Coronavirus Sars-CoV-2/Covid-19 Megathread

[Sheilbh]

And the fact that Ursula von der Leyen still has a job does not fill me with confidence for the future. I fear we have learned nothing for the next one.

When this story started developing in January - I remember thinking that the Commission's behaviour seemed panicked and sort of focused on shifting blame/avoiding responsibility. I still have that sense. The EMA have authorised three new factories (for AZ, Pfizer and Moderna) today which is good and should help ramp up production, but I feel like the Commission's focus has been more on avoiding blame than trying to address the problem by boosting capacity because even export restrictions don't mean more doses for Europeans - the doses are still owned by the company and scheduled for someone else.

From a UK-specific perspective I think there's been a lot of frustration with the fairly regular insinuations - from Commission sources - that there's been loads of AZ exported to the UK and that's why AZ was failing. Even the police raid in Italy was, according to Italian reports, based on a tip-off by the Commission. The initial briefing to the Italian media was they were 29 million secret doses destined for the UK - it's since been confirmed by Draghi, AZ and Italian officials that none are going to the UK and they're actually mainly for Europe. So from everything that's been reported those insinuations are false (the UK's had 1 million AZ doses from the EU in December, weeks before it was authorised in the EU). But I think part of that has been looking for someone to blame.

I don't know if that's vdL or people around her or, say, the Health Commissioner and I don't know if they have form for that in domestic politics. I have seen German correspondents say that vdL does have a record of some bad procurements in her departments domestically and also of things sort of exploding in her departments shortly after she leaves, but I don't know how fair those comments are. As I say I don't know if it's vdL but I thought Juncker's criticisms were measured and fair on this. I'd hope the Parliament use it as an opportunity to sort of flex a bit for some aggressive accountability and questions because I think some of the key mis-steps (which Juncker ran through) were at Commission level.

[Syt]

The Vienna city government has a new plan: up to 4 free PCR gargle/spit tests per week. Can be collected at local drug stores done, at home and then handed in at a widely available supermarket chain. Result within 24 hours.

Not sure of the point, because you can already get freely tested all over town on short notice.

[Zanza]

Von der Leyen is a mediocre politician with few domestiv successes to show. I wrote that here when she was elected.

[Zanza]

From a UK-specific perspective I think there's been a lot of frustration with the fairly regular insinuations - from Commission sources - that there's been loads of AZ exported to the UK and that's why AZ was failing. Even the police raid in Italy was, according to Italian reports, based on a tip-off by the Commission. The initial briefing to the Italian media was they were 29 million secret doses destined for the UK - it's since been confirmed by Draghi, AZ and Italian officials that none are going to the UK and they're actually mainly for Europe. So from everything that's been reported those insinuations are false (the UK's had 1 million AZ doses from the EU in December, weeks before it was authorised in the EU). But I think part of that has been looking for someone to blame.

The British should understand that concept well enough with their decade-long tradition of blaming the EU for all kinds of things. What do you expect? Our politicians somehow being more mature and less eager to deflect from their mistakes than your own?

[Sheilbh]

The British should understand that concept well enough with their decade-long tradition of blaming the EU for all kinds of things. What do you expect? Our politicians somehow being more mature and less eager to deflect from their mistakes than your own?

Exactly - I think it's why we know it when we see it.

[Sheilbh]

Quite concerned by France where the UK variant has now become dominant and the (potentially) vaccine-resistant South African variant makes up about 10% of cases.

Plus today they're reporting over 40,000 new cases and about 900 deaths. But France is still persisting with regional "lockdown lite" measures because, from what I understand, Macron basically bet on avoiding a third lockdown and is now resisting even regional full-lockdowns because that of that but also fears that there'll be widespread resistance/non-compliance. It looks really bad and feels like lockdown is only a matter of time - again it reminds me a lot of the UK in December

Also the spread of the SA variant in France is another reason why I think we really need proper border control/quarantine measures - but no doubt we'll just faff about with ever increasingly complex lists of permitted routes etc

[Syt]

Quite concerned by France where the UK variant has now become dominant

In Vienna, 90+% is UK variant; South African strain seems to have been contained in Tyrol for now.

