Assessment of the circulation of SARS-CoV-2, variants of concern, non-pharmaceutical interventions and vaccine deployment in the EU / EEA, 16th update


Since its emergence in March 2021, the variant of concern (COV) B.1.617.2 (Delta) has rapidly become predominant in the European Union / European Economic Area (EU / EEA). Over 99% of newly reported cases are attributed to this variant. The Delta variant demonstrated a significant transmission advantage over previously circulating SARS-CoV-2 strains. However, full vaccination remains protective against serious outcomes such as hospitalization, admission to intensive care, and death. Currently available vaccines have played a crucial role in limiting viral circulation and in particular limiting the impact of Delta variant infections.

Despite the fact that over 565 million doses of vaccine have been administered in the EU / EEA to date, only 61.1% (range: 18.4-79.4%) of the total EU population / EEE have been fully vaccinated to date. The total population includes children and adolescents for whom the vaccine is not available or who may not yet be included in national target groups. There are considerable country-to-country and sub-national variation in vaccine use, resulting in a large portion of the EU / EEA population remaining susceptible to SARS infection -CoV-2.

Modeling scenarios that take into account vaccine coverage, vaccine efficacy, natural immunity, and population contact rates – in the context of continuous Delta circulation – indicate that the potential burden of risk disease in the EU / EEA due to the Delta variant is high by the end of November, unless vaccination coverage can be increased rapidly in the total population over the next few weeks.


Risk assessed in this update

The risk assessed in this update is as follows: Based on current levels of vaccine coverage and the dominance of the Delta variant in the EU / EEA, what risk does SARS-CoV-2 pose for the general population and the vulnerable population in the years to come? month?

This update was prompted by the forecast modeling undertaken by ECDC and the planned relaxation of non-pharmaceutical and other measures announced by EU / EEA countries.

Our previous assessment published on June 10, 2021 (15th update) described the risk at that time and ranked EU / EEA countries based on SARS-CoV-2 transmission (expressed as low, moderate concern). , high and very high). Here, we assess the risk for large groups of EU / EEA countries based on their current and projected levels of immunization coverage for the total population (low 75% of the total population). Using mathematical modeling, we predict the disease burden by the end of November 2021. The risk assessment of the SARS-CoV-2 pandemic is further stratified for the following groups in the total population: the population general vaccinated and unvaccinated; the vulnerable population vaccinated and unvaccinated. The assessment is based on the following: i) the vaccinated have a lower probability of infection and ii) a lower impact of such infection than the unvaccinated, while iii) the vulnerable population suffers a greater impact. high in case of infection, compared to the general population. Based on modeling projections, virus circulation and disease burden by the end of November 2021, the following can be anticipated:

  • Countries with COVID-19 vaccine coverage at or below the current EU average level in the total population and planning to relax non-pharmaceutical interventions (NPIs) have a high risk of experiencing a significant increase in cases, hospitalizations and mortality by the end of November 2021. In such a scenario, due to very high viral circulation, fully vaccinated vulnerable populations are also at risk of contracting an infection with a severe outcome.
  • Countries with COVID-19 vaccine coverage above the current EU average level, and especially those with the highest current coverage, in the total population have a lower and manageable risk of experiencing a sharp increase in cases, hospitalizations and mortality by the end of November 2021, unless there is a rapid decline in vaccine effectiveness due to decreased immunity.

Response options

  • Countries should continuously strive to increase their COVID-19 vaccine coverage in all eligible age groups, in order to limit the burden of infections posed by the Delta variant in the fall. This requires ongoing monitoring of vaccination and associated social determinants to understand where and in which population groups and communities immune deficiency persists.
  • According to current ECDC forecasts, depending on the local epidemiological situation and COVID-19 vaccine coverage, non-pharmaceutical interventions will still be needed by the end of November to control the circulation and impact of the Delta variant. .
  • Closing the COVID-19 vaccination gaps in vulnerable populations and healthcare workers before the winter months is also essential to mitigate risks to health systems, which can be affected by influenza and others. respiratory viruses, in addition to SARS-CoV-2, as the winter season approaches, posing the risk of further increasing the demand for care.
  • To increase vaccination coverage, it will be essential to fight inequalities in access to COVID-19 vaccination in different population groups. It is also important to understand the factors that determine low vaccine uptake in certain population groups, including issues related to vaccine uptake and access, so that targeted, context-specific and effective interventions can be achieved. be developed.
  • Risk communication activities should clearly and systematically emphasize the important role that existing vaccines against COVID-19 and influenza play in protecting people from serious illness. The messages should also stress that although many countries have relaxed public health measures in recent months, maintaining hygiene measures and avoiding unnecessary physical overcrowding remains cautious.
  • Given the continued risk of transmission among unvaccinated children, high levels of prevention and preparedness are required in the education system.
  • In addition to these response options, it remains crucial that COVID-19 surveillance systems are able to effectively monitor and report COVID-19 cases, hospitalizations and deaths, in order to guide decisions on measures. health issues and understand their impact. The effectiveness of the vaccine should also be monitored to inform the strategies of immunization programs.
  • The genomic sequencing of samples remains of great importance to characterize the variants currently in circulation and to detect the emergence of new variants with worrying characteristics.

What’s new in this assessment?

  • This rapid risk assessment assesses the risk posed by the circulation of the Delta variant of SARS-CoV-2 by the end of November 2021, based on modeling scenarios and projected levels of vaccine coverage.
  • Updated data on seroprevalence and reinfection with SARS-CoV-2 is included, along with available evidence on the effectiveness of the COVID-19 vaccine, decline in immunity and breakthrough infections.
  • Information on vaccine reluctance and best practices for approaching hesitant populations and tackling misinformation is included, along with advice on risk communication and a list of suggested key messages.

Read more


High risk of fall increase in COVID-19 cases and deaths in countries with insufficient vaccination coverage, warns ECDC

EU / EEA countries that have not yet achieved sufficiently high COVID-19 vaccine coverage in their total populations, which plan to relax non-pharmaceutical interventions in the next two weeks, are at high risk of experiencing a significant increase in cases, hospitalizations and mortality by the end of November.

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