of the Covid-19 vaccines shipped to EU/EEA countries by the vaccine producing enterprises, as well as data on the exact number of Covid-19 vaccine doses administered to people divided by age group and other ranking criteria. The objective of this tracking system was to gather data on (1) the effectiveness of the vaccination campaigns at a national level in terms of delivering doses of the Covid-19 vaccines to the targeted priority groups; (2) the capacity of countries to deliver all available doses of the Covid-19 vaccines to the members of their population; and (3) the identification of any gaps in the Covid-19 vaccine deployment and vaccination campaign progress. As of 15 January 2021, these data were assembled through the European surveillance system (abbreviated as “TESSy”) and could be consulted on the ECDC website under the form of Covid-19 vaccine tracking tables.Footnote 449
Already at the beginning of February 2021, it started to become clear that the EU would be dealing with a cost of tens of billions of euros because of the delayed and chaotic roll-out of its Covid-19 vaccination campaigns, compared to countries where the vaccination campaigns were making rapid progress, such as the United States and the United Kingdom. It was then estimated by Bloomberg Economics that the ongoing need for lockdowns throughout the EU because of delayed inoculations, implied that the EU bloc’s economy was only functioning at about 95 per cent of its pre-Covid-19 pandemic level, equating to about 12 billion euros (USD 19 billion) per week of lost economic output.Footnote 450
At the time, the EU was already running weeks behind some of its peer countries in terms of Covid-19 inoculations, while at the same time proceeding at a much slower pace with scheduling new vaccination appointments. Unless the EU would, somehow by miracle, start to gain ground, it was expected to be compelled to maintain lockdowns, or similar Covid-19 containment measures, while the other major economies, notably those of the United States and the United Kingdom, would be able to fully return to work. Bloomberg estimated that a further vaccination delay of 1 to 2 months would imply economic losses of 50–100 billion-euro (USD 80 billion—USD 160 billion), while it was already then feared that the delays would be much longer than only 1–2 months.Footnote 451 These early calculations on the economic loss of the EU vaccination procurement failure highlighted the massive stakes for the EU Commission, which at the time, moreover, became entangled in a public discussion with vaccine producer AstraZeneca over supply delays and over threats that the EU would start imposing export restrictions for Covid-19 vaccines.Footnote 452 At the time, according to the Bloomberg Vaccine Tracker, the EU had been serving a mere 2.9 doses of the Covid-19 vaccines per 100 people, far under the 14.7 of the United Kingdom and the 10 of the United States.Footnote 453
As if all of this was not disastrous enough, as of February 2021, many further problems occurred with the Oxford-AstraZeneca Covid-19 vaccine. For the EU, the Oxford-AstraZeneca Covid-19 vaccine had from the beginning been an important component of its vaccination plans, despite the obvious disadvantages of the vaccine that were already clear when the EU went ahead with its procurements, most notably the fact that the efficacy rates of the Oxford-AstraZeneca Covid-19 vaccine were far under these of its mRNA counterparts, notably the Pfizer-BioNTech and Moderna Covid-19 vaccines, implying that being inoculated with the Oxford-AstraZeneca Covid-19 vaccine would for many people all over the world never be their first choice, further exacerbated by the fact that it was becoming clear that several of the clinical trials of the Oxford-AstraZeneca Covid-19 vaccine had been conducted in such a manner as to elicit further criticism. It later also appeared that the Oxford-AstraZeneca Covid-19 vaccine was less effective than the other Covid-19 vaccines for protecting against new variants of the Covid-19 virus. But the EU—which had convinced its Member States that a joint procurement of the Covid-19 vaccines was preferable to a scenario in which individual Member States would have competed one another for access to the scarce Covid-19 vaccine supplies—had made a huge bet on acquiring doses of the Oxford-AstraZeneca Covid-19 vaccine, most probably because it was the cheapest vaccine available on the market, and for the EU bureaucrats who were in charge of purchasing the Covid-19 vaccines, nothing else had mattered more than paying the lowest possible prices. (Cf. Sects. 188.8.131.52 and 184.108.40.206.)
