Vaccination Progress and Changes in COVID-19 Containment Measures - RKI
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1 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
COVID- CONTAINMENT MEASURES ANALYSIS, ISSUE
Vaccination Progress and Changes in
COVID-19 Containment Measures
Evidence-Based Public Health (ZIG 2) | Center for International Health Protection (ZIG)
Robert Koch Institute2 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
Vaccination Progress and Changes in COVID-19 Containment Measures
Robert Koch-Institute, 2021
Funding
This report was developed under the project Analysis of international epidemiological data and response
measures, a project funded by the German Federal Ministry of Health (BMG).
Authors
Thurid Bahr, ZIG 2
Johanna Hanefeld, ZIG
Charbel El-Bcheraoui, ZIG2
Acknowledgements
The authors gratefully acknowledge Luisa Denkel, Angela Fehr and the Public Health Intelligence team for
their valuable input and feedback on this report.
Suggested Citation
Bahr, T., Hanefeld, J. and El-Bcheraoui, C., 2021. Vaccination Progress and Changes in COVID-19
Containment Measures in Chile, France, Germany, Israel, Italy, the United Kingdom and the United Arab
Emirates, December – April 2021. Report. COVID-19 Containment Measures Analysis, Issue 1, Robert Koch
Institute, Berlin.
Disclaimer
The content of this report expresses the opinions of its authors and does not necessarily represent the views of
the Robert Koch Institute.3 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
Summary
This issue analyzes progress of national COVID-19 vaccination campaigns and COVID-19 containment measures
in Chile, France, Germany, Israel, Italy, the United Kingdom (UK) and the United Arab Emirates (UAE). Weekly
COVID-19 incidence per 100,000 population has been increasing slightly in the UAE, increasing strongly in
Chile, France, Germany and Italy, decreasing slightly in the UK and decreasing strongly in Israel since early
March 2021. France and Italy are currently experiencing an increase in weekly COVID-19 hospital occupancy
whereas Israel and the UK are experiencing decreasing trends in hospital occupancy. Weekly COVID-19 intensive
care unit (ICU) occupancy is also increasing in France, Germany and Italy whereas it is decreasing in Israel and
the UK. Variant of concern (VoC) B.1.17 continues to increase and now accounts for at least 71 % of circulating
variants in France, Germany, Israel, Italy and the UK.
Vaccination campaigns are ongoing in all of the seven countries. As of 2 April 2021, 36.31, 46.29 and 60.72% of
the population had received at least one dose of a COVID-19 vaccine in Chile, the UK, and Israel respectively. By
the same date, 11.98, 12.27 and 13.37% of the population in Germany, Italy and France had received at least one
dose. As of 23 February 2021, 35.2% of the population in the UAE had received at least one dose. All countries
included in this analysis began their vaccination campaigns among prioritized vulnerable groups at the highest
risk of developing severe disease or dying. All of them have expanded their vaccination campaigns over time to
include more population groups. Israel is currently the only country to universally offer a vaccine to anyone in
the population 16 years and older. Vaccine acceptance mostly increased between November 2020 and early
March 2021 in France, Germany, Italy and the UK. Vaccine acceptance in Israel strongly decreased between
November 2020 and February 2021 and slightly increased between end of February and early March 2021.
Between December 2020 and April 2021, the seven countries most frequently tightened measures related to
international travel, workplaces and schools. Israel loosened workplace closures, cancellations of public events,
stay-at-home requirements and restrictions on internal movement between February and March 2021. In early
March, the UK also started relaxing COVID-19 containment measures, amongst others for schools.
COVID-19 vaccinations are crucial to reduce severe disease and the burden on health systems. In Israel and the
UK, lesser severity of COVID-19 can be observed, as measured by COVID-19 hospital occupancy and COVID-19
ICU occupancy. VoC B.1.1.7 does not significantly reduce the effectiveness of the distributed vaccines. The
effectiveness of distributed vaccines against VoC B.1.351 and P.1 is subject to ongoing research and currently
available evidence suggests reduced effectiveness for some administered vaccine types. Relatively lower
vaccination coverage, such as currently seen in France, Germany and Italy, coupled with heavy circulation of the
virus in populations increases the risk that virus variants less susceptible to currently distributed vaccines may
emerge. Therefore, countries with low vaccination coverage should urgently speed up vaccination campaigns to
increase vaccination coverage. Declining vaccine acceptance can also affect the progress of national vaccination
campaigns in countries with high and low vaccination coverage. Both issues require effective risk communication
and community engagement around COVID-19 vaccines. Countries with high and low vaccination coverage
should also uphold effective COVID-19 containment measures to contain virus circulation within country and
limit across-country transmission.4 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
Zusammenfassung
Die vorliegende Ausgabe behandelt den Fortschritt nationaler Impfkampagnen und von COVID-19
Eindämmungsmaßnahmen in Chile, Deutschland, Frankreich, Israel, Italien, den Vereinigten Arabischen
Emiraten (VAE) und dem Vereinigten Königreich (VK). Seit Anfang März 2021 steigt die wöchentliche COVID-
19-Inzidenz pro 100.000 Einwohner in den VAE leicht an, in Chile, Frankreich, Deutschland und Italien stark
an, hat im VK leicht abgenommen und in Israel stark abgenommen. Frankreich und Italien verzeichnen derzeit
einen Anstieg der wöchentlichen COVID-19-Krankenhausbelegung, während Israel und Großbritannien einen
rückläufigen Trend bei der Krankenhausbelegung verzeichnen. Die wöchentliche COVID-19 Intensivbelegung
nimmt in Frankreich, Deutschland und Italien zu, während sie in Israel und im VK abnimmt. Die Virusvariante
(VoC) B.1.17 macht inzwischen mindestens 71% der im Umlauf befindlichen Varianten in Frankreich,
Deutschland, Israel, Italien und Großbritannien aus.
