For a while, during the worst of the pandemic last year, European governments largely seemed to reach a consensus. Barring a few exceptions (such as Sweden), countries in the region locked down their economies, keeping people at home in a bid to slow the pace of infection. In time, bolstered by plentiful vaccines, the continent has seen a resumption of near-normalcy: Public-health restrictions have loosened, and travel has restarted.
But as temperatures drop, and as rising cases place Europe back in the epicenter of the pandemic, the continent is once again being forced to grapple with tougher measures in a desperate bid to alleviate pressure on hospitals that are coming under strain. This time, however, European countries are no longer in broad agreement on the best path forward.
While several countries have followed France's lead by implementing vaccine passports as a way to encourage people to get vaccinated, others are poised to follow the alternative recently set out by Austria, which this week instructed millions to stay home except for essential activities, such as going to work, grocery shopping, and exercise. Unlike previous national lockdowns, however, this one applied to only a subset of the country: the unvaccinated. Yesterday, the Austrian government took it one step further, announcing that restrictions would extend to the rest of the population for a maximum of 20 days starting next week and that vaccination would become obligatory as early as February.
The goal of both models is ultimately the same--to get more people vaccinated--but the differences are key. In France, vaccination is strongly encouraged, though not necessarily required. Under its vaccine-passport system, those who are unvaccinated can still access public spaces if they can provide proof of having recently recovered from a COVID-19 infection, or a negative COVID test. In Austria, the opposite has now become true: Not only are unvaccinated people (excluding those who have recently recovered from COVID and children under the age of 12) poised to be barred from public spaces even after the national lockdown ends, facing fines of up to 1,450 euros ($1,640) if they fail to comply, but they will soon be subject to legal repercussions if they refuse to get a jab.
The question facing governments in Europe and elsewhere is which approach--carrot versus stick--will prove the most effective. By singling out the unvaccinated, Austria may succeed in increasing its vaccination rate, but it also runs the risk of driving vaccine skepticism even further.
In Austria, the unvaccinated still make up a sizable proportion of the population. Nearly a third of the country, or roughly 2 million people, has opted against getting a jab--resulting in one of the lowest vaccination rates in Western Europe. Meanwhile, the country continues to break records for daily reported cases just as intensive-care units in some parts of the country near capacity.
To hear Austrian Chancellor Alexander Schallenberg tell it, this week's drastic intervention wasn't designed to punish those who aren't vaccinated. Rather, it was meant to prevent those who have been vaccinated from being "held hostage" by the unvaccinated minority. To subject everyone to new restrictions (as the government has now been compelled to do, albeit for a time-limited period) would be to risk undermining the incentives that compelled so many people to get vaccinated in the first place. It would also fail to address the fact that the growing strain on the country's ICUs is largely being driven by unvaccinated patients. Austria's neighbors--Germany, the Czech Republic, and Slovakia--have since announced that they will follow suit with tighter restrictions on the unvaccinated.
"At some point, reality has to hit home: If the health-care system reaches its limits, then additional steps have to be taken eventually," Eva Schernhammer, the epidemiology-department chair at the Medical University of Vienna, told me. In the minds of some, she said, "it just doesn't feel right [for] the government to impose measures on those who have done everything they can just to protect those who didn't."
The challenge of addressing the lag in vaccination is what ultimately drove French President Emmanuel Macron to mandate the use of vaccine passports earlier this year. Despite what many naysayers said about the impact that such a strategy would have on more vaccine-hesitant populations (mea culpa, I was one of them), this approach has largely been viewed as a success. Even though France is one of the world's most vaccine-hesitant countries, it has now vaccinated roughly three-quarters of its population, according to the government's vaccine tracker--nearly double the number of people who indicated that they would be willing to get a jab at the end of last year. Although the country's infection rate continues to rise, it remains low relative to that of many of its neighbors.
But what worked for France hasn't necessarily worked for Austria. Despite implementing its own vaccine-passport system this year, the country's vaccination rate has nonetheless stagnated--a trend that has been attributed in part to the high levels of vaccine hesitancy among Europe's German-speaking countries, where dispassionate public-health messaging has been supplanted by vocal anti-vaccine sentiment and conspiracy theories. In Austria, this phenomenon has manifested most notably in the rise of the new vaccine-skeptical People Freedom Fundamental Rights Party (known by its German acronym, MFG), which recently garnered enough support to enter one of the country's largest regional parliaments.
So far, the unvaccinated lockdown in Austria appears to be having its desired effect, with some vaccination centers reportedly seeing an uptick in people seeking a first dose. But it has also spurred thousands of people to protest the new measures, which many have decried as discriminatory. Now that the lockdown is being extended to everyone, and now that vaccinations will soon be made a legal requirement, those protests are only likely to grow. One risk facing the Austrian government is that these new measures could spur even further support for parties such as the MFG and the more established far-right Freedom Party, whose leader said the new restrictions make Austria tantamount to "a dictatorship." Another risk is that they could push those who are merely hesitant about getting a COVID vaccine to adopt a more hard-line anti-vax position.
"One thing that people really want is some level of choice, and one of the Achilles' heels of vaccines has been the feeling that it's government-driven and it's not about choice," Heidi Larson, the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told me. Larson noted that although vaccine passports offer some element of choice (in that the unvaccinated can opt to provide a negative COVID test instead), unvaccinated-only lockdowns and vaccine mandates could be seen as more punitive.
But perhaps the greatest risk for Austria right now is that these measures alone won't be enough to minimize hospitalizations, which is the primary metric that the government is focused on. That the tightening of restrictions in recent weeks isn't yet reflected in the numbers is a worrying sign, Schernhammer said.
"You can impose rules, but if people don't follow, then it gets hard to do anything," she said. "We have reached uncharted territory already, because what happens now will be seen in the ICU in two weeks."