Obviously, the EU’s big bet on the Oxford-AstraZeneca Covid-19 vaccine came before AstraZeneca had notified the European Commission that it would be unable to meet its initially promised deliveries of 270 million doses during the first half of 2021, and that it would only be capable of delivering around 100 million doses during said time period. Then, to make things even worse, in the second half of March 2021, news started to make the front pages about blood clots being found in several people to whom the Oxford-AstraZeneca Covid-19 vaccine had been administered. Vaccine politics are of an extremely sensitive nature. Already, all over the world, the Covid-19 vaccines had themselves been met with a lot of criticism and even suspicion, which was in particular the case for the Oxford-AstraZeneca Covid-19 vaccine, due to the fact that the vaccine was considered less effective than the mRNA Covid-19 vaccines. The United States had even still not granted an EUA to the Oxford-AstraZeneca Covid-19 vaccine. This explains why some countries reacted to the fact that side effects were reported about the Oxford-AstraZeneca Covid-19 vaccine by immediately putting its use to a halt, “out of an abundance of caution” and in order to prevent further undermining public confidence in the vaccine. Ironically, a wide variety of other EU countries then followed suit, which in turn hurt the public confidence in the Oxford-AstraZeneca Covid-19 vaccine even more. A notable exception was Belgium, usually not reluctant for brutalizing its population, that simply went ahead with administering the vaccine as if nothing was going on, even making an offer to purchase the stocks other countries would not be using any more.Footnote 454
These problems with the Oxford-AstraZeneca Covid-19 vaccine resulted in a complete crisis of confidence, which endangered the already troublesome EU vaccination campaign even more. Scepticism about the Oxford-AstraZeneca Covid-19 vaccine has since then persisted no matter what scientists said and was, moreover, bound to deepen even more. From a survey undertaken by “YouGov” around that time—by Matthew Smit announced under the headline: “Europeans now see AstraZeneca vaccine as unsafe, following blood clots scare“Footnote 455—, it more precisely appeared that less than half of the population of Spain, Italy, France and Germany deemed the Oxford-AstraZeneca Covid-19 vaccine safe. Ironically, as the EU mounted pressure to get a fair share of deliveries the of Oxford-AstraZeneca Covid-19 vaccine, just as fewer and fewer of EU citizens actually still wanted it.Footnote 456
With each additional headline about the Oxford-AstraZeneca Covid-19 vaccine, the EU’s reputation was dinged again. The EU has long been chastised as an undemocratic and bureaucratic behemoth, but as it kept struggling with acquiring sufficient vaccines, the EU was accused of gross incompetence as well. At the same time, the majority of EU citizens still did not get access to any of the vaccines, regardless their reputation of being good (namely the Pfizer-BioNTech and Moderna Covid-19 vaccines), or second-rate and even dangerous (notably the Oxford-AstraZeneca Covid-19 vaccine).Footnote 457
For all their struggles with Covid-19 vaccine rollouts at home, the EU had on the other hand been good at allowing Covid-19 vaccines produced on European soil to be exported, by mid-March 2021 having sent more than 40 million vaccines abroad.Footnote 458
End-March 2021, as the EU started looking for a way out of the mess it had created, officials thought of a new strategy to help them speed up the vaccination process: controlling vaccine exports to countries like the United Kingdom and the United States. In order to justify this approach, Von der Leyen started referring to the principles of “reciprocity” and “proportionality” in exports. Von der Leyden also declared that the EU was willing to use whatever instrument needed to ensure compliance with these principles. The EU had by then exported an estimated 34 million doses of Covid-19 vaccines,Footnote 459 including about 10 million to the United Kingdom.Footnote 460
Notwithstanding the complete disaster of the EU vaccination campaign during Q1 2021, it would take EU officials until the end of March 2021 before starting to admit mistakes had been made regarding the Covid-19 vaccination procurements. This, moreover, only happened after six EU Member States, mid-March 2021, made a public complaint about the vaccine-distribution which they considered unfair. In a joint letter to the EU Commission and the EU Council, the leaders of Austria, the Czech Republic, Bulgaria, Slovenia, Latvia, and later Croatia, had more precisely urged for opening a debate on the issue of the distribution of the available Covid-19 vaccines within the EU. On 13 March 2021, the EU Commission responded that the available doses of the Covid-19 vaccines had been divided among the EU Member States in relation to the population numbers of each EU Member State and by further taking into account epidemiological data, adding that it was up to Member State governments to establish how to distribute them further among their population.Footnote 461
Shortly after, in an article that appeared in the German newspaper “Der Tagesspiegel”, EU Commission Vice-President Timmermans was quoted admitting that mistakes had been made on the Covid-19 vaccine-orders.Footnote 462
By 23 March 2021, the United Kingdom had been administering about 46 Covid-19 vaccine doses per 100 people, and the United States 38. Meanwhile, the EU had only been serving 14 Covid-19 vaccine doses per 100 people, at a moment when, for the umpteenth time, more lockdowns all over the EU Member States were either on the horizon or already effectively being put in place.Footnote 463 (Cf. Sect. 2.4.3) The EU Commission president, Ursula von der Leyen, at the time, still kept declaring that 70% of all EU adults would be fully vaccinated for Covid-19 by the end of the summer of 2021, although at the preceding pace, it became increasingly feared that it would be well into 2022 when the EU would reach that target.Footnote 464
By the end of March 2021, EU leaders themselves started venting their own frustration over the sluggish deliveries of Covid-19 vaccines and manufacturing delays, while anxiety was rising among the EU population over the rapid spread of new Covid-19 variants. (Cf. Sect. 1.1.2.)
The contrast between the grim picture within the EU and the inoculations in its renegade member country, “Brexit Britain”, obviously did not improve the mood in Brussels. The leadership continued to deny its own culpability, while searching for a scapegoat, most notably AstraZeneca itself that continued to face production problems in its plant in Belgium, and therefore failed to deliver to the EU in accordance with what had been agreed upon. The EU more in particular blamed AstraZeneca that it favoured the United Kingdom, all the while ignoring the terms of its own purchasing agreement with the company, and the extremely slow pace at which it had reached this agreement.Footnote 465 None of these doubts, however, prevented the EU Commission from threatening to trample over the property rights of various Covid-19 vaccine manufacturers located within the EU,Footnote 466 although as often with regard to the United Kingdom, the EU’s bark would continue to prove to be worse than its bite.