[Zanza]

For the European Union, the second quarter cannot come soon enough. The vaccine roll-out has been beset by problems, some unforeseen, some the responsibility of member states, some down to the European Commission's procurement strategy, and some of it down to AstraZeneca.

But none of it is pretty.

The success of the UK's roll-out, by contrast, has been galling. For eurosceptics, it is the ultimate vindication of Brexit; for the EU, Britain's success has literally been at Europe's expense, due to a belief that AstraZeneca gave tens of millions of vaccine doses to the UK that should have gone to the EU.

Getting a dispassionate or fair-minded perspective on what has gone wrong is not easy. The arguments are mired in hidden contracts, the complexities of clinical data, and a poisonous post-Brexit climate.

But there are big questions about whether not the EU was properly set up to deal with a once-in-a-century mass vaccination campaign.

"The EU is not a state," Guntram Wolff, director of the Brussel-based think tank Bruegel, told RTÉ's News at One on Tuesday. "It doesn't have full executive powers in the health policy area. The powers are really still at member state level. If you want to really fix this you would need a treaty change."

By contrast, the US is a state. In May last year, it launched Operation Warp Speed, a multi-agency drive pouring billions into R&D, clinical trials, manufacturing and distribution around eight Covid-19 vaccine candidates.

Developers were given billions of dollars even if it was not clear their vaccines would be approved by the US regulator.

"In exchange [for the investment], it looks like the US government then owns, say, the first 100 million doses of the vaccines that are being made at these plants here in America," Chad P. Brown, senior fellow at the Peterson Institute for International Economics, told the Trade Talks podcast.

The US also subsidised American companies making inputs: glass vials, syringes, bio-reactors. That meant US vaccine manufacturers were first in line for these inputs, pushing firms from other countries to the back of the queue.

If Warp Speed was all about America first, the EU strategy was about providing vaccines for all 27 member states - big and small, rich and poor - and for developing countries.

The European Commission launched its Vaccines Strategy on 15 June, a month after Operation Warp Speed.

"This is the EU at its best," health commissioner Stella Kyriakides said at the time. "Pooling resources, joining efforts, bringing tangible results to the everyday lives of people. No one is safe until everyone is safe and we will leave no stones unturned in our efforts to protect EU and global citizens."

The ambition was the high-speed development of safe, affordable vaccines that would be made available for Europe and beyond. Pharmaceutical companies would have some of their upfront costs paid for through Advance Purchase Agreements (APAs), with member states paying the remainder if and when successful vaccines became available.

Member states had agreed a €2.7 billion Emergency Support Instrument (ESI) for the Covid-19 response as a whole, and most of this went on vaccine development.

By contrast, the Trump Administration threw $18 billion at Warp Speed, something French President Emmanuel Macron ruefully admitted gave the US an edge.

"They had more ambition than us," Macron told Greek television, "regardless of our own investment... They applied it to vaccines, to research. We were not quick enough, nor strong enough on that. This is absolutely true and it was thought that the vaccine would take a long time to take off."

The EU was also in unchartered territory. The Commission had never embarked on such a negotiation. Member states were worried about handing over jealously-guarded national health powers. Capitals were pushing their own ideas about the best technologies to use, and which candidate vaccine to go for.

A steering board was set up comprising officials from all 27 national departments of health, and the European Commission. It appointed a Joint Negotiating Team made up of representatives from seven member states, and it reported to the board once a week.

"There were huge amounts of money involved," says one official close to the process. "It was unprecedented, especially with the handing over of health competences. There was a degree of nervousness."

But critics say getting member state buy-in further hampered the EU negotiating effort.

"Member states wanted on the one hand, as is so often the case in Europe, to delegate the task, and on the other, to sit there around the table and take all relevant decisions themselves," says Guntram Wolff. "This decision-making by committee is just slow. It leads to the lowest common denominator, instead of a bold and risk-friendly strategy."

However, officials said they moved much faster than usual, and managed to keep the process on track, despite 27 competing priorities. "It was a miracle they held it together," says one official.

Whereas the US invested big and early, and spread the risk over the whole spectrum - procurement, research and development, clinical trials - the EU was playing catch-up, and was focusing mostly on procurement.