Bis zum 2. April 2021 hatten 36,31, 46,29 und 60,72% der Bevölkerung in Chile, dem VK und Israel mindestens
eine Dosis eines COVID-19-Impfstoffs erhalten. Zum gleichen Zeitpunkt hatten 11,98, 12,27 und 13,37% der
Bevölkerung in Deutschland, Italien und Frankreich mindestens eine Dosis erhalten. Bis zum 23. Februar 2021
hatten 35,2% der Bevölkerung in den VAE mindestens eine Dosis erhalten. Alle untersuchten Länder begannen
ihre Impfkampagnen unter priorisierten schutzbedürftigen Gruppen mit dem höchsten Risiko eines schweren
Krankheitsverlaufes oder zu sterben. Alle Länder haben ihre Impfkampagnen im Laufe der Zeit auf mehr
Bevölkerungsgruppen ausgeweitet. Israel ist derzeit das einzige Land, das allen Personen ab 16 Jahren ein
Impfangebot macht. Insgesamt hat die Impfakzeptanz in Frankreich, Deutschland, Italien und Großbritannien
zwischen November 2020 und Anfang März 2021 zugenommen, unterliegt aber Schwankungen. Die
Impfakzeptanz in Israel nahm zwischen November 2020 und Februar 2021 stark ab und stieg zwischen Ende
Februar und Anfang März 2021 leicht an.
Zwischen Dezember 2020 und April 2021 haben die sieben Länder ihre Eindämmungsmaßnahmen bezüglich
internationaler Reisen, Arbeitsplätzen und Schulen am häufigsten verschärft. Israel lockerte zwischen Februar
und März 2021 Eindämmungsmaßnahmen an Arbeitsplätzen, für öffentliche Veranstaltungen und bezogen auf
die Bewegungsfreiheit. Anfang März begann das VK ebenfalls, Maßnahmen zur Eindämmung von COVID-19
zu lockern, so zum Beispiel für Schulen.
In Israel und dem VK, den beiden Ländern mit dem größten Impffortschritt (1. Dosis), ist der Schweregrad von
COVID-19 Erkrankungen gemessen an der Krankenhaus- und Intensivbelegung geringer als in den anderen
Ländern. Dies unterstreicht die Bedeutung von Impfungen als Maßnahme gegen schwere Krankheitsverläufe
und die Überlastung von Gesundheitssystemen. VoC B.1.17 verringert die Wirksamkeit der in den sieben
Ländern verimpften Impfstoffe nicht signifikant. Die Wirksamkeit verimpfter Impfstoffe gegen VoC B.1.351 und
P.1 wird derzeit erforscht, und aktuell verfügbare Erkenntnisse deuten darauf hin, dass einige verabreichte
Impfstofftypen weniger wirksam sind. Eine geringere Impfrate, wie sie derzeit in Frankreich, Deutschland und
Italien zu beobachten ist, in Verbindung mit einer starken Zirkulation des Virus in der Bevölkerung erhöht das
Risiko des Auftritts von Virusvarianten, gegen die derzeit verimpfte Impfstoffe weniger wirksam sind. Daher
sollten Länder mit geringerer Impfrate ihre Impfkampagnen dringend beschleunigen. Eine sinkende
Impfakzeptanz kann sich negativ auf den Impffortschritt in Ländern mit sowohl hoher als auch niedriger
Impfrate auswirken. Beide Herausforderungen erfordern eine effektive Risikokommunikation und
Bevölkerungsbeteiligung zu COVID-19-Impfstoffen. Länder mit hoher und Länder mit niedriger Impfrate
sollten weiterhin effektive COVID-19-Eindämmungsmaßnahmen aufrechterhalten, um Viruszirkulation
innerhalb des Landes einzudämmen und grenzüberschreitenden Viruseintrag zu begrenzen.5 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
1. Problem Statement
Weekly COVID-19 incidence per 100,000 population has been increasing slightly in the UAE, increasing
strongly in Chile, France, Germany and Italy, decreasing slightly in the UK and decreasing strongly in Israel
since early March 2021. France and Italy are currently experiencing an increase in weekly COVID-19 hospital
occupancy whereas Israel and the UK are experiencing decreasing trends in hospital occupancy. Weekly COVID-
19 ICU occupancy is also slightly increasing in France, Germany and Italy whereas it is decreasing in Israel and
the UK (see sections 2.1 and 2.2, Figure 1). Vaccination campaigns are ongoing in all of the seven countries. As
of 2 April 2021, 36.31, 46.29 and 60.72% of the population had received at least one dose of a COVID-19 vaccine
in Chile, the UK, and Israel respectively. By the same date, 11.98, 12.27 and 13.37% of the population in Germany,
Italy and France had received at least one dose. As of 23 February 2021, 35.2% of the population in the UAE had
received at least one dose (see section 3.1). VoC B.1.17 continues to increase and now accounts for at least 71 % of
circulating variants in France, Germany, Israel, Italy and the UK (see section 2.3). This variant does not
significantly reduce the effectiveness of administered vaccines.i However, studies have shown varying degrees of
reduced effectiveness of administered vaccines against VoC B.1.351 and P.1. ii New virus variants might also
emerge with as of yet unknown effects on vaccine effectiveness. Relatively lower vaccination coverage, such as
currently seen in France, Germany and Italy, coupled with heavy circulation of the virus in populations increases
the risk that virus variants less susceptible to currently distributed vaccines may emerge.iii Declining vaccine
acceptance can also affect the progress of national vaccination campaigns (see section 3.2, Figure 2). Lifting
COVID-19 measures in the face of increasing COVID-19 incidence and/or vaccination coverage that is too low to
curb transmission in the population would probably lead to another surge in the seven countries (see sections
4.1 and 5., Figure 3).