220.127.116.11.2 Situation on 1 April 2021: Hardly an April Fools-Joke
From statistics released by the ECDC on 31 March 2021, it appeared that no EU country had achieved the twin goals that the EU had set out for the end of March 2021, namely that (1) 80% of healthcare laborers and (2) 80% of those aged 80 or older would by then be vaccinated. Only five countries in the EU and the EEA considered together had administered at least a first Covid-19 vaccine dose to at least 80% of those aged 80 and over. Iceland appeared to have been most successful, with a vaccination rate of 98% in vaccinating healthcare workers. Iceland also had fully vaccinated 88.5% of its elderly people. Ireland and Malta had administered the first dose to 90% of its elderly, while Sweden and Finland had vaccinated more than 85% of the elderly. Three other countries—namely Denmark, Norway and Portugal—were just under the 80% threshold. Meanwhile, half of the EU/EEA countries had not even vaccinated 60% of its elderly population. One of these was Bulgaria, with a mere 5.1% of those over 80 years old vaccinated. No data were available for several other countries, including Germany and the Netherlands.Footnote 467
Statistics regarding the Covid-19 vaccination uptake among healthcare laborers painted a similar worrisome picture. Only four countries had achieved the goal set by the EU, with Estonia and Hungary reporting having vaccinated 100% of healthcare workers with the first dose of a Covid-19 vaccine, while Romania and Spain were both over 90%. Hungary, moreover, reported a 99.6% uptake of full vaccination among healthcare workers, while Romania was just under 80%.Footnote 468
By 4 April 2021, Hungary—that had shortly before suffered the most Covid-19 deaths per capita in the EU and had one of the world’s highest Covid-19 fatality rates—was near the top of the charts for vaccinations out of the 27 EU member states, with more than 20% of its people having received at least one jab. This compared with an average of 12.5% across the EU. That was because Hungary had not waited for EMA jab approvals and had imported two Chinese and one Russian Covid-19 vaccine in order to supplement its supply shortages.Footnote 469
By 1 April 2021, just 11% of the EU bloc’s population had received at least one dose of a Covid-19 vaccine, compared to nearly 30% in the United States and more than 45% in the United Kingdom.Footnote 470 This in light of the fact that, besides the 80% goal for the abovementioned two target groups, the EU Commission had in January 2020 also set another target, namely that EU Member States were to vaccinate a minimum of 70% of all adults by the summer of 2021.Footnote 471
The ECDC statistics also revealed that 86,000,000 Covid-19 vaccine doses had been distributed to EU/EEA countries by 31 March 2021, of which 71,200,000 had been administered.Footnote 472
According to the ECDC, there were several reasons behind the missed deadlines. Among these, most countries reported as the main reason challenges related to the supply and delivery of the Covid-19 vaccines. Six countries reported staffing shortages, and another six countries reported communication challenges due to misinformation and disinformation around the Covid-19 vaccines, which had affected Covid-19 vaccine acceptance among the population. Among the latter countries were Croatia, Cyprus, Czech Republic, Germany, Romania and Sweden.Footnote 473
On 1 April 2021, when most EU Member States started to experience their “third wave” of the Covid-19 pandemic, with variants of the Covid-19 virus being present in all 27 EU member states (cf., furthermore, Sect. 18.104.22.168), Bloomberg made its own assessment of the EU vaccination campaign. According to Bloomberg, EU’s vaccine rollout remained “sluggish” because of the following reasonsFootnote 474:
Unlike the United Kingdom and the United States, the EU’s procurement efforts had not bothered to prioritize domestic deliveries first.
At the end of March 2021, some 77 million Covid-19 vaccination doses had been exported from the EU to 33 non-EU countries, in addition to millions of doses of the Covid-19 vaccines to lower income countries through the COVAX facility. While since January 2020, the EU had issued legal measures in accordance with which enterprises needed export permissions, by that time, only one delivery to a foreign country had effectively been halted.
The EU’s vaccination campaign was mainly suffering from significant delays of deliveries of the Oxford-AstraZeneca Covid-19 vaccine. By the end of March 2021, AstraZeneca had only delivered about 18 million doses of the Oxford-AstraZeneca Covid-19 vaccine since January 2021, while it had committed to providing at least 30 million doses before the end of March 2021, still well below the 120 million doses it had originally promised.
The vaccination campaigns of each EU member country was characterized by several differences. By the end of March 2021, some countries—like Ireland, Malta and Sweden—had vaccinated more than 85% of their elderly population over 80, while several other countries, such as France and Italy, only about half of the same population group.
A multitude of EU Member States had decided to temporarily use the Oxford-AstraZeneca vaccine only in some age groups; others had started to purchase vaccines from Russia, China or Israel, and some Member States were embroiled in a discussion over how the Covid-19 vaccine deliveries had to be divided across the EU bloc.