"The US investments were more focused on production, clinical trials, and as part of that getting access to the vaccines," says Rasmus Bech Hansen, CEO of Airfinity, a science consultancy.

"But they were investing more in making sure that the vaccines could be produced at scale and the development pace accelerated. That is really the key difference."

While the US was less risk-averse, member states spent negotiating capital on indemnity, to ensure that if something went wrong with a vaccine, Big Pharma and not taxpayers would be on the hook.

The cost factor also cropped up when it came to how the negotiated vaccine doses were distributed. Member states had agreed a straightforward pro-rata allocation, with countries getting doses according to their population size.

However, Sandra Gallina, the EU's chief negotiator, told a European Parliament committee this week that the trend was for member states to order less than their pro-rata allocations.

In other words, capitals were hedging, since pouring money into something that may not work out can be politically fraught. Other countries said they would step in to "soak up" what was left over, in order that the agreed price did not rise.

In any event, the European Commission insisted it had bought more than enough doses - 2.3 billion in all - from the portfolio of six candidates to ensure that Europeans would be vaccinated.

Then came a damning Der Spiegel article on 18 December.

The article claimed that between August and October, the Commission had negotiated contracts with AstraZeneca, Johnson & Johnson and the French company Sanofi, yet had not concluded firm deals with Pfizer/BioNTech and the US company Moderna.

Clinical trials at the time were showing that Pfizer/BioNTech and Moderna were the most promising candidates.


By contrast, the US had secured 600 million doses of Pfizer/BioNTech and 500 million doses of Moderna.

The magazine claimed the Commission did not nail down firm contracts with Pfizer/BioNTech and Moderna until mid-November, and even then ordered fewer doses than it could have. Der Spiegel said the Commission secured only 200 million doses of Pfizer/BioNTech, with an option on a further 100 million, but that the company had offered 500 million in the first round.

This at a time when clinical trials were showing efficacy of 95%.

These claims have been categorically denied by the European Commission.

One EU source says that by the time the Der Spiegel article appeared, hindsight was playing a big role. Pfizer/BioNTech had already been granted approval by the UK regulator and its mRNA technology was being hailed as the big breakthrough, but in October that was not the case.

"Before October, even in the scientific world there were doubts as to the feasibility of using mRNA technology for vaccines," says the source.

On the claim that Pfizer/BioNTech and Moderna offered more doses and the Commission refused, this is strongly refuted. It's understood that at the outset all the candidate manufacturers were offering many hundreds of millions of doses, as you would expect in any negotiation, but the figures were quickly brought down to between 300-400 million doses per company.

The source points out that last summer no-one knew if any of these vaccines were going to be successful, so the Commission, in tandem with member states, sought a broad portfolio of six vaccines in order to spread the risk, and a broad average of 300-400 million doses each.

"Of course, knowing where we are now," says the source, "it would have made sense to order two billion doses of Pfizer. It's easy to say we should have ordered more, but during the negotiations and when we concluded the contract, and although some clinical trials were going in the right direction, there was definitely not that certainty."

EU officials now say that AstraZeneca fulfilled the entirety of its contract with the UK, with millions of doses coming from EU facilities, yet delivered only one quarter of the EU's contract.

However, once those clinical trials started to bear fruit, the UK grabbed a head start on vaccine approval, opting for emergency authorisations, permitted under EU rules, for three vaccines: Pfizer/BioNTech was authorised on 2 December, AstraZeneca on 20 December and Moderna on 8 January. By late December, the UK had ordered 367 million doses, including 100 million from AstraZeneca.

Also, in early January the UK opted for a first dose strategy, meaning that instead of citizens requiring a second jab within three weeks they could wait for three months, meaning that more people could at least get a first dose quickly.

The European Medicines Agency (EMA), by contrast, is not mandated to grant emergency approvals. It did, however, move to an accelerated procedure, cutting the assessment time from 210 to 150 working days, and using a "rolling review" approach so that experts could review clinical data even as the vaccines were still being developed.

In December, the EMA was under pressure from some capitals to speed up the process. But the agency was also mindful of Europe's anti-vax sentiment. "While speed is of the essence, safety is our number one priority," the agency's Irish executive director Emer Cooke told MEPs.