2. Epidemiological Comparison
2.1 Weekly new COVID-19 cases per 100,000 population in Chile, France, Germany, Israel, Italy, the United
Arab Emirates and the United Kingdom, December 2020-April 2021: Since early March 2021, weekly COVID-
19 incidence has been increasing slightly in the UAE, increasing strongly in Chile, France, Germany and Italy,
decreasing slightly in the UK and decreasing strongly in Israel. As of late March 2021, weekly incidence per
100,000 population stands at 47.97 in Israel, 54.24 in the UK, 136.84 in Germany, 150.06 in the UAE, 236.99
in Chile, 257.49 in Italy and 386.06 in France (Figure 1).1
2.2 Weekly COVID-19 hospital and intensive care unit (ICU) occupancy rate per 100,000 population in France,
Germany, Israel, Italy and the United Kingdom, December 2020-April 2021: Since early March 2021, weekly
COVID-19 hospital occupancy per 100,000 population has been increasing slightly in France and Italy,
decreasing slightly in Israel and decreasing moderately in the UK. As of late March 2021, weekly COVID-19
hospital occupancy per 100,000 stands at 9.17 in the UK, 12.03 in Israel, 37.41 in France and 49.46 in Italy. Since
early March 2021, weekly ICU occupancy per 100,000 population has been increasing slightly in France and
Germany, increasing moderately in Italy, decreasing slightly in Israel and decreasing moderately in the UK. As
of late March 2021, weekly COVID-19 ICU occupancy per 100,000 stands at 1.3 in the UK, 2.93 in Israel, 3.47 in
Germany, 5.5 in Italy and 6.28 in France (Figure 1).
1
Although weekly incidence data is available until early April (week 13-2021), it is not reported in this section. In early April 2021, public
holidays due to Easter celebrations were observed in a number of the seven countries and this has likely affected reported incidence. For
the same reason, COVID-19 hospital and ICU occupancy for that week are also not reported in this section. However, epidemiological
data for early April is included in Figure 1.COVID-19 Containment Measures, Issue 1 | Vaccinations Figure 1: Weekly COVID-19 incidence, hospital and ICU occupancy rate per 100,000 population and vaccination coverage in Chile, France, Germany, Israel, Italy, United Arab Emirates and the United Kingdom, weeks 49-2020 – 13-2021. The top row displays countries with higher vaccination coverage, the bottom row displays countries with lower vaccination coverage.iv
COVID-19 Containment Measures, Issue 1 | Vaccinations
2.3 Variants of Concern: B.1.1.7 is dominant (accounting for at least 50% of circulating variants) in Germany,
Israel, Italy and the UK. B.1.1.7 was first reported in the UK on 20 September 2020 and has been comprising
more than 95 % of circulating variants in England since mid-February 2021.v B.1.1.7 was first reported in the
UAE on 16 November 2020.2 The variant was first reported in Germany on 27 November 2020 and occurs in 88
% of all sequenced positive samples.vi The variant was first reported on 19 and 20 December 2020 in France and
Italy and comprises 71.9 and 86.7 % of circulating variants, respectively.vii VoC B.1.1.7 was first reported in Chile
on 22 December 2020.3 The variant was first reported in Israel on 23 December 2020 and comprises more than
90% of circulating variants in the country.4, viii
3. Vaccination Coverage
3.1 Vaccination coverage in Chile, France, Germany, Israel, Italy, the United Arab Emirates and the United
Kingdom, December 2020-April 2021: As of 2 April 2021, 36.31, 46.29 and 60.72% of the population had
received at least one dose of a COVID-19 vaccine in Chile, the UK, and Israel respectively. By the same date,
11.98, 12.27 and 13.37% of the population in Germany, Italy and France had received at least one dose. The most
recent data for the UAE indicates that as of 23 February 2021, 35.2% of its population had received at least one
dose.ix As of 2 April 2021, full vaccination was at 4.45, 5.17, 5.57, 7.67, 20.12 and 55.64% in France, Germany,
Italy, the UK, Chile and Israel, respectively. As of 23 February 2021, 22.1% of the population in the UAE had been
fully vaccinated against COVID-19. x Chile administers vaccines by Pfizer/BioNTech and Sinovac. France,
Germany Italy and the United Kingdom administer Oxford/AstraZeneca, Moderna and Pfizer/BioNtech
vaccines. Israel administers vaccines by Moderna and Pfizer/BioNTech. The UAE administer
Oxford/AstraZeneca, Pfizer/BioNTech, Sinopharm/Beijing, Sinopharm/Wuhan and Sputnik V-vaccines.xi Chile
predominantly administers the Sinovac vaccine.xii France, Germany and Italy have predominantly administered
the Pfizer/BioNTech vaccine, followed by the Oxford/AstraZeneca vaccine and a small proportion of Moderna
vaccines.xiii Information on administered vaccine types for the remaining countries was not readily available at
time of report writing.