Internal fights over access to vaccines started highlighting just how difficult it was for a bloc of 27 countries to remain united under pressure.Footnote 475
On 1 April 2021, Bloomberg, in addition, announced that it had had access to an internal EU document in which EU authorities themselves had made their own assessment of the Covid-19 vaccination debacle. From this document, it appeared that five countries that had earlier before turned away more expensive BioNtech-Pfizer Covid-19 vaccine doses in favour of the cheaper vaccine version from Oxford-AstraZeneca were under the impression of having paid a high price for their mistake. Because of this, Bulgaria, Croatia, Estonia, Latvia and Slovakia, which all had declined part of their expensive BioNtech-Pfizer Covid-19 vaccine allotments in order to wait for deliveries of AstraZeneca doses, were among the slowest in the EU bloc to be able to administer Covid-19 vaccines. While Pfizer had met its commitments, AstraZeneca had delivered just 30 million of its originally committed 120 million doses throughout Q1 2021. As a result, Bulgaria and Croatia were expected to only vaccinate 45% of their populations by the middle of 2021, according to the document, the lowest in the EU after the Czech Republic. Estonia was expected to vaccinate 50%, Latvia 53% and Slovakia 46%. This in comparison to e.g., 61% in Germany, 80% in Denmark and 93% in Malta.Footnote 476
The EU Commission declared, on 31 March 2021, that more than 100 million doses of the Covid-19 vaccines had been delivered to its Member States in Q1 2021, matching its lowered target. The EU expected the pace to pick up in Q2 2021, when it was forecast to receive 360 million doses of Covid-19 vaccines.Footnote 477
Still according to information provided by Bloomberg, based upon its reading of the abovementioned EU internal document, on 31 March 2021, the EU had administered 15.5 doses per 100 people (an assessment slightly above the 11% that appeared from the above-quoted ECDC figures of the same date). This was in any case less than a third of what the United Kingdom had managed, while the United States had administered 45 doses per 100 people. The internal document concluded that the governments of the EU Member States had failed to hit the targets set by the EU Commission to vaccinate 80% of healthcare workers and people aged 80 and above by the end of March 2021, and that they would also most likely fail in achieving the 70% vaccination threshold of all adult population by the summer of 2021.Footnote 478
Be this as it may, by 2 April 2021, it had become abundantly clear that the EU had already fallen short of its (moderate) target of having at least 80% of elderly people (aged 80 years and older) and 80% of healthcare professionals vaccinated against Covid-19 before the end of March 2021.Footnote 479 Figure 9.5 presents a schematic representation of the share of people who received at least one dose of a Covid-19 vaccine on 31 March 2021 in some countries.
22.214.171.124.3 Further Covid-19 Vaccine Problems and the Search for Solutions
Whereas the EU at the beginning of 2021 was still desperate for doses of the Oxford-AstraZeneca Covid-19 vaccine, by April 2021, it started pivoting to the BioNTech-Pfizer Covid-19 vaccine instead, finally indicating that it would not seek further doses from AstraZeneca beyond those already purchased. Instead, the bloc started negotiating a new contract with Pfizer-BioNTech for 1.8 billion additional doses of their Covide-19 vaccine over the next 2 years.Footnote 480
The pivot away from AstraZeneca, which had initially been the main pillar of the EU inoculation program (cf. Sects. 126.96.36.199 and 188.8.131.52), came after months of discord over delayed shipments and worries over rare potential side effects of the Oxford-AstraZeneca Covid-19 vaccine shots. The European vaccine campaign got, moreover, also confronted with Johnson & Johnson’s own delays in its rollout in Europe because of similar concerns and after regulators had paused the use of its vaccine in the United States.Footnote 481
By April 2021, with most EU citizens still having no clue when they would finally get vaccinated and with what vaccine, the EU was facing growing criticism for its extreme slow procurement of Covid-19 vaccine doses. The EU had fallen even further behind the United States and the United Kingdom, as it suffered blow after blow in its inoculation campaign, first with major supply disruptions from AstraZeneca in late January 2021, and then with the emergence of the potential rare blood clotting disorder in both the Oxford-AstraZeneca and Johnson & Johnson Covid-19 vaccines, which battered the general public’s confidence in the Covid-19 vaccines even more, leading to numerous appointment cancellations all over Europe.Footnote 482
All this finally made the EU finally turn to Pfizer during the second half of April 2021, raising the question if the EU should not have done this from the start instead of having bet on the cheaper and less effective Oxford-AstraZeneca Covid-19 vaccine (cf. Sect. 184.108.40.206). The new agreement between the EU and Pfizer-BioNTech was even to include potential booster shots to increase the immunity of people who had already been inoculated, as well as possible new shots or boosters targeting emerging variants of the Covid-19 vaccine that might prove resilient against existing vaccines.Footnote 483
On 25 April 2021, Ursula von der Leyen claimed to The New York Times that AstraZeneca had squandered the EU bloc’s trust. By Monday 26 April 2021, the EU Commission, backed by all 27 EU Member States, announced that it had decided to take AstraZeneca to court.Footnote 484
