COMPARE: The different strategies used in Europe to vaccinate against Covid-19

It's frequently referred to as "the EU's vaccine rollout", but although the EU took control of vaccine purchasing for most of its member states, how the vaccine is actually delivered en masse to people is up to each individual country.

Some governments have prioritised healthcare workers while others put the elderly at the front of the queue and when it comes to rollout speed some countries, like Denmark, forged ahead while others, including France and Germany, got off to a much more leisurely start.

And when it comes to AstraZeneca, there are multiple different policies.

Here's how the rollout is organised in the nine countries covered by The Local.

READ ALSO: How fast are European countries vaccinating against Covid-19?

France

After a slow start that earned the French government much justified criticism, vaccine rates have ramped up in recent days and France is now vaccinating around 350,000 people a day. By April 13th it had vaccinated 11.3 million people, of whom 3.9 million have had both doses. This equates to 16.5 percent of the population (or over 20 percent of the adult population) having their first dose and 5.7 percent fully vaccinated.

Policy - France has been vaccinating in priority group order, beginning in January with staff and residents in the country's Ehpad nursing homes before expanding gradually to healthcare workers and other age groups. Anyone aged 55 or over is now eligible for the vaccine in France along with people with serious health conditions and healthcare and emergency workers.

Vaccination is expected to be opened up to the rest of the population by mid June, with a target to have offered the vaccine to everyone who wants it by August 31st, according to the health minister, or 'the end of the summer' according to the president.

The vaccine is being administered in specialist vaccine centres, giant "vaccinedromes" in sports stadiums, "vaccinedrive" drive-in centres and through GPs or family doctors and pharmacies.

READ ALSO How to book an appointment for a Covid vaccine in France

Vaccines - There are four vaccines authorised for use by the French medical regulator Haute autorité de Santé - Pfizer, Moderna and Johnson & Johnson which are authorised for all age groups and AstraZeneca which since March has been authorised only for over 55s. People aged under 55 who had already received one dose of AstraZeneca - which includes the country's health minister Olivier Véran - will receive a different vaccine for their second dose. People in France are not offered a choice of the type of vaccine their receive.   

Sweden

As of April 14th, Sweden had given 1,543,414 people their first dose and 631,807 their second dose: 18.8 and 7.7 percent of the adult population respectively. The Nordic nation that has become known for its lax Covid-19 measures initially set itself a target of offering vaccination to all adults (and children in eligible risk groups) before Midsummer (late June), but after delayed vaccine deliveries it now aims to offer the first dose to all those eligible by mid-August.

Policy - Sweden has split its prioritisation into four phases, but since the start of the vaccine rollout it has shifted the focus to prioritise the oldest people first, after several regions initially focused on healthcare workers. Here is what the four phases look like currently:

Phase 1: People who live in care homes for the elderly; people who have at-home care, and people who live with them. People working in healthcare and care facilities who have close contact with people in the above risk groups.

Phase 2: People aged 65-69; people who are on dialysis or are recent transplant recipients and people who live with them; people with severe disabilities who receive LSS assistance and are aged over 18.

Phase 3: People aged 60 to 64, and all adults aged 18-59 who either belong to a risk group for Covid-19 or would have particular difficulty following the public health advice (for example people with certain learning difficulties, or people living in socially vulnerable situations such as homeless people).

Phase 4: Other adults aged 18-59, oldest first.

The vaccine programme is run by Sweden's 21 regions so is at different stages in different parts of the country, with most having completed or nearly completed Phase 1, and now vaccinating people aged over 65. In five regions, only over-70s are eligible, and two regions are opening up booking to people aged 60-64 this week. The vaccine is being administered mostly at doctors' offices, as well as in care facilities and hospitals (particularly for recent transplant recipients), and at some larger facilities, for example in sports stadiums and arenas. 

Vaccines - Three vaccines have been authorised for use in Sweden: Pfizer, Moderna, and AstraZeneca. AstraZeneca is currently authorised only for over-65s. Rollout of the vaccine from Johnson & Johnson was paused on March 14th before it had begun, after reports of rare blood clotting. The two doses of the Pfizer and Moderna vaccine are recommended to be administered six weeks apart, with an interval of nine to 12 weeks recommended for AstraZeneca. People in Sweden are not given a choice of which vaccine they receive.

Norway 

The vaccination program in Norway got off to a slow start and suffered a number of setbacks since. Its original vaccination plan had to be revised in March. By April 14th the country has vaccinated over 897,000 people with their first does and 296,000 with their second dose. This equates to 16.1 percent of the adult population receiving their first does and 5.4 percent of the adult population being fully vaccinated. 

