At that time, the number of new cases per capita in the US was nearly three to one less than that of Europe. As European governments charted their roadmaps to normalcy, America battled a rise in infections and warned of pressure on hospitals.
But by Monday, when the new rules came into effect and thousands of tourists flew across the Atlantic to American cities, the two regions had experienced a dramatic reversal in fortunes.
The number of infections is on the rise in most countries that are part of the Schengen area, the bloc of 26 countries where the rules for entering the US have been relaxed. Travelers from the United Kingdom and Ireland were also involved in the US policy shift.
“We are at another critical point of the pandemic’s resurgence,” WHO regional director Hans Kluge said last week, warning that the rate of transmission in the region was “seriously worrisome”.
“According to one reliable forecast, if we stay on this trajectory, we could see another half a million COVID-19 deaths in Europe and Central Asia by February 1 next year,” Kluge warned, adding that 43 of the 53 landing on his patch could also see high or extreme stress on hospital beds.
Europe’s current wave has not resulted in as high a death rate as the summer peak in the US. But it serves as a reminder of the cyclical nature of the pandemic, experts say.
“The situation across Europe was in some ways to be expected. We expected the number of cases to increase around this time of year,” said Paul Wilmes, a professor at the Luxembourg Center for Systems Biomedicine.
Others note that the relative success of some highly vaccinated countries such as Spain and Portugal – where cases have remained at manageable levels despite general upward trends across the continent – could serve as an example for governments in Europe and elsewhere.
“It’s happening in many countries, but it’s not inevitable,” said Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine. “We need to look at what’s happening and what policies are triggering it…there are things that can be done.”
Vaccine rollouts in the US surpassed Europe’s in the early months, but the two regions crossed over in the summer when the number of new injections in the EU surpassed that of the US.
Now the focus is shifting to unvaccinated parts of both regions as leaders struggle to get their steady vaccine drives going.
US President Joe Biden has bolstered his rhetoric about unvaccinated people in recent weeks by telling reporters in the White House that they “can do a lot of damage, and they do.”
“The unvaccinated overcrowding in our hospitals is flooding emergency and intensive care units, leaving no room for someone with a heart attack, pancreatitis or cancer,” the president said in September.
A handful of European governments are starting to mimic his optimistic stance, as they grow frustrated with the slowdown in the rollout and take a more direct approach to those hesitant to take a chance.
German Health Minister Jens Spahn said the country is facing a “massive” pandemic of unvaccinated this month. “The truth is there would be far fewer Covid-19 patients” [intensive care] if everyone who could get a vaccine,” he said.
“It is increasingly recognized that those people who don’t want to contribute to solving the challenges of the pandemic are putting other people at risk,” McKee said. “They undermine other people’s recovery, and there is an increasing impatience” towards them from politicians and the public, he added.
But the two regions ultimately face recognizable challenges.
In Europe, another gap in vaccine uptake has become equally apparent; countries in the west and north of the continent have recorded high numbers, with Portugal and Spain leading the way in Europe’s Iberian Peninsula, where the proportion of the population that is fully vaccinated is 87% and 80% respectively. But to the east, that trend is sharply declining.
Romania and Bulgaria in particular, which are not included in the Schengen travel area and thus not included in the US’s relaxed entry rules, have difficulty administering doses. Slovakia, Poland, Slovenia and the Czech Republic have also failed to keep up with their neighbors to the west, with all four countries having so far vaccinated less than 60% of their population.
“This isn’t new — we’ve seen this for other vaccines,” Wilmes said. “In some countries you see inherent levels of compliance to go along with vaccination campaigns, compared to others.”
“We know that vaccination has an impact on transmission – the more people within a population are vaccinated, the more you can limit transmission,” he added. But he noted that dwindling immunity has become a “clear reality” and poses an additional challenge for governments.
The other major pillar of the US approach was on face masks; Biden made face coverings mandatory on federal property during his first day in office, and has since urged states to ensure its use in schools, offices and elsewhere.
But the mask has become a symbol of a divided society in the US, and partisan tendencies strongly determine how often they are used.
Europe has avoided that gap, experts say. “People don’t see wearing masks as an invasion of personal freedoms like some parts of the US do. There’s definitely a cultural difference,” Wilmes said.
Rules for travel in Europe have been relaxed in recent months and many countries have rolled back restrictions on gatherings – raising concerns across the continent that the new surge in cases could be accompanied by a return of measures.
“The countries that have eased the measures did so at times when the number of cases was low and against the background of many people being vaccinated,” Wilmes said. “We don’t have crystal balls – it’s a hard decision for governments to make.”
Many European countries, such as France, Italy and Germany, have now embraced vaccine passports, with the EU’s digital certificate system and some national equivalents used to authorize entry to bars, clubs and restaurants.
The safeguards have been “an important measure to limit the transfer,” Wilmes said.
“Vaccine passports have been useful both in preventing unvaccinated people from mixing with each other and in encouraging people to get vaccinated,” added McKee.
The US has not followed the EU system, but Biden has gone ahead with plans to introduce a vaccine requirement for certain farms and fields. His administration announced last week that vaccine rules, which apply to private companies with 100 or more employees, certain health professionals and federal contractors, will come into effect on Jan. 4.
“Vaccination is the best way out of this pandemic,” Biden said in a statement. “And while I would have preferred that requirements were not needed, too many people remain unvaccinated to get out of this pandemic for good. So I put requirements in place — and they work.”