At the time, AstraZeneca had only succeeded in delivering about a quarter of the 120 million doses planned for Q1 2021.Footnote 485 Officials at the EU’s executive branch had become particularly angry at AstraZeneca’s continued reluctance in delivering vaccine doses to the EU that were produced in Oxford and Staffordshire, however, this production was supposedly prioritized for delivery to UK residents on a contractual basis. When announcing its decision to take AstraZeneca to court, a spokesman for the European Commission declared that the complaint had been filed because certain terms of the purchasing agreement between AstraZeneca and the EU had not been respected, and the enterprise had not been willing to propose a reliable, alternative strategy to ensure timely deliveries to the EU. The complaint was officially filed with the Belgian courts on Friday 22 April 2021. A first hearing before the Enterprise Court (“Ondernemingsrechtbank”) located in Brussels was scheduled for Wednesday 27 April 2021.Footnote 486
220.127.116.11 Some Final Data from April-May 2021
An interim assessment of the mid-April 2021 EU Covid-19 vaccination debacle showed that, in most EU countries, vaccine rollout had remained extremely slow during the early months of 2021. E.g., in Belgium, after facing some of the worst mortality statistics in the world, the government had focused on vaccinating the most vulnerable: by 3 May 2021, 86.8% of the elderly over 80 had been fully vaccinated, and 84.18% of the people aged between 65 and 84.Footnote 487 But at the beginning of May 2021, Belgium was only just starting to administer Covid-19 vaccines to the younger parts of its population as well. The good news was that Belgium had managed to reduce the time between the delivery of the Covid-19 vaccine doses and their actual administration, from on average 18 days in March 2021, to about four days in the last week of April 2021.Footnote 488
A similar trend could be observed in many other EU countries. Apart from the latecomers Bulgaria, Latvia, Croatia and Romania, just over 20% of the population in each of the other EU Member States had received a dose of a Covid-19 vaccine by 3 May 2021, with Malta leading the way at 52.43%.Footnote 489
For the 23 EU Member States that managed to report their Covid-19 vaccine administration data to the European Centre for Disease Prevention and Control, the median uptake rate for the people over-80 was 73.1% as of 3 May 2021. Some countries were, similar to Belgium, starting to make progress with vaccinating their general population as well. E.g., Germany was celebrating the milestone of one million doses administered in a single day on Thursday 20 April 2021, and France had broken its own record by administering 545,000 doses of a Covid-19 vaccine on Thursday, 29 April 2021 and 549,000 on Friday 30 April 2021.Footnote 490
Importantly, from internal estimates of the European Commission that were shared with the newspaper the Guardian, it appeared that shortage of supply, which had been the main and continuing problem during the early months of 2021, no longer was the main barrier by the end of April 2021.Footnote 491 While only 14 million Covid-19 vaccine doses had been delivered to EU Member States in January 2021, this increased to 28 million in February 2021, and 60 million in March 2021, after which EU officials claimed that an additional 105 million doses of Covid-19 vaccines had been delivered throughout April 2021, while the European Commission was expecting further deliveries of 125 million Covid-19 vaccine doses in May 2021, and 200 million in June 2021. Provided that these prospects were more or less accurate, this was expected to put the EU back on track to reach an annual capacity of 4 billion Covid-19 vaccine doses for 2021.Footnote 492 According to The Guardian, this was a huge departure from the rut the EU was in a few months earlier, when the two moments on which AstraZeneca had cut its planned deliveries to the EU, had led to a huge panic in Brussels and the rest of the EU.Footnote 493 It appeared that the turning point had come when, after several meetingsFootnote 494 with officials from BioNTech-Pfizer, Moderna, AstraZeneca, Johnson & Johnson, Curevac and Sanofi, on 14 April 2021, European Commission President Von der Leyen was able to announce that a delivery of 50 million additional BioNTech-Pfizer Covid-19 vaccine doses that had initially been scheduled for Q4 2021 would be brought forward to Q2 2021.Footnote 495
Table 9.4 presents an overview of the number of Covid-19 vaccines administered on 16 April 2021 in some countries.
After all of this, by 6 May 2021, Ursula von der Leyen, still kept claiming that the EU vaccine strategy had been a “success”, although (only) a quarter of EU citizens had received a first jab of a Covid-19 vaccine.Footnote 496
9.4.4 The UK Vaccination Campaign
18.104.22.168 The Successful Procurement Approach of “Kate The Great”
The differences in approach, but also in success rate, regarding both the purchases of the Covid-19 vaccines and the actual vaccination campaigns themselves, could not have been bigger than those between the EU and the United Kingdom. The United Kingdom had, moreover, shortly before the outbreak of the Covid-19 pandemic, left the EU, which in the eyes of some confirmed that Brexit had been the right political choice.
As described before (cf. Sect. 9.4.3), the EU’s way for purchasing Covid-19 vaccines had been purely bureaucratic, with: (1) a seasoned EU official at the head of the negotiating and purchasing team, (2) an actual purchasing approach based on the most stringent EU procedures imaginable, and (3) a strategy of focusing on the cheapest prices, instead of on fast orders and deliveries.
We have already discussed in the previous Sect. 9.4.3 to which debacle this led during Q1 2021 and the biggest part of April 2021.
