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Nous vous proposons les résumés d’une série d’articles récents de la littérature scientifique internationale relative à la pandémie de COVID-19. Cette sélection porte plus particulièrement sur les aspects socio-culturels et éthiques qui sous-tendent l’acceptation des stratégies de vaccination contre la COVID-19 au sein de la population générale. 

La majorité des données sont issues de l’expérience accumulée au Royaume-Uni et en Israël qui ont été les deux grands pionniers en matière de campagne de masse de vaccination. Dans ces deux pays on a pu aussi étudier rétrospectivement les limites des stratégies déployées pour le dépistage et pour la contention de l’épidémie, étudier la transmissibilité de nouveaux variants (notamment le variant SARS-CoV-2 appartenant à la lignée B.1.1.7) leur impact sur l’effet protecteur de la vaccination ainsique les conséquences sanitaires et économiques. A partir des données obtenues de manière rétrospective des modélisations de transmission de l’infection à COVID-19 ont pu être établies selon différents scénarios. Ces modèles offrent des perspectives de permettre dans le futur un meilleur contrôle de la transmission ainsi qu’un ciblage plus précis des sous-groupes à risque dans la population et réticents à la vaccination sur la base de facteurs de risques démographiques et socio-culturels.

Williams L.,* Flowers P., McLeod J. , Young D., Rollins L., and The CATALYST Project Team.
Social Patterning and Stability of Intention to Accept a COVID-19 Vaccine in Scotland: Will Those Most at Risk Accept a Vaccine?
Vaccines (Basel). 2021 Jan; 9(1): 17. Published online 2021 Jan 4. doi: 10.3390/vaccines9010017

Vaccination is central to controlling COVID-19. Its success relies on having safe and effective vaccines and also on high levels of uptake by the public over time. Addressing questions of population-level acceptability, stability of acceptance, and sub-population variation in acceptability are imperative. Using a prospective design, a repeated measures two-wave online survey was conducted to assess key sociodemographic variables and intention to accept a COVID-19 vaccine. The first survey (Time 1) was completed by 3436 people during the period of national lockdown in Scotland and the second survey (n = 2016) was completed two months later (Time 2) when restrictions had been eased. In the first survey, 74% reported being willing to receive a COVID-19 vaccine. Logistic regression analyses showed that there were clear sociodemographic differences in intention to accept a vaccine for COVID-19 with intention being higher in participants of white ethnicity as compared with Black, Asian, and minority ethnic (BAME) groups, and in those with higher income levels and higher education levels. Intention was also higher in those who had “shielding” status due to underlying medical conditions. Our results suggest that future interventions, such as mass media and social marketing, need to be targeted at a range of sub-populations and diverse communities.

Intention to accept a COVID-19 vaccine is currently high in Scotland and our findings suggest that intention to receive the vaccine did not fall in the context of lower infection rates and fewer restrictions. However, the data also point to a sizeable minority of the public who are hesitant about receiving a future COVID-19 vaccine. Of note, intention was higher in participants of white ethnicity as compared with those from BAME groups, and in those with higher levels of income and education. Our findings and those from other studies suggest that future interventions need to be targeted at a range of sub-populations and diverse communities. To do so, we need to better understand the barriers to vaccination in these groups so that we can collectively be better prepared to deliver appropriate evidence-based culturally and community-appropriate messaging aimed at maximising COVID-19 vaccine uptake.

Davies N. G., Abbott S., Barnard R. C., Jarvis C. I., Kucharski A. J., Munday J. D., Pearson C.A.B, et al. 
Surveillance for Azole-Resistant Aspergillus fumigatus in a Centralized Diagnostic Mycology Service, London, United Kingdom, 1998-2017.
Science. 2021 Apr 9; 372(6538): eabg3055. Published online 2021 Mar 3. doi: 10.1126/science.abg3055  

A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, VOC 202012/01 (lineage B.1.1.7), emerged in southeast England in September 2020 and is rapidly spreading toward fixation. Using a variety of statistical and dynamic modeling approaches, we estimate that this variant has a 43 to 90% (range of 95% credible intervals, 38 to 130%) higher reproduction number than preexisting variants. A fitted two-strain dynamic transmission model shows that VOC 202012/01 will lead to large resurgences of COVID-19 cases. Without stringent control measures, including limited closure of educational institutions and a greatly accelerated vaccine rollout, COVID-19 hospitalizations and deaths across England in the first 6 months of 2021 were projected to exceed those in 2020. VOC 202012/01 has spread globally and exhibits a similar transmission increase (59 to 74%) in Denmark, Switzerland, and the United States.