3.2 Vaccine acceptance in Chile, France, Germany, Israel, Italy and the United Kingdom, November 2020-March
2021: Vaccine acceptance has increased overall between November 2020 and March 2021 in France, Germany,
Italy and the UK, from 25 to 41 %, 40 to 62 %, 41 to 62 % and 55 to 71 % respectively. However, most recently
vaccine acceptance decreased in Germany, Italy and the UK between late February and early March 2021, from
62 to 57%, 62 to 57% and 71 to 65%, respectively. This decline in acceptance coincided with media reports on
very rare cases of unusual blood clots in people vaccinated with the Oxford/AstraZeneca vaccine. Several
European countries also temporarily paused vaccinations with the Oxford/AstraZeneca vaccine in mid-March
2021, including France, Italy and Germany.xiv Data for Israel shows a decreasing trend in vaccine acceptance
between November 2020 and February 2021, from 66% to 21 %. This trend reversed to a slight increase in early
March 2021, to 26% (Figure 2). 5 A journal article published in Vaccine in late 2020 reports 87% vaccine
acceptance in Chile for a nationally representative sample.xv
2
There is currently no data on the prevalence of B.1.1.7 in the UAE.
3
There is currently no data on the prevalence of B.1.1.7 in Chile.
4
This data stems from cov-lineages.org and is based on media reports. As more testing for VoC and more sequencing happens, it is
possible that evidence on the presence of B.1.1.7 will be found which predates the country data given here.
5
Poll data reported for France, Germany, Israel, Italy and the UK builds on nationally representative samples.COVID-19 Containment Measures, Issue 1 | Vaccinations Figure 2: Vaccine acceptance in Germany, France, Israel, Italy and the United Kingdom, November 2020 to March 2021. Figure reproduced from Imperial College London / YouGov COVID-19 Behaviour Trackerxvi
COVID-19 Containment Measures, Issue 1 | Vaccinations 3.3 National vaccination campaigns in Chile, France, Germany, Israel, Italy, the United Arab Emirates and the United Kingdom, December 2020-April 2021: All surveyed countries began their vaccination campaigns among prioritized vulnerable groups at the highest risk of developing severe disease or dying with the aim of reducing mortality and severe disease, and the burden on healthcare workers and healthcare systems. xvii In France, Germany, Israel, Italy, and the UK this included population groups living in institutionalized collective housing, especially nursing homes.xviii Chile, France, Israel, Italy and the UK also prioritized healthcare workers from the early stages on.xix Germany and the UAE stood out among the seven countries as they did not offer a vaccine to health care workers in their very first round of vaccinations, opting to vaccinate their oldest population groups first instead.xx All countries have expanded their vaccination campaigns over time to include more population groups. France, Italy, Germany and the UAE have progressively expanded their vaccination campaigns in line with their national vaccination strategies to include key workers, younger population groups and those with specific co-morbidities.xxi Since early April, Germany has begun providing COVID-19 vaccines through general practices. This step aims at increasing the speed and reach of the German vaccination campaign.xxii As of mid- February 2021, Israel has completed vaccination of priority groups and has moved to universally offer a COVID- 19 vaccination to its entire population of 16 years and older. To counter declining vaccine acceptance, Israel is now offering vaccinations in popular places like cafés and is offering incentives to those who get vaccinated, such as free food and drinks.xxiii By mid-February 2021, the UK offered all care home residents and staff, all adults 70 and over, all those considered extremely vulnerable and all frontline healthcare and social care workers a first vaccine dose.xxiv To protect vulnerable groups from rising COVID-19 incidence, in early February 2021 the UAE temporarily restricted vaccinations to the elderly and groups with chronic diseases only. xxv In mid-January, vaccinations had been offered to senior citizens, people with chronic diseases or disabilities, as well as healthcare and some essential workers in the UAE.xxvi The country reports that by mid-January 2021, all medical staff had received the first vaccine dose.xxvii 4. Policy Comparison 4.1 COVID-19 containment measures in Chile, France, Germany, Italy, Israel, the United Arab Emirates and the United Kingdom, December 2020-April 2021: Between December 2020 and April 2021, the seven countries most frequently tightened measures related to international travel, workplaces and schools. Chile tightened international travel measures between December 2020 and January 2021. France tightened restrictions on the use of public transport, internal movement, and international travel between February and March 2021. The country relaxed restrictions on internal movement between December 2020 and January 2021 and lifted restrictions on the use of public transport and school closures between March and April 2021. Germany tightened school and workplace closures and stay-at-home requirements between December 2020 and January 2021, tightened restrictions on internal movement between January and February 2021, tightened international travel restrictions between March and April 2021 and relaxed workplace closures and international travel controls between February and March 2021. Israel tightened workplace closures, restrictions on public gatherings, international travel controls and restrictions on the use of public transport between December 2020 and January 2021. The country loosened workplace closures, cancellations of public events, stay-at-home requirements and restrictions on internal movement between February and March 2021. Israel further loosened workplace closures and restrictions on public gatherings between March and April 2021. In late February 2021, Israel introduced a certification system for completed vaccinations and recovery from COVID-19 (“Green Pass”). Proof of vaccination can be provided via an app or as a paper certificate. Green Pass holders are entitled to access leisure venues, such as restaurants and bars, hotels, sports and cultural venues and places of worship. xxviii Italy tightened school closures between February and March 2021, tightened workplace closures between March and April 2021 and relaxed workplace closures between January and February 2021. The UAE tightened school closures, workplace closures and restrictions on internal movement between January and February 2021 and progressively relaxed school closures between February and April 2021. The UK tightened school closures, workplace closures, stay-at-