On the other hand, there was the completely opposite approach of the United Kingdom, with: (1) placed at the head of the Covid-19 vaccines purchasing team, a highly specialized and seasoned businesswoman (2) took a purchasing approach based upon broad investments in the vaccine candidates from various producers, coupled with quick purchasing decisions once a Covid-19 vaccine candidate seemed to be ready for use, and (3) had as overall aim liberating the United Kingdom as quickly as possible from the Covid-19 crisis into which the UK government had plunged the country throughout the year 2020.
The first step on the road to the United Kingdom’s highly successful vaccination campaign was taken when, in May 2020, UK Prime Minister Boris Johnson had taken the bold step of appointing Kate Bingham to chair the new UK Covid-19 Vaccine Taskforce, a crucial new body that was to oversee the investment and procurement of Covid-19 inoculations. According to the British press, it is not entirely clear how Johnson appointed Bingham, as no formal procedure seems to have been followed, but the mission given to Bingham was clear: to invest billions of taxpayers’ dollars in Covid-19 vaccine candidates that could offer the United Kingdom a way out of its continued lockdown situations. The Vaccine Task Force itself had mainly been the brainchild of Sir Patrick Vallance, the UK government’s chief scientific adviser, who had seen the need “for a dedicated, nimble private-sector team of experts embedded in the Government to drive forward the development of vaccines for the United Kingdom and internationally”.Footnote 497 The new Vaccine Task Force was then installed under the Department for Business, Energy and Industrial Strategy in May 2020, and Kate Bingham was, as said, invited to chair it, reporting directly to the Prime Minister, alongside Vice President Clive Dix.Footnote 498
No one better than Bingham herself can explain the unorthodox (from a government’s point of view) approach she took in leading the Vaccine Task Force, which she described in a statement published in The Lancet:Footnote 499
The Vaccine Taskforce aims to ensure that the UK population has access to vaccines as soon as possible, while working with partners to support equitable access for populations worldwide, whether rich or poor.
Our strategy has been to build a diverse portfolio across different formats to give the UK the greatest chance of providing a safe and effective vaccine, recognising that many, and possibly all, of these vaccines could fail. We have focused on vaccines that are expected to elicit immune responses in the population older than 65 years: over three-quarters of deaths caused by SARS-CoV-2 infection are in this older population, so it is essential that any vaccine is able to protect this group. Scalability of vaccine manufacture was also a key criterion, with the goal being to manufacture in the UK, if possible, to secure supply and create long-term resilience.
The Vaccine Taskforce has now secured access to six vaccines (from more than 240 vaccines in development) across four different formats: adenoviral vectors, mRNA, adjuvanted proteins, and whole inactivated viral vaccines, which are promising in different ways. The most advanced vaccines, such as those developed by AstraZeneca and the University of Oxford, BioNTech and Pfizer, and Janssen, are based on novel formats for which we have little experience of their use as vaccines, although the initial immunogenicity and safety data are encouraging.
Vaccines based on frequently used vaccine formats, such as adjuvanted protein vaccines developed by Novavax, and by GSK and Sanofi, and inactivated whole viruses developed by Valneva, will not be available until late in 2021.
We also have an agreement with AstraZeneca to supply a neutralising antibody cocktail as a prophylactic treatment once clinical trials are completed and it is approved by regulators. This treatment will be provided in the short term for people who cannot receive a vaccine, such as people who are heavily immunosuppressed and cannot mount an immune response, or people who need immediate protection, such as health-care workers.
The Vaccine Taskforce has options to purchase sufficient doses of each vaccine type to vaccinate the appropriate UK population.
A major challenge is that the global manufacturing capacity for vaccines is vastly inadequate for the billions of doses that are needed, and the UK manufacturing capability to date has been equally scarce. The Vaccine Taskforce has provided funding for flexible and surge production in several new UK sites for vaccine manufacture to provide the UK population with a new vaccine in less than 9 months from the identification of the pathogen. We also plan to bring new vaccine technologies and capabilities to the UK for future pandemic preparedness.
No-one has ever done mass vaccination of adults anywhere in the world before and the two-dose regimen, plus cold-chain restrictions for some vaccines, adds to the complexity of this deployment operation. National Health Service England has flexible deployment plans to start the vaccination of prioritised cohorts as soon as the vaccines are approved by the regulatory authorities (…).
Bingham’s statement already indicates the huge difference about both approach and priorities, compared to the EU task force (cf. Sect. 22.214.171.124), as well as her much greater sense of reality.
The Bingham team, basically, behaved like a consumer who really wanted to acquire a scarce commodity, while the EU team had acted like a cumbersome administration that did not particularly care whether or not the Covid-19 vaccines would be acquired quickly, and who only seemed interested in bidding on the price.
Bingham herself commented on these differences as follows (in an interview with “Der Spiegel” of 18 February 2021):Footnote 500
Being quick and nimble was definitely important. The fact that I’ve been in the industry for 30 years and the team that I work with have been in the industry at least as long, if not longer, meant that we had connections very broadly across the industry. So that meant I could just pick up the phone and speak directly to a company. With one company we had our first meeting on a Thursday and we had a follow up meeting on Saturday, and would agree the rough outline of a deal the following week.