In December 2020, evidence began to emerge that a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, Variant of Concern 202012/01 (lineage B.1.1.7, henceforth VOC 202012/01), was rapidly outcompeting preexisting variants in southeast England (1). The variant increased in incidence during the second national lockdown in November 2020, which was mandated in response to a previous and unrelated surge in COVID-19 cases, and continued to spread after the lockdown despite ongoing restrictions in many of the most affected areas. Concern over this variant led the UK government to enact stronger restrictions in these regions on 20 December 2020 and eventually to impose a third national lockdown on 5 January 2021. As of 29 March 2021, VOC 202012/01 comprises roughly 95% of new SARS-CoV-2 infections in England and has now been identified in at least 114 countries (2). Our current understanding of effective pharmaceutical and nonpharmaceutical control of SARS-CoV-2 does not reflect the epidemiological and clinical characteristics of VOC 202012/01. Estimates of the growth rate, disease severity, and impact of this novel variant are crucial for informing rapid policy responses to this potential threat.

Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review
JMIRx Med. 2021 Apr-Mbwogge M. JMIRx Med. 2021 Apr-Jun; 2(2): e27254. Published online 2021 Apr 12. doi: 10.2196/27254. 

Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all.
The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions.
Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included “mass testing,” “test and trace,” “contact tracing,” “COVID-19,” “SARS-CoV-2,” “effectiveness,” “asymptomatic,” “symptomatic,” “community screening,” “UK,” and “2020.” Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings.
The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively.
There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services.

Sandmann F.G., Davies N.G., Vassall A.,  Edmunds W.J., Mark Jit and Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. 
The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: a transmission model-based future scenario analysis and economic evaluation
Lancet Infect Dis. 2021 Jul; 21(7): 962–974. doi: 10.1016/S1473-3099(21)00079-7. 

In response to the COVID-19 pandemic, the UK first adopted physical distancing measures in March, 2020. Vaccines against SARS-CoV-2 became available in December, 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing in the UK to gain insights about possible future scenarios in a post-vaccination era.
We used an age-structured dynamic transmission and economic model to explore different scenarios of UK mass immunisation programmes over 10 years. We compared vaccinating 75% of individuals aged 15 years or older (and annually revaccinating 50% of individuals aged 15–64 years and 75% of individuals aged 65 years or older) to no vaccination. We assumed either 50% vaccine efficacy against disease and 45-week protection (worst-case scenario) or 95% vaccine efficacy against infection and 3-year protection (best-case scenario). Natural immunity was assumed to wane within 45 weeks. We also explored the additional impact of physical distancing on vaccination by assuming either an initial lockdown followed by voluntary physical distancing, or an initial lockdown followed by increased physical distancing mandated above a certain threshold of incident daily infections. We considered benefits in terms of quality-adjusted life-years (QALYs) and costs, both to the health-care payer and the national economy. We discounted future costs and QALYs at 3·5% annually and assumed a monetary value per QALY of £20 000 and a conservative long-run cost per vaccine dose of £15. We explored and varied these parameters in sensitivity analyses. We expressed the health and economic benefits of each scenario with the net monetary value: QALYs × (monetary value per QALY) – costs.
Our model findings highlight the substantial health and economic value of introducing SARS-CoV-2 vaccination. Smaller outbreaks could continue even with vaccines, but population-wide implementation of increased physical distancing might no longer be justifiable. Our study provides early insights about possible future post-vaccination scenarios from an economic and epidemiological perspective.

de Figueiredo A., Larson H.J, Reicher S.D. E 
The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: a transmission model-based future scenario analysis and economic evaluation
ClinicalMedicine. 2021 Sep 9 : 101109. doi: 10.1016/j.eclinm.2021.101109 [Epub ahead of print]