"These vaccines will be given to millions of people in the EU, and we are keenly aware of the huge responsibility we have to get these recommendations right to protect the European population."

Europeans might have been able to live with the complexities of the negotiation process, and the EMA's need for due diligence, had it not been for the AstraZeneca factor.

It's a problem which has ripped through the EU's roll-out. The first sign of trouble was when the Anglo-Swedish company alerted the Commission on 8 January that "initial volumes will be lower than anticipated" due to "reduced yields at a manufacturing site within our European supply chain".

In fact, of the 90 million doses the company was due to deliver in the first quarter, it would only manage 30 million, and in the second quarter only 70 million out of 180 million.

There followed a bitter and very public dispute between the EU and AstraZeneca, culminating in Brussels demanding that the contract be published. When the contract was published on 29 January, the Commission said it proved that AstraZeneca had promised to produce its EU doses at two British plants, as well as two European plants.

EU officials now say that AstraZeneca fulfilled the entirety of its contract with the UK, with millions of doses coming from EU facilities, yet delivered only one quarter of the EU's contract.

There is ill-disguised fury at this situation. One senior EU figure says the company effectively agreed two almost identical contracts, one with Britain, one with Europe, that could not both be fulfilled at the same time.

"AstraZeneca has sold three factories out of the four they have in the European contract twice," says one EU diplomat. "Once to the EU and once to the UK. In doing so, it has pitted two blocs, which are already in a fraught divorce, against one another."

At the end of January the European Commission set up an export authorisation scheme on foot of the AstraZeneca revelations. It was officially designed to ensure greater "transparency", but the intention was to unveil where the UK was getting its AstraZeneca doses from.

Since then, the Commission says it has authorised 381 vaccine exports outside the EU, and blocked one - a consignment of 250,000 doses bound for Australia from Italy.

Despite grave concerns within the global pharmaceutical community about the Commission's ever-tightening restrictions, it's clear that Brussels believes that by finding out what vaccine doses go where, the EU now has some moral weight in demanding a rebalance.

On Thursday, Commission president Ursula von der Leyen told EU leaders the transparency mechanism showed the EU had exported 77 million doses around the world, including 21 million to the UK.

In turn, the EU had received 88 million doses, of which 68 million had been administered.

Leaders, even those like the Taoiseach Micheál Martin who are worried about Brussels getting into an escalating vaccine war, believe this information gives the EU leverage in its three-way dispute with AstraZeneca and the UK.

The summit statement on Thursday night carefully balanced talk of protecting supply chains, while keeping up the pressure on companies who failed to abide by contracts.

While there have been detailed talks between the Commission, AstraZeneca and the UK government, there has been no breakthrough yet, although a positive-sounding statement on Wednesday night spoke of a "win-win situation" for citizens on both sides of the Channel.

Senior EU figures believe the defence that the UK's contract with AstraZeneca is simply better, or harder, than the EU's contract does not fly, and is, in any event, a weasel argument when millions of Europeans are being denied life-saving vaccines.

Yet, the EU is contemplating an equally hardball response. Senior figures say that the UK is strongly reliant on Pfizer/BioNTech vaccines, produced in Europe, for the roll-out of second jabs.

Those doses in turn rely on UK lipid nanoparticles which are essential to the production of the mRNA vaccines. That will have to be taken into account if the European Commission decides to block AstraZeneca or Pfizer doses going from EU plants to the UK.

EU leaders certainly hope things don't come to that. What Europe is banking on is that some 300 million doses of Pfizer/BioNTech, Moderna, Johnson & Johnson (and AstraZeneca) vaccines will begin to flood member states from April onwards, and that the vaccine standoff will be quickly forgotten.

It's arguable that if AstraZeneca had delivered what it was contracted to deliver in the first quarter, then the European roll-out would have been significantly more successful, although still not as quick as those in the UK, Israel and the US.

But those who lambast the EU for its failures need to face the counterfactual. What if the EU hadn't got involved at all?

An unseemly scrap between Austria and other member states at this week's summit provides a glimpse of what things might have been like if member states had adopted an every man for himself approach.