1 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
home requirements, and international travel restrictions between December 2020 and January 2021 and relaxed
school closures between March and April 2021 (Figure 3). Beginning in early March, the UK started relaxing
COVID-19 containment measures on the basis of opening plans devised by each of the four nations, England,
Northern Ireland, Scotland and Wales.xxix Due to the coding scheme applied by Our World in Data, the lifting of
these policies does not fully display in Figure 3.6 In mid-march 2021, the European Commission also introduced
a proposal for a “Digital Green Certificate” for EU member states that would serve to reinstate freedom of
movement of EU citizens if they have been either vaccinated against COVID-19, can provide a current negative
COVID-19 test result or have recovered from COVID-19.xxx
6
See also endnote xxxi.COVID-19 Containment Measures, Issue 1 | Vaccinations
1 December 2020 1 January 2021 1 February 2021 1 March 2021 1 April 2021
School Closures Required (all levels)
Workplace Closures Required for all but key
workers
Cancellation of Public Events Required cancellations
Restrictions on Public < 10 people
Gatherings
Chile
Stay-at-Home Requirements Required (few exceptions)
International Travel Controls Quarantine from high-risk Ban on high-risk regions
regions
Public Transport Closures Recommended closing (or
reduced volume)
Restrictions on Internal Restrict movement
Movement
School Closures Required at some levels Recommended
Workplace Closures Required for some Required for all but key
workers
Cancellation of Public Events Required cancellations
Restrictions on Public < 10 people
Gatherings
France
Stay-at-Home Requirements Required (except essentials)
International Travel Controls Ban on high-risk regions Quarantine from high-risk
regions
Public Transport Closures No measures Required closing (or No measures
prohibiting most using it)
Restrictions on Internal Restrict movement No measures Restrict movement
Movement
School Closures Recommended Required (all levels)
Workplace Closures Required for some Required for all but key Required for some
workers
Cancellation of Public Events Required cancellations
Restrictions on Public < 10 people
Germany
Gatherings
Stay-at-Home Requirements Recommended Required (except essentials)
International Travel Controls Ban on high-risk regions Quarantine from high-risk Ban on high-risk regions
regions
Public Transport Closures Recommended closing (or
reduced volume)
Restrictions on Internal Recommended movement Restrict movement
Movement restriction
School Closures Required at some levels
Workplace Closures Required for some Required for all but key Required for some Recommended
workers
Israel
Cancellation of Public Events Required cancellations Required cancellations Recommended cancellations
Restrictions on Public 10 – 100 people < 10 people 10 – 100 people
Gatherings
Stay-at-Home Requirements Required (except essentials) No measures1 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
International Travel Controls Ban on high-risk regions Total border closure
Public Transport Closures No measures Recommended closing (or
reduced volume)
Restrictions on Internal Restrict movement No measures
Movement
School Closures Required at some levels Required at all levels
Workplace Closures Required for all but key Required for some Required for all but key
workers workers
Cancellation of Public Events Required cancellations
Restrictions on Public < 10 people
Gatherings
Italy
Stay-at-Home Requirements Required (except essentials)
International Travel Controls Ban on high-risk regions
Public Transport Closures Recommended closing (or
reduced volume)
Restrictions on Internal Restrict movement
Movement
School Closures Recommended Required at all levels Required at some levels Recommended
Workplace Closures Recommended Recommended Required for some Required for some
United Arab Emirates
Cancellation of Public Events Required cancellations
Restrictions on Public < 10 people
Gatherings
Stay-at-Home Requirements No measures
International Travel Controls Quarantine from high-risk
regions
Public Transport Closures No measures
Restrictions on Internal Recommend movement Restrict movement
Movement restriction
School Closures Recommended Required at all levels Required at some levels
Workplace Closures Required for some Required for all but key
workers
Cancellation of Public Events Required cancellations
United Kingdom
Restrictions on Public < 10 people
Gatherings
Stay-at-Home Requirements Recommended Required (except essentials)
International Travel Controls Quarantine from high-risk Ban on high-risk regions
regions
Public Transport Closures Recommended closing (or
reduced volume)
Restrictions on Internal Restrict movement
Movement
Figure 3: Heatmap COVID-19 Containment Measures in Chile, France, Germany, Israel, Italy, the United Arab Emirates and the United Kingdom, 1 December 2020 – 1 April 2021xxxiCOVID-19 Containment Measures, Issue 1 | Vaccinations
5. Synthesis
For the majority of the countries included in this analysis, COVID-19 incidence per 100,000 population has been
increasing since early March 2021. In Israel and the UK, where vaccine coverage has increased steadily over the
past weeks, incidence has been decreasing. Hospital and ICU occupancy, where data is available, have been
mostly mirroring these trends (Figure 1). Israel, the UK, Chile and the UAE lead in vaccination coverage, with
36.31% or more having received on vaccine dose, while France, Germany and Italy lag behind with 13.37% or less
having received one vaccine dose.