The UK Government is considering the introduction of vaccine passports for domestic use and to facilitate international travel for UK residents. Although vaccine incentivisation has been cited as a motivating factor for vaccine passports, it is unclear whether vaccine passports are likely to increase inclination to accept a COVID-19 vaccine.
We conducted a large-scale national survey in the UK of 17,611 adults between 9 and 27 April 2021. Bayesian multilevel regression and poststratification is used to provide unbiased national-level estimates of the impact of the introduction of vaccine passports on inclination to accept COVID-19 vaccines and identify the differential impact of passports on uptake inclination across socio-demographic groups.
We find that a large minority of respondents report that vaccination passports for domestic use (46·5%) or international travel (42·0%) would make them no more or less inclined to accept a COVID-19 vaccine and a sizeable minority of respondents also state that they would ‘definitely’ accept a COVID-19 vaccine and that vaccine passports would make them more inclined to vaccinate (48·8% for domestic use and 42·9% for international travel). However, we find that the introduction of vaccine passports will likely lower inclination to accept a COVID-19 vaccine once baseline vaccination intent has been adjusted for. This decrease is larger if passports were required for domestic use rather than for facilitating international travel. Being male (OR 0·87, 0·76 to 0·99) and having degree qualifications (OR 0·84, 0·72 to 0·94) is associated with a decreased inclination to vaccinate if passports were required for domestic use (while accounting for baseline vaccination intent), while Christians (OR 1·23, 1·08 to 1·41) have an increased inclination over atheists or agnostics. Change in inclination is strongly connected to stated vaccination intent and will therefore unlikely shift attitudes among Black or Black British respondents, younger age groups, and non-English speakers.
Our findings should be interpreted in light of sub-national trends in uptake rates across the UK, as our results suggest that passports may be viewed less positively among socio-demographic groups that cluster in large urban areas. We call for further evidence on the impact of vaccine certification and the potential fallout for routine immunization programmes in both the UK and in wider global settings, especially those with low overall trust in vaccinations.

Goldman R.D. Yan T.D, Seiler M., Cotanda C.P., Brown J.C, Klein E.J., Hoeffe J., et al. and For the International COVID-19 Parental Attitude Study (COVIPAS) Group.  
Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey
Vaccine. 2020 Nov 10; 38(48): 7668–7673. Published online 2020 Oct 10. doi: 10.1016/j.vaccine.2020.09.084

More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic.
An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020.
65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine’s novelty (52%).
The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine’s safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.

Green M.S., Abdullah R., Vered S.,  Nitzan D.
A study of ethnic, gender and educational differences in attitudes toward COVID-19 vaccines in Israel – implications for vaccination implementation policies. 
Isr J Health Policy Res. 2021; 10: 26. Published online 2021 Mar 19. doi: 10.1186/s13584-021-00458-w

Vaccines for COVID-19 are currently available for the public in Israel. The compliance with vaccination has differed between sectors in Israel and the uptake has been substantially lower in the Arab compared with the Jewish population.
To assess ethnic and socio-demographic factors in Israel associated with attitudes towards COVID-19 vaccines prior to their introduction.
A national cross-sectional survey was carried out In Israel during October 2020 using an internet panel of around 100,000 people, supplemented by snowball sampling. A sample of 957 adults aged 30 and over were recruited of whom 606 were Jews (49% males) and 351 were Arabs (38% males).
The sample of Arabs was younger than for the Jewish respondents. Among the men, 27.3% of the Jewish and 23.1% of the Arab respondents wanted to be vaccinated immediately, compared with only 13.6% of Jewish women and 12.0% of Arab women. An affirmative answer to the question as to whether they would refuse the vaccine at any stage was given by 7.7% of Jewish men and 29.9% of Arab men, and 17.2% of Jewish women and 41.0% of Arab women. Higher education was associated with less vaccine hesitancy. In multiple logistic regression analysis, the ethnic and gender differences persisted after controlling for age and education. Other factors associated with vaccine hesitancy were the belief that the government restrictions were too lenient and the frequency of socializing prior to the pandemic.
The study revealed a relatively high percentage reported would be reluctant to get vaccinated, prior to the introduction of the vaccine. This was more marked so for Arabs then Jews, and more so for women within the ethnic groups. While this was not a true random sample, the findings are consistent with the large ethnic differences in compliance with the vaccine, currently encountered and reinforce the policy implications for developing effective communication to increase vaccine adherence. Government policies directed at controlling the pandemic should include sector-specific information campaigns, which are tailored to ensure community engagement, using targeted messages to the suspected vaccine hesitant groups. Government ministries, health service providers and local authorities should join hands with civil society organizations to promote vaccine promotion campaigns