So we had to make ourselves good customers to make people want to supply to the UK because there was going to be limited amount of vaccine initially. Our goal was to do whatever we could do to encourage the companies to talk to us. That meant we had a sort of “UK offer”, as it were, which is if the company needed support in the scale of the manufacturing and fill finish and if we could offer that, we offered it and if the company needed us to help with running the clinical trials, we did that, too.
The UK had a very strategic approach, which was to secure vaccines quickly. And the European approach seems to be more sort of a more typical procurement approach, which was more about making sure you got the best value for money for your vaccines.
During the first hearing of 2021 of the Public Accounts Committee of the UK House of Commons on Monday 11 January 2021, Binghman added to this the following:Footnote 501
We talked about this in our report that was published in December. The conditions that the EU set to allow us to participate were conditions we felt were not attractive. We were not able to join any decision making on which vaccines; we had to abandon the negotiations we either had under way or had concluded with AZ; and we also were not able to talk to future potential vaccine companies that they may not be talking to currently, but would do in the future. We felt the conditions were too tight, and that we would be able to act more quickly if we did it independently. Equally, we remained very close and supportive, and continued discussions throughout to help them with their decision making and anything else that we could do. We just thought it was a better approach for us, and I think with hindsight that was the right decision, because we were able to secure the vaccines quicker and start vaccinating more quickly.
To nail your point about value for money, if we wanted the cheapest vaccines, we would have said that we would be happy to receive them in 2022. I have no idea how much cheaper they would be, but they would be cheaper, because what we wanted was the most scarce resource, which is the vaccines that were available as soon as they came off the production line in those early days. It is a trade-off to say, “What are the costs we’re paying?”, which are about £10 a dose. Again, I do not think that is excessive and it is in line with what we pay for flu. If we wanted to focus purely on price, however, which we did not, that would have been at the cost of the delivery date.
Shortly after the huge success of the Covid-19 vaccination approach that the United Kingdom had resorted to became clear, Bingham started being hailed as the “vaccine tsarina” by the British press, a term used in the United Kingdom to refer to people who are hired by the government to coordinate major social tasks. Another nickname she received was “Kate The Great”.Footnote 502
Her merits go without saying, most certainly in comparison to the disastrous consequences of the approach that had been applied by the EU vaccination purchasing team (cf. Sect. 126.96.36.199). Thanks to the efforts of Bingham and her team, the United Kingdom became the first country to sign a contract for the BioNTech-Pfizer Covid-19 vaccine, which ensured a quick launching of the UK vaccination campaign already at the end of December 2020. Although the United Kingdom was not the biggest buyer of Covid-19 vaccines when compared to the United States and the EU, Bingham and her team were able to act more skillfully and had better contacts in the industry. All the Western pharmaceutical enterprises Bingham and her team approached, were enterprises with which she herself or one or more members of her team had existing, good relationships, in one form or another. Bingham also brought with her what has been referred to as a best-practices habitus from the private sector: for the first few weeks after being installed, the Vaccine Taskforce worked around the clock and on weekends to identify the Covid-19 vaccine candidates with the best prospects of rapid regulatory approval. Bingham also insisted on speeding up the decision-making process. Throughout the whole proceedings of the UK Vaccine Task Force, Bingham acted on the feeling that she only had one chance to be right and no time.Footnote 503
Be this as it may, thanks to the extremely successful approach of the Bingham Vaccine Task Force, the United Kingdom succeeded to both launch and proceed with its vaccination campaign in a fast manner from the early start, which was welcome after the manner in which the UK government had responded to the Covid-19 crisis in general.Footnote 504 (Cf. Sect. 188.8.131.52.5.)
