1st Feb 2023


What Estonia and Slovakia did to beat AstraZeneca 'hesitancy'

  • Four-in-five AstraZeneca doses remained unused across Europe more than two weeks following their delivery (Photo: European Commission)

European populaces are increasingly expressing frustration both towards the stringent lockdowns that have constrained their lives and sluggish inoculation programmes that have tested their patience.

The EU's Covid-19 vaccine supply is indeed forecast to amount to as few as 100 million doses by the end of March. This number pales in comparison to the bloc's population of 446 million.

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  • The snubbing of the AstraZeneca vaccine is underpinned by fears it is less effective than the Pfizer-BioNTech and Moderna vaccines, in the wake of weeks of negative European press coverage (Photo: Cheshire East Council)

Yet despite this limited availability, European countries are now running into another unexpected problem as they seek to accelerate rollouts. Vaccine snobbery.

The AstraZeneca jab, notably, has found itself shunned by some societies amid controversy even though it is only one of three vaccines currently approved by the European Medicines Agency.

Four-in-five AstraZeneca doses remained unused across Europe over two weeks following their delivery. In Germany, appointment openings for the shot, meanwhile, are being left vacant.

The snubbing of the AstraZeneca vaccine is undergirded by fears that it is less effective than those produced by Pfizer-BioNTech and Moderna on the heels of weeks of negative European press coverage.

European officials have also squabbled with the British-Swedish company that produces the vaccine over its alleged under-fulfilment of contractual obligations.

Numerous European countries, responding to limited clinical trial data on its efficacy among elderly people, have also restricted its use to populations under the age of 70, 65 or even 55, further sparking qualms and creating the impression that the AstraZeneca jab is a "second class" vaccine.

In France, where vaccine scepticism is rife, French president Emmanuel Macron has announced that he himself would be willing to get the AstraZeneca jab, moving to reassure his constituents that the vaccine is safe and effective.

Though AstraZeneca reported lower efficacy on its vaccine compared to Pfizer-BioNTech and Moderna and questions linger concerning its utility against new strains of the virus, Scottish data revealed that it has been 94 percent effective in preventing hospitalisations in the country. The World Health Organization, furthermore, has recommended it for all adults.

Estonia and Slovakia's 'solutions'

Against this less-than-ideal backdrop, some countries have stood out.

Estonia, for example, has managed to completely exhaust its AstraZeneca supply and Slovakia has made significant headway in doing the same.

The strategies being pursued in the two countries could, therefore, present a viable roadmap for addressing the choosiness problem and hastening vaccine uptake across the continent.

Like many others, Estonia and Slovakia have decided to initially confine the use of the AstraZeneca vaccine to younger people, until more evidence becomes available on its effectiveness among seniors.

But rather than directing its administration, like other countries, only to health practitioners, homecare workers and other priority groups who are already closer to the front of the queue for the Pfizer-BioNTech and Moderna vaccines, Slovakia has launched a mass vaccination programme aimed at teachers and childcare workers.

Estonia, for its part, has begun inoculating frontline workers including teachers, police officers and members of the armed forces ahead of schedule.

By targeting the initiatives to groups lower on the vaccine tier lists of the two countries, the possibility of getting the AstraZeneca vaccine has become, for many, a serendipitous moment rather than a stroke of misfortune as it has been perceived, for example, by dentists in Germany.

While the Slovak programme is principally geared towards enabling educators to safety return to the classroom – primary school has recently gone back to in-person instruction – it has also bolstered vaccine distribution and seen the country avoid the pitfalls facing many of its European peers.

Facilitated by a central online portal that permits education employees to swiftly sign up for appointments at vaccination centres, more than 26,000 teachers under the age of 55 alone were vaccinated with their first dose within two weeks.

Interest in some regions has reportedly reached up to 80 percent.

Though previously an inoculation laggard, the success of the programme has witnessed Slovakia ascend to the top half of EU countries on vaccination rates, all the while aiding the safe reopening of schools.

And the initiative is now being expanded to include public transportation employees, taxi drivers and some retail workers who are engaged in regular social interaction as part of their jobs.

Estonia's programme has proven similarly popular, with a reported 70-percent uptake among its police forces.

Given severe supply constraints, many of the recently inoculated residents would have only been eligible to get a jab in late spring or even summer at the earliest.

This has provided a crucial motivating factor spurring strong uptake.

The buy-in, undoubtedly, is also tied to the dire pandemic situation facing the two countries.

Desperate times

Slovakia has reported among the highest-per-capita fatality rates in the world in recent weeks and its hospitalisations have hit record peaks.

Estonia, meanwhile, has recorded the second-highest rate of new coronavirus cases in Europe.

Their success though, also underscores the need for governments to design vaccine programmes that are responsive to social expectations.

In Germany, several regional prime ministers are indeed now calling on authorities to loosen the country's prioritisation scheme to allow younger individuals, even if they are farther down the priority list, to be administered unclaimed doses.

Government communication can play a role too in hitting home the message that all approved vaccines confer protection, including particularly from hospitalisation and death, and that an individual's first vaccine need not be the final and only jab they ever receive.

As supply increases, opportunities, in fact, will arise for individuals to attain booster shots. Health officials, scientists and manufacturers are already anticipating the introduction of annual jabs to combat emerging variants.

The EU has set a goal of vaccinating 70 percent of adults by late summer, crucial if economies are to reopen, travel to return and societies to revert to many pre-pandemic routines.

The early experience with AstraZeneca, however, reveals that accelerating shots-in-arms will not only be a logistical matter but one requiring innovative governance that accounts for the social factor and puts the right incentive structures in place.

Author bio

Shane Markowitz is an associate fellow at the GLOBSEC Policy Institute in Bratislava. His writing has been published in The Washington Post, World Politics Review, EUobserver, Social Europe, openDemocracy, and the journal Populism.


The views expressed in this opinion piece are the author's, not those of EUobserver.

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