Haas E.J.,  McLaughlin J.M, Khan F.,  Angulo F.J, Anis E., Lipsitch M.,  Singer S.R, et al. 
Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study. 
Lancet Infect Dis. 2021 Sep 22 doi: 10.1016/S1473-3099(21)00566-1 [Epub ahead of print]

On Dec 20, 2020, Israel initiated a nationwide COVID-19 vaccination campaign for people aged 16 years and older and exclusively used the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine (tozinameran). We provide estimates of the number of SARS-CoV-2 infections and COVID-19-related admissions to hospital (ie, hospitalisations) and deaths averted by the nationwide vaccination campaign.
In this retrospective surveillance study, we used national surveillance data routinely collected by the Israeli Ministry of Health from the first 112 days (Dec 20, 2020, up to our data cutoff of April 10, 2021) of Israel’s vaccination campaign to estimate the averted burden of four outcomes: SARS-CoV-2 infections and COVID-19-related hospitalisations, severe or critical hospitalisations, and deaths. As part of the campaign, all individuals aged 16 years and older were eligible for inoculation with the BNT162b2 vaccine in a two-dose schedule 21 days apart. We estimated the direct effects of the immunisation programme for all susceptible individuals (ie, with no previous evidence of laboratory-confirmed SARS-CoV-2 infection) who were at least partly vaccinated (at least one dose and at least 14 days of follow-up after the first dose). We estimated the number of SARS-CoV-2 infection-related outcomes averted on the basis of cumulative daily, age-specific rate differences, comparing rates among unvaccinated individuals with those of at least partly vaccinated individuals for each of the four outcomes and the (age-specific) size of the susceptible population and proportion that was at least partly vaccinated.
We estimated that Israel’s vaccination campaign averted 158 665 (95% CI 144 640–172 690) SARS-CoV-2 infections, 24 597 (18 942–30 252) hospitalisations, 17 432 (12 770–22 094) severe or critical hospitalisations, and 5532 (3085–7982) deaths. 16 213 (65·9%) of 24 597 hospitalisations and 5035 (91·0%) of 5532 of deaths averted were estimated to be among those aged 65 years and older. We estimated 116 000 (73·1%) SARS-CoV-2 infections, 19 467 (79·1%) COVID-19-related hospitalisations, and 4351 (79%) deaths averted were accounted for by the fully vaccinated population.
Without the national vaccination campaign, Israel probably would have had triple the number of hospitalisations and deaths compared with what actually occurred during its largest wave of the pandemic to date, and the health-care system might have become overwhelmed. Indirect effects and long-term benefits of the programme, which could be substantial, were not included in these estimates and warrant future research.

Rosen B. Waitzberg R., Israeli A., Hartal M.,1 Davidovitch N.
Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program.
Isr J Health Policy Res. 2021; 10: 43.  Published online 2021 Aug 2. doi: 10.1186/s13584-021-00481-x

As of March 31, 2021, Israel had administered 116 doses of vaccine for COVID-19 per 100 population (of any age) – far more than any other OECD country. It was also ahead of other OECD countries in terms of the share of the population that had received at least one vaccination (61%) and the share that had been fully vaccinated (55%). Among Israelis aged 16 and over, the comparable figures were 81 and 74%, respectively. In light of this, the objectives of this article are: 
1. To describe and analyze the vaccination uptake through the end of March 2021
2. To identify behavioral and other barriers that likely affected desire or ability to be vaccinated
3. To describe the efforts undertaken to overcome those barriers

Israel’s vaccination campaign was launched on December 20, and within 2.5 weeks, 20% of Israelis had received their first dose. Afterwards, the pace slowed. It took an additional 4 weeks to increase from 20 to 40% and yet another 6 weeks to increase from 40 to 60%. Initially, uptake was low among young adults, and two religious/cultural minority groups – ultra-Orthodox Jews and Israeli Arabs, but their uptake increased markedly over time.

In the first quarter of 2021, Israel had to enhance access to the vaccine, address a moderate amount of vaccine hesitancy in its general population, and also address more intense pockets of vaccine hesitancy among young adults and religious/cultural minority groups. A continued high rate of infection during the months of February and March, despite broad vaccination coverage at the time, created confusion about vaccine effectiveness, which in turn contributed to vaccine hesitancy. Among Israeli Arabs, some residents of smaller villages encountered difficulties in reaching vaccination sites, and that also slowed the rate of vaccination.