The success of the approach of the Bingham task force was in a symbolic manner validated on 8 December 2020, when the United Kingdom got to be the first country in the world to start serving a Covid-19 vaccine to its population.Footnote 505 The UK government later pledged that all adults living in the UK would be receiving a Covid-19 vaccine before the end of July 2021. This would imply that the United Kingdom would accomplish its vaccination campaign within less than eight months. Contrary to similar promises made by the EU, it moreover soon became likely that the United Kingdom would be able to live up to this promise. As, initially, the deadline had been late autumn of 2021, the fact that the United Kingdom got even ahead of schedule demonstrated the success of its Covid-19 vaccination campaign, which is to a large extent thanks to the professional approach of Bingham’s Vaccine Taskforce.Footnote 506
One of the main differences in approaches between the EU and the United Kingdom regarded their different purchasing agreements. While the purchasing agreements with AstraZeneca were superficially similar, the UK negotiators had nevertheless shown a much better insight in the production and supply chain of vaccines. As a result, the UK purchasing agreement contains an explicit clause in which it was stated that AstraZeneca was to ensure that the UK supply chain would be “appropriate and sufficient” for delivering the necessary doses of the Oxford-AstraZeneca Covid-19 vaccine to the country for guaranteeing a smooth vaccination campaign. This implied that in case that production in the UK plants would turn out to be insufficient for delivering vaccines to the United Kingdom at any time, AstraZeneca was bound to be getting the necessary doses from elsewhere in its global production network. In contrast, the purchasing agreement between the EU and AstraZeneca did not mention a similar clause. Other key elements in the purchasing agreement between the United Kingdom and AstraZeneca concerned clauses dealing with commitments of the suppliers of AstraZeneca and the willingness to invest in the development of the Covid-19 vaccine beforehand.Footnote 507 (Cf. Sect. 184.108.40.206) Another key factor that helps explain the high success rate of the UK approach is that the procurement strategy of the UK Vaccine Taskforce, contrary to the one of the EU, was based on rapid deliveries, rather than on the price of the vaccine doses.Footnote 508 As a result, already by December 2020, the United Kingdom had purchased enough doses of the approved Covid-19 vaccines to serve its entire population.Footnote 509
220.127.116.11 The Result: An Accelerated Vaccination Campaign
Based on early approvals of the Covid-19 vaccines by the Medicines and Healthcare products Regulatory Agency (abbreviated as “MHRA”), the United Kingdom started to administer Covid-19 vaccines as of December 2020.Footnote 510 The vaccination campaign proved to be highly successful from the early start, which explains why, already In February 2021, the UK government made the announcement that every adult living in the United Kingdom would be administered a first dose of a Covid-19 vaccine by the end of July 2021, which, as said earlier, was even one month earlier than had originally been intended.Footnote 511
On 3 March 2021, the United Kingdom reported that 20,982,571 people had received the first dose of a Covid-19 vaccine, while 20 million people had already been fully vaccinated.Footnote 512
By 6 March 2021, already more than 21 million people living in the United Kingdom had been administered at least one dose of a Covid-19 vaccine. On said date, the UK vaccination programme also entered the second part of its first phase. This implied that as good as all members of the first four priority groups—namely elderly people aged 70 and over, nursing home residents, healthcare laborers and those with special seclusion needs—had already been offered a Covid-19 vaccine. Around that same date, more than one million people living in the United Kingdom had also been administered a second dose of a Covid-19 vaccine.Footnote 513 By the same date of 6 March 2021, most regional parts of the United Kingdom had managed to serve high proportions of the population belonging to the priority age groups with a Covid-19 vaccine.Footnote 514
Until 6 March 2021, the United Kingdom had been relying on two Covid-19 vaccines that had obtained approval by the MHRA for its vaccination campaign. The BioNTech-Pfizer Covid-19 vaccine was the first to have been given the green light in December 2020. It, moreover, appeared that the doses of this vaccine used in the UK vaccination campaign were exclusively imported from Puurs, Belgium, while the Belgian population itself had at the time virtually no access to the BioNTech-Pfizer Covid-19 vaccine. The second Covid-19 vaccine that the UK vaccination campaign relied on was the Oxford-AstraZeneca one. The doses of the latter vaccine used in the United Kingdom were mostly manufactured in Britain by two biotech plants, namely Oxford BioMedica, based in Oxford, and Cobra Biologics, based at Keele Science Park, Staffs. Deliveries of a third Covid-19 vaccine, manufactured by the US enterprise Moderna, were expected to become available as of April 2021, with the doses to be delivered to the United Kingdom also stemming from EU production lines.Footnote 515
According to MedicalNewsToday, by 9 April 2021, more than 6 million people in the United Kingdom had been administered with both doses of one of the approved Covid-19 vaccines that require two doses. Some even started to hold that the United Kingdom was approaching herd immunity.Footnote 516 From an Opinium online survey of 2,006 adults conducted between 8 and 9 April 2021, it appeared that 44% of the respondents were approving of the UK government’s management of the Covid-19 pandemic, compared to 36% who disapproved. These were the best results since May 2020.Footnote 517
However, the UK vaccination campaign also had some drawbacks. E.g., according to a study published in The Lancet on 25 March 2021, there were huge inequalities in Covid-19 vaccine uptake. It more precisely appeared that people living in socio-economically deprived areas, in particular people belonging to certain ethnic minority groups, were less likely to obtain a Covid-19 vaccine. This was attributed to a number of reasons, including barriers to access and distrust of the authorities.Footnote 518
On 10 May 2021, England recorded zero daily deaths from Covid-19 for the first time since July 2020, a situation that was welcomed by experts who declared that it reflected the impact of the Covid-19 mitigation measures and of the Covid-19 vaccinations. In addition, at the same date, no Covid-19 related deaths were recorded in Scotland or Northern Ireland. However, four Covid-19-related deaths were still recorded in Wales. Experts such as Rowland Kao—a professor of epidemiology at the University of Edinburgh who was part of the Spi-M modelling subgroup of Sage, a scientific advisory group that dealt with emergencies—and Dr Michael Head, a senior research fellow in global health at the University of Southampton, declared that the drop in Covid-19 related deaths mainly reflected the impact of the Covid-19 vaccination campaign.Footnote 519
However, around mid-May 2021, a new concern arose as more and more cases of the Indian variant of the Covid-19 virus—known as B.1.617.2—started spreading in the United Kingdom, with scientists however at the time still expressing their belief that the Covid-19 vaccines remained effective against this variant.Footnote 520