Covid vaccine rules in France, Italy and now Austria provide a window into what to expect

“It is a drastic measure. I would have preferred to go another way. But if one year in having the vaccine, of having national campaigns, of having media explaining again and again what this is about, that we have such a high degree of insecurity, of people believing in fake news … we have a necessity to take this drastic step,” Schallenberg added.

Countries elsewhere are starting to consider similarly drastic measures to persuade more people to get shots, despite criticisms that low vaccination rates made them unrealistic and would deprive millions from earning a livelihood.

On Sunday, days after his country’s scientists first reported the existence of the Omicron variant, South African President Cyril Ramaphosa announced that authorities were looking into whether to mandate Covid-19 vaccinations — and booster shots — for workers and for entry to some public spaces. Kenya was one of the first African nations to introduce restrictions on the unvaccinated last week.

The question over whether or not to pull the trigger on mandates, and how to weigh up the risk to civil liberties against a serious threat to overstretched healthcare systems, has caused a lot of hand-wringing across the world — especially in Europe, a proud bastion for liberal democracy.

But just as lockdowns have become a part of pandemic life, the rapidly emerging view in Europe is that vaccine mandates are not just plausible — they could pay off. Rules in France, Italy and now Austria provide a window into what to expect.

After the initial lockdown of the unvaccinated on November 14, half a million more people received their first dose, according to the chancellor. That upwards trajectory has continued, though the vast majority of vaccinations are booster shots, Peter Klimek, an associate professor at the Medical University of Vienna and adviser to Austria’s health ministry, said.

“From a modelling perspective, it’s clear that if you increase the vaccine uptake, it won’t be enough by itself to stop the virus from circulating, but it’s a huge step to stop the collapse of the healthcare system,” Klimek said. “Will a mandate help? Yes, if we find ways to make it work.”

While some minds won’t change, others — like Jaruslav — will, albeit begrudgingly. For the price of some protests, some European politicians are beginning to come to the conclusion that pushback is worth it in order to compel a slice of the population that would have otherwise been hard to win over.

Hale and his colleagues are in the process of adding data on Covid vaccine mandates to their tracker with the aim of answering the big question: Do they work? Of more than 180 countries that the Blavatnik School of Government tracks, Hale said a few stood out for having effective mandates: France, Israel, China and Brazil.

“There’s an optimist story to be told that, for the vast majority of people, this is not actually that controversial. There’s a lot of focus on the resisters, and rightly so. But it’s quite a lot of movement in the right direction,” Hale said.

Thanks in part to its swelling vaccination rate — along with a massive increase in testing linked to the Covid pass, and the reintroduction of mask mandates in regions badly hit by the Delta variant — mainland France managed to largely sidestep the fourth wave that swept through Europe over the summer. About 70% in France are now fully vaccinated.

Vittoria Colliza, a Paris-based epidemiologist at Inserm, the French public-health research center, told CNN that the introduction of the pass “was the key to getting out of a stalling situation, where we had reached a saturation point,” and proved it was possible to incentivize people previously reluctant to get the vaccine. But now, as European countries with high vaccination rates struggle to contain yet another surge in cases, Colliza said it was clear that additional incentives would be needed to escape the worst as immunity wanes.

Since the measure was announce in mid-September, Italy’s vaccination coverage has crept up about 5 percentage points. Though not a huge increase, experts argue that at this stage in pandemic, every percentage point helps.

Dr. Roberto Burioni, a leading Italian virologist at San Raffaele University in Milan, said the strict measures of the expanded health pass has not only allowed the country to fully vaccinate around 73% of the population, but also avoid painful restrictions, like the lockdown now enforced in Austria. Burioni also said the pass, which is necessary to access nightlife, had motivated young people in Italy to get jabs.

“What in my opinion was the most remarkable effect is that we experienced a very, very high vaccination rate on the age group from 20 to 30,” Burioni said, which he put at about 84%. “These youngsters are very important in the diffusion of the virus. Because, you know, they have a very intense social life. They’re one of the reasons Italy is in a better position than other countries.”

But he said that even with the tough mandates, and his efforts to fight anti-vaccine disinformation as part of Italy’s Covid strategy, there remains a small, loud minority of the population who are dead-set against vaccinations, and seemingly nothing will change their mind. That group, while small, still poses a big problem for Italy in reaching its ultimate goal of vaccinating 90% of the eligible population, Burioni added.

“I can’t believe somebody is refusing this after 150,000 deaths in Italy — everybody here has a relative, a friend who died of Covid. I encounter people in the intensive care unit with Covid who still say that they wouldn’t get the shot. They don’t regret it, they say ‘Oh no, please don’t vaccinate me.'”

While the politicization of Covid vaccines, particularly by populist groups in Europe, has made many governments reluctant to enforce mandates on their populations, the risk of harsh lockdowns canceling another chance at a Christmas recovery season has led many to reassess.

In Greece, where infections are rising, Prime Minister Kyriakos Mitsotakis said Tuesday that Covid-19 vaccinations would be made mandatory for all citizens over the age of 60. The Greek government had recently banned unvaccinated adult citizens from entering cinemas, theaters, museums or gyms — with or without a test. Access to public services, banks and shops without a negative test was already restricted for the unvaccinated. The Czech Republic, which is seeing its highest case counts of the pandemic, is also tightening requirements along similar lines.

The ratcheting of restrictions on the unvaccinated is part of a wider movement toward vaccine mandates globally, Thomas Hale says. “Austria’s a very dramatic example. But it’s very much part of a bigger trend.”

But as countries aim to use lockdowns more judiciously, or avoid them entirely, Hale believes we’ll continue to see more leaders moving toward mandates. British Prime Minister Boris Johnson said in mid-November that the definition of “fully vaccinated” would have to shift at some point to account for booster shots. And, on Monday, the United Kingdom announced it would offer booster vaccines to all adults — and cut the gap between second and third doses from six months to three — in an effort to slow the spread of Omicron.

“I think they [mandates] do work. I think they especially motivate people who are not vaccine adverse, but who are kind of vaccine lazy, a little bit hesitant. And in some countries, that’s a big chunk of the population,” Hale said, pointing again to France.

“But if you’re facing people who are really against vaccination, then it’s not as clear to me that those measures will remove that barrier.”