The challenges were addressed via a mix of messaging, incentives, extensions to the initial vaccine delivery system, and other measures. Many of the measures addressed the general population, while others were targeted at subgroups with below-average vaccination rates. Once the early adopters had been vaccinated, it took hard, creative work to increase population coverage from 40 to 60% and beyond.

Significantly, some of the capacities and strategies that helped Israel address vaccine hesitancy and geographic access barriers are different from those that enabled it to procure, distribute and administer the vaccines. Some of these strategies are likely to be relevant to other countries as they progress from the challenges of securing an adequate vaccine supply and streamlining distribution to the challenge of encouraging vaccine uptake.

Giubilini A., Savulescu J., Wilkinson D.  
Queue questions: Ethics of COVID-19 vaccine prioritization
Bioethics. 2021 Feb 8 : 10.1111/bioe.12858. doi: 10.1111/bioe.12858 [Epub ahead of print]

The rapid development of vaccines against COVID-19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID-19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the view that those who are most vulnerable to COVID-19 should get the vaccine first. While this is intuitively attractive, we argue that there are other possible values and criteria that need to be considered. These include both intrinsic and instrumental values. The former are numbers of lives saved, years of life saved, quality of the lives saved, quality-adjusted life-years (QALYs), and possibly others including age. Instrumental values include protecting healthcare systems and other broader societal interests, which might require prioritizing key worker status and having dependants. The challenge from an ethical point of view is to strike the right balance among these values. It also depends on effectiveness of different vaccines on different population groups and on modelling around cost-effectiveness of different strategies. It is a mistake to simply assume that prioritizing the most vulnerable is the best strategy. Although that could end up being the best approach, whether it is or not requires careful ethical and empirical analysis.

Alanezi F., Aljahdali A.,  Alyousef S.M.,Alrashed H., Mushcab H., AlThani B., Alghamedy F., et al.
A Comparative Study on the Strategies Adopted by the United Kingdom, India, China, Italy, and Saudi Arabia to Contain the Spread of the COVID-19 Pandemic. 
J Healthc Leadersh. 2020; 12: 117–131. Published online 2020 Oct 30. doi: 10.2147/JHL.S266491

The objective of this study was to compare the strategies adopted by the United Kingdom, Italy, China, India, and Saudi Arabia to contain the spread of the COVID-19 pandemic.
Materials and Methods
A review of the literature was carried out to collect data on the strategies used by China, Italy, India, the United Kingdom, and Saudi Arabia to contain the spread of the COVID-19 virus. The global analysis of 65 published literature references allowed observing the effectiveness and efficiency of the strategies used by these countries to control the spread of the COVID-19 virus.
Both mitigation and suppression strategies were adopted by the United Kingdom, India, Italy, China, and Saudi Arabia to control the spread of the COVID-19 pandemic. It was observed that China has achieved a greater success in flattening the curve compared to the other countries. In China, few new daily cases have occurred since March, and it has been the only country that has managed to keep the COVID-19 pandemic under control. On the other hand, reductions in the number of daily cases (since May 2020) were detected in the United Kingdom, Italy, and Saudi Arabia (since July 2020). Also, during the last 3 months (June, July and August) India has shown the highest growth in the total number of confirmed cases and in the number of new daily cases, compared to the mentioned countries.
The review of the strategies adopted by China, India, the United Kingdom, Italy and Saudi Arabia to combat the COVID-19 pandemic can guide countries in the design and development of mitigation and suppression approaches to control the spread of the COVID-19 virus. Containment strategies such as lockdowns cannot continue in the long term. Therefore, countries must adopt mitigation and prevention strategies to protect people from infection and learn to live with the virus.

Iftekhar E.N., Priesemann V., Balling R., Bauer S., Beutels P.,  Valdez A.C., Cuschieri S.,  et al.   
A look into the future of the COVID-19 pandemic in Europe: an expert consultation
Lancet Reg Health Eur. 2021 Sep; 8: 100185. Published online 2021 Jul 30. doi: 10.1016/j.lanepe.2021.100185

How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.

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