One study from Israel shows that COVID-19 vaccinations with the Pfizer/BioNTech vaccine effectively reduce
disease severity in COVID-19 cases.xxxii Another observational study from Israel reports reduced infectiousness
of vaccinated individuals, which means that vaccinations may contribute to suppressing SARS-CoV-2
transmission in the population.xxxiii Public Health England reports that hospitalizations and deaths are decreasing
more quickly in the age groups of 65 and over than in the other age groups and attributes this to the vaccination
campaign.xxxiv Israel has progressively relaxed containment measures for schools, workplaces, public gatherings
and internal movement. In early March 2021, the UK also began lifting containment measures. In countries with
lower vaccination coverage and increasing COVID-19 incidence (France, Italy, Germany), COVID-19
containment measures applicable to schools and workplaces and restrictions on internal movement were
tightened between 1 December 2020 and 1 April 2021. However, France also relaxed school and public transport
COVID-19 containment measures in the spring of 2021, while Germany relaxed workplace closures (Figure 3).
Both countries with high and low vaccination coverage should uphold effective COVID-19 containment measures
to contain virus circulation within country and limit across-country transmission.
Vaccine effectiveness is impacted by circulating COVID-9 variants. VoC B.1.17, which accounts for at least 71 %
of circulating variants in France, Germany, Israel, Italy and the UK, does not significantly reduce the effectiveness
of the vaccines administered in those countries. However, if VoC B.1.351 and P.1 were to spread beyond their
current low levels in France, Germany, Italy and the UK or if new virus variants were to emerge, this could put
the effectiveness of the distributed vaccines at risk. xxxv In Chile, the presence of VoC P.1 has been reported,
although the precise extent of P.1 circulation in that country is not known.xxxvi There is initial evidence that the
Sinovac vaccine shows decreased effectiveness against P.1,xxxvii which could pose a risk to public health gains from
the Chilean vaccination campaign.7
Relatively lower vaccination coverage, such as currently seen in France, Germany and Italy, coupled with heavy
circulation of the virus in populations increases the risk that virus variants less susceptible to currently distributed
vaccines may emerge. Therefore, countries with low vaccination coverage should urgently speed up vaccination
campaigns to increase vaccination coverage. Oscillating levels of vaccine acceptance in European countries over
time show that vaccine acceptance cannot be taken for granted by decisionmakers. In Israel – the country with
the highest vaccination coverage – vaccine acceptance has declined in early 2021 and the speed at which
vaccination coverage increased has leveled off (Figure 2). Effective risk communication and community
engagement on COVID-19 vaccines should therefore be expanded in all countries wishing to continue or increase
progress in COVID-19 vaccinations.
7
Since early February 2021, the Sinovac COVID-19 vaccine has comprised the majority of COVID-19 vaccine doses administered in
Chile. Source: Our World in Data. “COVID-19 vaccine doses administered by manufacturer, Chile”. Available at
https://ourworldindata.org/grapher/covid-vaccine-doses-by-manufacturer?stackMode=relative, accessed 8 April 2021.1 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
6. Evidence Rating
Decisionmakers can use the evidence presented in this analysis to decide on the timing of COVID-19
containment measures tightening and loosening and when taking decisions on the roll-out of vaccination
campaigns. The evidence presented in this analysis builds on data in the public domain on COVID-19 cases,
hospital and ICU occupancy of COVID-19 cases, vaccination coverage and COVID-19 containment measures and
vaccination policies. To ensure comparability of national epidemiological COVID-19 data, all of the
epidemiological data used in this analysis stems from Our World in Data. Our World in Data compiles some of
its own data and additionally builds on data from the Center for Systems Science and Engineering at Johns
Hopkins University, the European Centre for Disease Prevention and Control and government sources.
Complete data on COVID-19 cases, hospital and ICU occupancy and vaccination coverage was available for four
out of seven countries. For one country, no suitable data was available for hospital occupancy due to COVID-19
and for two countries, no data was available on hospital and ICU occupancy due to COVID-19. Continuous data
on vaccination coverage over time was available for six out of seven countries over time. For one country, only
two data points on vaccination coverage were available. Data was available for COVID-19 containment measures
and vaccination policies in all countries. The evidence does not allow for any conclusions on the relative weight
of the influence of COVID-19 containment measures versus vaccination coverage on COVID-19 incidence and
the shares of COVID-19 cases that are hospitalized or in ICU. Data on VoC circulation was available for five out
of seven countries. The representativeness and validity of data on the share of VoC is limited for Israel and Italy,
good for France and Germany and very good for the UK. Data on COVID-19 vaccine acceptance was available for
six out of seven countries. Data on types of COVID-19 vaccines by manufacturer administered in countries was
available for four out of seven countries.COVID-19 Containment Measures, Issue 1 | Vaccinations
References
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PHI. “Update Virusvarianten”, Erlass 1849_33 of 7 April 2021.
viii WHO-EURO conference call, 4 March 2021.
