Over the weekend tensions flared over new pandemic restrictions. Europe's vaccination drive is reaching a critical point. So what are the options facing decision-makers to fight back against a new wave of coronavirus infections?
Across Europe, the COVID-19 pandemic shows no signs of abating with several countries announcing further restrictions in recent days to contain a surge in new cases.
Frustration over how politicians are dealing with a spike in cases spilled onto the streets over the weekend in Belgium, the Netherlands and Austria.
Questions hang over the efficiency of vaccinations, a booster shot, the validity of COVID health passes as well as continuing preventive measures as the pandemic lingers.
The European Commission is expected to announce its recommendations "in the coming days".
So how are different countries currently handling the pandemic?
"We need to vaccinate," said EU spokesperson for health, Stefan De Keersmaecker said on Monday, "it's that simple".
But it's easier said than done, with vaccination campaigns being up to national governments. Each country must take into account the local conditions, spread of the virus and the capacity of their national health systems.
Germans will be "vaccinated, cured or dead," by the end of winter, Germany’s health minister Jens Spahn said on Monday.
He called the spike in infections due to the Delta variant dramatic and called on Germans to get vaccinated or get COVID.
The country has one of the lowest vaccination rates in Western Europe at 68 per cent. A debate over compulsory vaccination has begun in Germany, but Spahn remains sceptical about such an approach.
As well as a new lockdown, Austria announced last week that vaccination will be made compulsory from February 1, making it the first EU country to issue such a mandate.
For Dr David Nabarro, the WHO's special envoy on COVID-19, relying only on a full vaccination strategy is a gamble for rich countries.
"It has never been done before and it would really be an inappropriate public health strategy to do so," he told the UK parliament’s All-Party Group on vaccines.
The main threat in creating new variants is the reliance on existing vaccines, Nabarro warned.
What needs to be done is a "combination approach" of masks and other health interventions, "which is to do everything possible to empower people to avoid being infected by the pathogen," he said.
Whether Europe should vaccinate children aged 5-11 years-old is an open inquiry. The European Medicine’s Agency is currently investigating the possibility of lowering the vaccination age, and are expected to deliver their findings in the coming weeks.
In Canada, children aged 5-11 will be allowed a dose of the Pfizer vaccine. The paediatric dose would be one third of the adult dose and be doses would be administered in a 21 day window.
A booster dose?
But while vaccination programmes continue to progress, it is now becoming apparent that a booster dose, meaning a third dose for many people, will now be needed to keep COVID-19 cases numbers down.
In the UK, the third dose has already been authorised for people over-50 and vulnerable individuals since the beginning of September, with the goal of administering "10 million booster doses before Christmas," Johnson said.
Many European countries have launched their booster campaigns in recent weeks, but only 3.7 per cent of the continent's population has received a third injection, according to AFP.
Among the top performers when it comes to inoculations, Iceland is leading the way. Nearly 1 in 5 people have already received a booster dose in a population that is already 90 per cent vaccinated.
Faced with the resurgence of cases, the Icelandic government announced last Friday new health measures for its citizens, including the wearing of masks and the third dose for all those over 16.
Further to the east, Hungary and Serbia are in second place with 14 and 16 out of every 100 inhabitants respectively being triple vaccinated, according to data compiled by Our World in Data.
The EU’s drug watchdog (EMA) has begun evaluating data on a booster dose of the Janssen vaccine (also known as Johnson and Johnson). The study will investigate whether a second dose of the single shot vaccine should be given two months after the first dose in people aged 18 and over.
How long will COVID health passes be valid?
Some are now considering making a third dose a condition for a health pass to continue.
In France, people over the age of 65 will need a booster dose (a third dose for many) in order to keep their health pass.
The French Academy of Medicine had earlier rejected the idea, stating that the measure "transgresses the role of the health pass, which was to limit the risk of transmission of the virus and to encourage the population to be vaccinated."
The EU Digital COVID Certificate will be operational for 12 months after the date of application. The Commission can amend certain provisions, which can pave the way for the executive to extend the certificate's validity and add a third dose as necessary requirement.
Greek PM Kyriakos Mitsotakis is calling for a third dose six months after the last dose to be added to the health pass to keep it valid.
While in Rome, the Italian government is planning on making the health pass valid for nine months after a complete vaccination.
New anti-COVID drugs
Antiviral pills are part of a growing arsenal in the fight against COVID-19, and two drugs have shown to dramatically reduce the risk of hospitalisation and death.
On Friday, the EU’s medicines watchdog (EMA) cleared the Merck anti-COVID pill for emergency use, and begun a review of Pfizer’s antiviral drug for formal authorisation.
The Merck pill (also known as molnupiravir or MK 4482) "can be used to treat adults with COVID-19 who do not require supplemental oxygen and who are at increased risk of developing severe COVID-19," EMA said in a statement.
The United Kingdom was the first country to approve the use of the anti-COVID pill molnupiravir.
The drug has been licensed for use treating adults with "mild to moderate" COVID-19 who are at risk of developing severe disease as a result of pre-existing health conditions like heart disease and obesity.
An antiviral drug, molnupiravir, is the first pill shown to be an effective treatment for COVID, and is intended to be taken twice a day for five days after symptoms of the virus appear.
In clinical trials the pill, which was originally conceived as a treatment for flu, almost halved the risk of death or hospitalisation from COVID.
In the US, the drugs are also waiting for the regulatory green light.
Biden’s administration has already bought up millions of the treatments. It has sparked debate in Europe of the EU making a similar joint purchase, as was negotiated with the vaccine purchases.