How Europe, After a Fumbling Start, Overtook the U.S. in Vaccination

Early on, while the United States and a handful of others surged ahead, the Europeans undermined their inoculation campaigns with repeated stumbles, delaying vaccine purchases, damaging public confidence in some shots and bungling the rollout when doses became available.

Now, the bloc is on a pace to end this week having given about 105 doses per 100 people, and at least one to just over 70 percent of adults, while the United States is at about 103 per 100 people and 69 percent of adults.

“The catch-up process has been very successful,” Ursula von der Leyen, president of the European Commission, the E.U. executive branch, said this week.

But the reversal is not just a story of the European Union and its member countries working out the early kinks, and in fact their vaccination campaigns remain far from trouble-free. Major political differences between the United States and Europe set them on divergent paths.

Europe has plenty of people who distrust the shots and their governments, but vaccine resistance in the United States is more widespread and vehement, particularly among conservatives, and falls more sharply along partisan lines. The E.U. vaccination effort has slowed recently, but not like the U.S. drive, which has declined more than 80 percent.

Policy-making in most of Europe is far more centralized than in the United States, where a jumble of federal, state and local measures yield wildly different approaches from place to place. Central governments have more control over health care and, crucially, some have been more willing to use mandates and high-pressure tactics to get people to take the shots.

“We are entering a new phase in Europe, where many leaders said vaccination wouldn’t be compulsory, but where the spread of the virus has made them realize that tough incentives could be desirable,” said Guntram Wolff, the director of the Bruegel Institute, a Brussels-based think tank.

In France, residents now have to show a “health pass” containing proof of vaccination or a negative test to gain entry to most indoor venues, including, starting in August, restaurants and bars. Unvaccinated high school students will have to stay home if a Covid-19 case is detected, while vaccinated students will be allowed in classrooms.

President Emmanuel Macron said the aim was to “put restrictions on the unvaccinated rather than on everyone.”

Italy announced similar measures last week. Germans have to show a proof of vaccination or a negative test to dine indoors at restaurants. In Britain, which left the European Union last year, residents in England will have to show that they have been inoculated to enter nightclubs, starting in September.

The governments of Greece, Italy and France are requiring health care workers to be vaccinated — or, in some cases, risk not being paid.

A vaccination site near Paris.Dmitry Kostyukov for The New York Times

In the United States, efforts to require inoculation of public employees suddenly picked up steam this week. The federal Department of Veterans Affairs announced a vaccine mandate for many employees, while the states of California and New York said their workers will have to be vaccinated or face frequent testing.

President Biden announced on Thursday that all civilian federal employees must be vaccinated against the coronavirus or submit to regular testing, social distancing, masking requirements and restrictions on most travel. He also called on state and local governments to offer $100 to people who get vaccinated.

But most state and local governments have not mandated vaccination for their employees, and some of them have prohibited employer mandates. Governments in the United States have also not used the kind of pressure being applied in Europe to get members of the general public vaccinated.

On Wednesday, a group of Republican senators said Mr. Biden should offer more scientific evidence before imposing any requirement, even on government employees. “This is America,” said Senator Charles E. Grassley of Iowa. “You can’t force people to get vaccinated.”

In Europe, public opinion polls show overwhelming support for vaccines as the only way out of the pandemic. A survey conducted in May found that 79 percent of E.U. residents intended to get inoculated “sometime this year.”

In France, 3.7 million people booked vaccine appointments in the week following Mr. Macron’s announcements, leading experts to suggest that many of the unvaccinated were not staunchly opposed but indecisive, or just in no hurry.

“Many people have been on the fence and would have waited until the end of the summer holidays to consider getting a shot,” said Alain Fischer, the head of France’s vaccination campaign. “The new requirements have given them a little boost.”

A hospital in Milan.Alessandro Grassani for The New York Times

National and regional health systems in many European countries have made the work easier, experts say, not only providing everyone with care but giving the government an established role in that care.

“In Spain, the fact that everyone is signed up with a family doctor helps bring structure,” said Rafael Bengoa, a former director of health systems at the World Health Organization and former health minister for the Basque Country region. He said doctors could better track priority groups in the early stages of the campaign, and identify those who had yet to be vaccinated.

But at first, the European Union’s efforts resembled the caricature its critics often cite — a bloated bureaucracy getting in its own way.

E.U. leaders decided to buy vaccine doses as one, rather than letting each country fend for itself, though it had little experience with huge purchases. It was slow to get a mandate from member states, and slow to make deals with drug makers. And the E.U. drug regulator was slower than its British and American counterparts to authorize shots.

The European Union had bet big on the University of Oxford-AstraZeneca vaccine, but the company ran into manufacturing problems, creating a severe shortage just weeks into the rollout. E.U. leaders and the drug maker traded accusations of bad faith.

Then rare blood clotting problems prompted a temporary suspension of that vaccine and political leaders questioned its effectiveness, prompting some Europeans to shun it. (Europe, like the United States, came to rely primarily on the Pfizer-BioNTech and Moderna vaccines.)

When doses were finally distributed en masse to member countries, they struggled to master the rollout logistics.

Those problems turned out to be temporary, but others linger.

Vaccine requirements in Europe have prompted some pushback. Heidi Larson, an anthropologist and the founder of the London-based Vaccine Confidence Project, said Europe and the United States faced similar challenges in addressing vaccine hesitancy, including anti-government rhetoric, and concerns about safety and individual freedoms.

In France, more than 160,000 people marched against the new requirements this month, and Mr. Macron’s government had to backtrack on some of its proposals to get a law passed enforcing the rules.

In Italy, the authorities have urged leading politicians to support vaccination, but some remain evasive. Matteo Salvini, leader of the right-wing League party, only received his first vaccine dose this week.

The European Union also has much wider geographic disparities than the United States. The wealthier western region, where in several countries, more than 80 percent of adults have had at least one vaccine dose, is far ahead of the east.

Just 19 percent of adults in Bulgaria and 32 percent in Romania have been at least partially vaccinated, and the pace has slowed sharply despite plentiful shots. They are the poorest E.U. members, where health care systems have suffered from low investment and public mistrust.

“Bulgaria is doing much worse than the worst state in the United States,” said Matteo Villa, a research fellow at the Italian Institute for International Political Studies.

European researchers are also increasingly concerned about a generational divide in highly vaccinated countries.

People under 45 years old were more hesitant to get the shots than those above that age, according to the E.U. survey.

“We have focused a lot on the elderly, which has left a very strong perception among younger people that they’re not at risk, or that if they are, the symptoms are very mild,” Dr. Larson said.

About 20.5 million doses were administered last week across the E.U., down from a peak of almost 28.4 million in early June. Officials expect a continued slide, and worry about how sharp it will be.

Countries that raced ahead in early vaccination have since slowed significantly, finding that some parts of their populations are hard to reach or persuade — and raising questions about the ultimate limits of their inoculation campaigns.

Britain and Israel, the early leaders, remain well ahead of almost all E.U. states. But Britain is vaccinating people about half as fast as the bloc — though about twice as fast as the United States — while Israel has slowed roughly to the American pace.

“In most European countries, those who wanted a vaccine have gotten it, but that was the easy part,” said Gerard Krause, a professor of infectious disease and epidemiology at the Helmholtz Center for Infection Research in Germany. “The next step in Europe is to go where the need is, to address language, cultural, and geographical barriers.”