ix Our World in Data, “Share of people who received at least one dose of COVID-19 vaccine”. Available at
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x Our World in Data, “Share of the population fully vaccinated against COVID-19”. Available at
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accessed 7 April 2021. Data for Germany current as of 2 April 2021. Data for France current as of 4 April 2021. Data for the
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xii Our World in Data. “COVID-19 vaccine doses administered by manufacturer, Chile”. Available at
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xiii ECDC. COVID-19 Vaccine Tracker. “Total number of vaccine doss distributed and administered in the EU/EEA countries
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xiv Picheta, Rob/CNN (16 March 2021), “Spain, Germany, France and Italy pause AstraZeneca vaccine rollout”. Available at
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xv Imperial College London / YouGov COVID-19 Behavior Tracker, “To what extent do you agree or disagree that if a Covid-
19 vaccine were made available to me [sic] this week, you would definitely get it”. Available at
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19BehaviourTracker/4Allbehaviorsovertime?:iid=1&:embed=y&:isGuestRedirectFromVizportal=y&:display_count=n&:show
VizHome=n&:origin=viz_share_link, accessed 31 March 2021. Data per country refers to share of respondents who selected
strongly agree (1) plus share of respondents who selected agree (2). Respondents were surveyed several times between the
last quarter of 2020 and the first quarter of 2021. First data point for France, Israel and the United Kingdom 11 November
2020; for Germany 15 November 2020; for Israel 29 January 2021. Final data point for Israel and the United Kingdom 10
March 2021; for France and Germany 11 March 2021; for Italy 12 March 2021. Respondents were asked to respond to items
on a scale from 1 (strongly agree) to 5 (strongly disagree). Respondent samples are representative of national populations.
Data for Chile from García, L. Y. and Cerda, A. A. (2020), "Acceptance of a COVID-19 vaccine: A multifactorial
consideration." Vaccine. 2020 Nov 10; 38(48): 7587, published online 26 October 2020. DOI:
10.1016/j.vaccine.2020.10.026. No suitable data was available for the United Arab Emirates
xvi Imperial College London / YouGov COVID-19 Behavior Tracker, “To what extent do you agree or disagree that if a Covid-
19 vaccine were made available to me [sic] this week, you would definitely get it”. Available at
https://ichpanalytics.imperialcollegehealthpartners.com/t/BDAU/views/YouGovICLCOVID-
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VizHome=n&:origin=viz_share_link, accessed 31 March 2021. Data per country refers to share of respondents who selected
strongly agree (1) plus share of respondents who selected agree (2). Respondents were surveyed several times between the
last quarter of 2020 and the first quarter of 2021. First data point for France, Israel and the United Kingdom 11 November
2020; for Germany 15 November 2020; for Israel 29 January 2021. Final data point for Israel and the United Kingdom 103 COVID-19 Containment Measures Analysis, Issue 1 | Vaccinations
March 2021; for France and Germany 11 March 2021; for Italy 12 March 2021. Respondents were asked to respond to items
on a scale from 1 (strongly agree) to 5 (strongly disagree). Respondent samples are representative of national populations.
Data for Chile from García, L. Y. and Cerda, A. A. (2020), "Acceptance of a COVID-19 vaccine: A multifactorial
consideration." Vaccine. 2020 Nov 10; 38(48): 7587, published online 26 October 2020. DOI:
10.1016/j.vaccine.2020.10.026. No suitable data was available for the United Arab Emirates.
xvii Data for France from Ministère des Solidarités et de la Santé (4 December 2020), “La stratégie vaccinale et la liste des
publics prioritaires”. Available at https://solidarites-sante.gouv.fr/grands-dossiers/vaccin-covid-19/article/la-strategie-
vaccinale-et-la-liste-des-publics-prioritaires, accessed 12 March 2021. Data for Italy from Ministero della Salute (2021),
“Piano strategico per la vaccinazione anti-SARS-CoV-2/COVID-19 (Decreto 2 gennaio 2021)”. Available at
https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2021&codLeg=78657&parte=1%20&serie=null,
accessed 12 March 2021. Data for the United Kingdom from Department of Health and Social Care (13 January 2021),
“Policy Paper: UK COVID-19 vaccines delivery plan”. Available at https://www.gov.uk/government/publications/uk-covid-
19-vaccines-delivery-plan/uk-covid-19-vaccines-delivery-plan#prioritisation-1, accessed 12 March 2021.
xviii Data for France from “Foire aux questions : le calendrier” (15 January 2021). Available at https://solidarites-
sante.gouv.fr/grands-dossiers/vaccin-covid-19/je-suis-un-particulier/article/foire-aux-questions-le-calendrier, accessed 12
March 2021.
xix Data for Chile from Ministerio de Salud, “Calendario de vacunación masiva contro COVID-19”. Available at
https://www.minsal.cl/calendario-de-vacunacion-masiva-contra-covid-19/, accessed 18 March 2021.
xx Data for Germany from Ständige Impfkommission am Robert Koch-Institut. “Beschluss der STIKO zur 4. Aktualisierung
der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung. STIKO-Empfehlung zur COVID-19
Impfung.“ (Aktualisierung vom 1. April 2021). Available at
https://www.rki.de/DE/Content/Infekt/Impfen/ImpfungenAZ/COVID-19/Stufenplan.html, accessed 7 April 2021. Data
for the United Arab Emirates from United Arab Emirates Ministry of Health and Prevention. “COVID-19 Vaccine”.
Available at https://www.mohap.gov.ae/en/AwarenessCenter/Pages/COVID-19-VaccinationInformation.aspx, accessed 7
April 2021. United Arab Emirates Government. “Vaccines against COVID-19 in the UAE”. Available at
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19-in-the-uae, accessed 7 April 2021.
xxi Data for France from “Foire aux questions : le calendrier” (15 January 2021). Available at https://solidarites-
sante.gouv.fr/grands-dossiers/vaccin-covid-19/je-suis-un-particulier/article/foire-aux-questions-le-calendrier, accessed 12
March 2021. Data for Germany from Ständige Impfkommission am Robert Koch-Institut. “Beschluss der STIKO zur 4.
Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung. STIKO-Empfehlung
zur COVID-19 Impfung.“ (Aktualisierung vom 1. April 2021). Available at
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xxii Bundesministerium für Gesundheit. “Fragen und Antworten zum Impfen in Arztpraxen“. Available at
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April 2021.
xxiii Times of Israel/Simona Weinglass (19 February 2o21). “Care for a shot with your shot? Tel Aviv sets up vaccine station at
local bar”. Available at https://www.timesofisrael.com/care-for-a-shot-with-your-shot-tel-aviv-sets-up-vaccine-station-in-local-
bar/, accessed 7 April 2021.
xxiv Department of Health and Social Care (13 January 2021), “Policy Paper: UK COVID-19 vaccines delivery plan”. Available
at https://www.gov.uk/government/publications/uk-covid-19-vaccines-delivery-plan/uk-covid-19-vaccines-delivery-
plan#prioritisation-1, accessed 12 March 2021. Public Health England (23 February 2021). “COVID-19: analysing first
vaccine effectiveness in the UK”. Available at https://publichealthmatters.blog.gov.uk/2021/02/23/covid-19-analysing-first-
vaccine-effectiveness-in-the-uk/, accessed 7 April 2021.
xxv Reuters (7 February 2021), “UAE temporarily restricts COVID-19 vaccinations to elderly, chronic diseases”. Available at
https://www.reuters.com/article/health-coronavirus-emirates-int-idUSKBN2A70DP, accessed 12 March 2021.
xxvi Our World in Data, “COVID-19 Vaccination Policy, Jan 16, 2021”. Available at https://ourworldindata.org/grapher/covid-
vaccination-policy?stackMode=absolute&time=2021-01-16&country=FRA~DEU~ISR~ITA~ARE~GBR®ion=Asia,
accessed 12 March 2021. Government of Dubai (December 2020), “COVID-19 Vaccine Awareness Guide”. Available at
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xxvii The National (17 January 2021). “UAE’s vaccine strategy protects those who protect us”. Available at
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xxviii Israeli Ministry of Health. “What is a Green Pass?”. Available at https://corona.health.gov.il/en/directives/green-pass-
info/, accessed 7 April 2021. Reuters (15 February 2021). “Israel to ease more COVID curbs, launch leisure 'Green Pass' on
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to-enjoy-bars-and-hotels-with-green-pass, accessed 7 April 2021.
xxix BBC. “What’s the roadmap for lifting lockdown?”. Available at https://www.bbc.com/news/explainers-52530518, accessed
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xxx European Commission. “COVID-19: Digital green certificates”. Available at https://ec.europa.eu/info/live-work-travel-
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xxxi All data on containment measures from Our World in Data, Policy Responses to the Coronavirus Pandemic, accessed on
7 April 2021. Data on school closures and workplace closures over time from https://ourworldindata.org/covid-school-
workplace-closures. Country policies on school closures are coded by Our World in Data as no measures, recommended,
required (only at some levels), required (all levels). Country policies on workplace closures are coded by Our World in Data
from no measures, recommended, required for some, required for all but key workers. Data on cancellation of public events
and restrictions on gatherings over time from https://ourworldindata.org/covid-cancel-public-events. Policies on public
events are coded by Our World in Data as no measures, recommended cancellations, required cancellations. Policies on
public gatherings are coded by Our World in Data as no restrictions, restrictions on very large gatherings (the limit is above
1000 people), restrictions on gatherings between 100 to 1000 people, restrictions on gatherings between 10 to 100 people,
restrictions on gatherings of less than 10 people. Data on stay-at-home restrictions over time from
https://ourworldindata.org/covid-stay-home-restrictions. Policies are coded by Our World in Data as no measures,
recommended not to leave the house, required to not leave the house with exceptions for essential purposes, required to not
leave the house with minimal exceptions. Data on public transport closures and restrictions on internal movement over
time from https://ourworldindata.org/covid-international-domestic-travel. Policies on public transport closures are coded by
Our World in Data as no measures, recommended closing, required closing. Policies restricting internal movement are
coded by Our World in Data as no measures, recommended movement restrictions and restricted movement.
xxxii Shilo, S., Rossman, H. & Segal, E. Signals of hope: gauging the impact of a rapid national vaccination campaign. Nat Rev
Immunol (2021). DOI: 10.1038/s41577-021-00531-0.
xxxiii Levine-Tiefenbrun, M., Yelin, I., Katz, R. et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with
the BNT162b2 vaccine. Nature Medicine (2021). DOI: 10.1038/s41591-021-01316-7
xxxiv Public Health England (25 March 2021), “Weekly national Influenza and COVID-19 surveillance report
Week 12 report (up to week 11 data)”. Available at https://www.gov.uk/government/statistics/national-flu-and-covid-19-
surveillance-reports, accessed 31 March 2021.
xxxv
WHO. (29 March 2021). “Global Consultation on a Decision Framework for Assessing the Impact of SARS-CoV-2
Variants of Concern on Public Health Interventions”. Presentation slides on file with authors.
xxxvi WHO. (30 March 2021). “COVID-19 Weekly Epidemiological Update”. Available at
https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---31-march-2021, accessed 8 April
2021. Data current as of 28 March 2021.
xxxvii WHO. (29 March 2021). “Global Consultation on a Decision Framework for Assessing the Impact of SARS-CoV-2
Variants of Concern on Public Health Interventions”. Presentation slides on file with authors.You can also read