Austria bet heavily on the cheaper AstraZeneca vaccine during the negotiations last year. When Pfizer/BioNTech made available 10 million emergency doses two weeks ago, Austria said it should get more than its pro-rata allocation because it was disproportionately exposed by the AstraZeneca shortfall.

Austria's Chancellor Sebastian Kurtz demanded that its needs be agreed by EU leaders at the summit, but they exasperatedly noted that other countries - Latvia, Bulgaria and Croatia - were actually more deserving of extra doses, and that Vienna had even decided not to draw down its full allocation during the negotiations last year.

"If 27 member states were independently negotiating with pharmaceutical companies, there would have been hell to pay," says one EU official.

"You could just imagine the turf war. It's not just that the joint procurement approach meant member states were getting the cheapest price.

"Some member states would not be able to afford large volumes of vaccines. And if Poland, the Czech Republic and Bulgaria can't get vaccinated, there's no point in Germany getting vaccinated."

Yet, the roll-out has inflicted enormous reputational damage on the EU, even if much of that damage has been fanned by a triumphalist UK press. Indeed, during this week's summit, the Taoiseach reminded leaders about how exposed Ireland is to the anti-EU odium being pumped out of Fleet Street, and how demoralising it is.

There will be a long and painful inquest into how things might have been done differently, and it may well be that member states will need to grant more powers to Brussels as a result.

Rasmus Bech Hansen, of Airfinity, says that since a pandemic comes under the sphere of biosecurity, mass vaccinations would normally be the preserve of national militaries and health systems. These are two fields in which the EU has notoriously limited competences.

"Vaccine procurement has [traditionally] been a defence spend," he says. "It is seen as part of biosecurity protection. It is an area where you need to take a lot of risk. Some vaccines might not work, so it is a very different mindset.

"The other thing about the defence sector is that they are used to making quick decisions under pressure and working closely with the private sector."

Hansen says the EU should have taken a decision at summit level last spring to establish a centralised command structure to drive a joint pandemic response, drafting in health and military figures from all member states and the Commission - even involving NATO.

This may sound far-fetched, but the idea of a respiratory pandemic sweeping the globe and killing nearly three million people in one year also sounded far-fetched. Until it happened.

https://amp.rte.ie/amp/1206394

Interesting, very balanced and nuanced piece on the EU vaccine rollout. Especially the counterfactual at the end is worth thinking about. And as with all crises, this might still lead to a deeper integration and more competences for the EU. Let's see.

[celedhring]

Yeah, I've always believed that as rocky as the joint procurement has been, the counterfactual - with winners and losers inside the EU, and nasty competition to get vaccines - would have been much much worse. I'm worried many won't see it, though.

[Crazy_Ivan80]

And as with all crises, this might still lead to a deeper integration and more competences for the EU. Let's see.

let's hope not. If there's anything the EU should not be it's a state.

[DGuller]

Does EU have any imperial authority in the bank to push through some reforms?

[Zanza]

Does EU have any imperial authority in the bank to push through some reforms?

If the Corona relief fund actually happens (which is in doubt with the recent decision of the German Constitutional Court), it would definitely be a major step towards deeper integration and possibly fiscal union.

[Tamas]

Hungary decided to start vaccinates pregnant and  breastfeeding women as one of the priority groups due to an increase in deaths among them "due to the new strains" (I still think it's just the combination of incredible number of infections and lack of any test and trace, which make the numbers look like there are more severe cases). Plan is to have them get the first Pfizer or Moderna shot in the 2nd or 3rd trimester so they get the second shot after giving birth, as that's expected to produce a stronger immune response.

Meanwhile, closer and closer family members of people I know in Hungary have their family members catch it and in a few cases die of it, and the numbers show  no real sign of slowing.

Except for the official number of people in hospitals. New cases per day keeps being very high but the number of people in hospitals started to stagnate. Due to all the secrecy, whether this is more and more younger people catching it, or hospitals filling up to the brim, or just straight out lying by the government, who knows. 

[Tamas]

Does EU have any imperial authority in the bank to push through some reforms?

If the Corona relief fund actually happens (which is in doubt with the recent decision of the German Constitutional Court), it would definitely be a major step towards deeper integration and possibly fiscal union.

With  all the jealousy and general attitude toward helping out "lazy" Southerners,  I very much doubt any such relief fund happens.

[Sheilbh]

https://amp.rte.ie/amp/1206394

Interesting, very balanced and nuanced piece on the EU vaccine rollout. Especially the counterfactual at the end is worth thinking about. And as with all crises, this might still lead to a deeper integration and more competences for the EU. Let's see.

Agreed. It's not mentioned but I think the experience with PPE - which partly drove the UK government's decision to offer to help any vaccine manufacturer who wanted to set up manufacturing in the UK (four said yes, four said no) - was very fresh in the mind when the move to joint procurement happened. It's largely forgotten now but I remember France seizing PPE destined for the UK and the Czechs and I think the risk of that happening to vaccines was huge.

It's why I think the Commission was a bit between a rock and a hard place on this. I think the criticism of that - slowness, inexperience, and the lowest common denominator of cheapness - is fair. But the risk of a PPE-style scramble was also very real. The tragedy of that is that it's exactly the states who managed to avoid the first wave, who were suspicious of spending a lot of money on expensive novel mRNA vaccines who are now suffering most in this winter wave.

And I think Macron's reflection on this that Europe listened to experts saying it would take a couple of years to develop a vaccine so they weren't ambitious enough is possibly true as well - he phrased it as "we were maybe too rational" (which sounds a little bit like saying "I'm too much of a perfectionist" in a job interview ). The UK effort started before there were any cases in Europe by giving extra funding to the Oxford researchers who'd previously developed an ebola vaccine, funding massively increased as the threat got closer; the US was project Warp Speed - but both were clearly a little bit moonshot-y. As it turned out we have multiple vaccines and it is attainable within a year with enough state support (I keep thinking about the possible lessons for climate from this), but perhaps Europe was being a little bit "too rational" about what was possible until the summer. I think this was probably re-inforced by states that avoided or suppressed the first wave because I wonder if they basically thought they knew how to manage this without vaccines and Spain and Italy could learn - it was only the countries lacking leadership or state capacity like the US or UK that needed to pin their hopes on vaccines.

But I think the slight counter-factual I think is most relevant is that the Inclusive Alliance was the main alternative - which isn't mentioned. From what I understand of that France, Germany, the Netherlands and Italy were going to buy on behalf of Europe. France, the Netherlands and Italy had all been hit quite badly and Germany has some of the very innovative pharma firms developing new vaccines. My suspicion is they wouldn't have the issues around inexperience and they would have been quicker and more accepting of risk (a little like the UK procurement strategy). That might have failed at the distribution end and led to fights between member states.

One other thought is that posisbly because the focus of the European effort was on procurement is that it didn't intend to boost manufacturing capacity - again this may be a little bit to do with member state/Commission dichotomy. So the UK offer on manufacturing means, if the factories work as planned, there should be about 1 billion doses being manufactured in the UK - most of which will be exported. Now obviously that might not work out, for example, AZ are supposed to be making 300 million doses in the UK this year and so far they've managed aboud 15-20 million. Similarly China, the US and India have massively increased the capacity to manufacture vaccines. That has happened in Germany - I think in deals with BionTech and Curevac - but less so in the rest of Europe and I wonder if that's because the EU's job was procurement so it was buying from company's existing and expected capacity - rather than asking how can we help expand the capacity. The EU wasn't really asked to help expand European manufacturing capacity and, in any event, that would generally be up to member states. It feels like it's only in the last few weeks that there's been a shift to actually boosting capacity as well with new factories approved for AZ, Pfizer and Moderna.

I'm not sure it will necessarily lead to deeper integration or competences though - it could do. I'd have more confidence in the relief fund driving more integration etc. But I think there may be resistance to that idea given that there's been issues at EU levels. Also, frankly, I think the EU's expertise and skill is at the market/regulatory/trade level - I think they need to build capacity and experience in delivery in other areas that directly affect individuals in any way where they are more than consumers. I would build that capacity and experience in other areas first before trying it in health which is a matter of literal life and death. Because I think the core legitimacy of the EU is still delivery legitimacy and if they bit off more than they could chew it would hurt them.