Policy - Norway has been vaccinating in order of priority and has finished vaccinating nursing home residents and those aged over 85 years old. Norway is currently offering vaccines to those in all age groups with underlying conditions and health care workers. Norway will soon offer those aged between 55 and 64  vaccines. 

The Nordic country also hopes to offer everybody over the age of 18 a vaccine by July. This could get pushed back to October if the country decides it will no longer use the AstraZeneca and Johnson & Johnson vaccines. 

READ ALSO: What does Johnson & Johnson delayed vaccine rollout mean for Norway 

Vaccination is handled by each municipality and vaccination distribution is based upon how many people in risk groups are in each area, the government can however reprioritise the distribution of vaccines to areas with high infections. 

Vaccines are free for everybody living in Norway but people cannot currently choose the vaccine they receive. 

Norway has said it will also look into utilising a ‘coronavirus certificate’ as part of its plan to reopen society. 

Vaccines - Four vaccines are currently approved for use in Norway. These are Pfizer, Moderna, Johnson & Johnson and AstraZeneca. Only Pfizer and Moderna have been in use since Norway chose to suspend the AstraZeneca vaccine’s use in March. The country has also ordered over 1 million doses of Johnson & Johnson’s Janssen vaccine. Norway is due to decide whether to reimplement AstraZeneca into its vaccination program. 

Italy

Italy's vaccination campaign is proceeding in fits and starts, not least because each of the country's 20 regions have a lot of say over who, how and when they vaccinate. Around 13.7 million doses had been administered by April 14th, with just over 4 million people – around 7 percent of the total population – fully vaccinated. Another 9 percent have had the first of the two jabs they need.

Policy - From the first Italy decided to prioritise healthcare workers, for whom vaccination has since been made compulsory.

People in nursing homes, over-80s and people with serious health conditions were next on the list – though changing advice about whether the AstraZeneca should be used on older or clinically vulnerable people meant that younger key workers including teachers and police found themselves offered the AZ shot ahead of schedule, while the elderly still waited for Pfizer or Moderna.

Concerned that Italy's considerable older population was getting left behind, the national government urged regional health services to vaccinate in strict age order. Most regions are still working their way through people in their 80s and 70s, with some now starting on people in their 60s.

IN CHARTS: Who is Italy vaccinating fastest?

Jabs are being delivered at more than 2,200 vaccination sites around the country, ranging from hospitals to mega-clinics set up in conference centres, train stations, airports and museums. Pharmacies and doctor's offices have also been given the go-ahead to begin administering shots.

Vaccines - Italy is currently using the Pfizer, Moderna and AstraZeneca vaccines, and until this week was expecting to start using the Johnson & Johnson vaccine imminently. Initially recommended for younger adults, the AstraZeneca vaccine is now reserved for over-60s only because of a possible link to rare blood clots in people below this age – though people below this threshold who have already had their first dose can continue to get their second as scheduled. People in Italy are not offered a choice of which vaccine they receive. 

Austria

In Austria, 21.32 percent of the population have had one injection and 8.74 percent have had both.

Austria currently administers three vaccines: BioNTech/Pfizer, Moderna and AstraZeneca.

In Austria, the official position is that choosing which vaccine you take is not currently possible - but may be in the future, when vaccine stocks increase. 

The Austrian Health Ministry addresses the matter directly, saying that due mainly to availability “a free choice may not be possible, similar to what we know from seasonal flu vaccines”. 

The guidance does however point out that some vaccines are less likely to be administered by GPs due to the need to store them at incredibly cold temperatures. 

While Moderna and Pfizer/Biontech need to be stored in special freezers, AstraZeneca and Johnson and Johnson do not. 

In March, a member of the Health Ministry told Austria’s Die Presse newspaper that allowing people to select vaccines will not be possible for “several months” due to a lack of supply. 

In Austria, you are told of which vaccine you will get after you make your appointment. 

While reports emerged of some people cancelling appointments when being offered a vaccine they didn’t want, some states have put in place rules which block or suspend people from rebooking a new appointment when they have cancelled one for “tactical reasons”. 

Switzerland

In Switzerland, only two vaccines are currently available: BioNTech/Pfizer and Moderna and the country has fully vaccinated (with both doses) 7.97 percent of its population.

Unlike in the EU, AstraZeneca was never approved in Switzerland, while the government declined to order the Johnson & Johnson jab. 

Nobody in Switzerland has the right to choose which vaccine they receive. 

READ MORE: Can you choose which Covid-19 vaccine to take in Switzerland?

As reported by The Local Switzerland journalist Helena Bachmann when she received her first shot in February in the canton of Vaud, patients are only told at the last moment which vaccine you are set to receive. 

Reader question: How does the actual vaccine process work in Switzerland?

Unlike in some other countries, information as to which vaccines are given out at which vaccination centres is not made public - meaning you cannot choose a particular centre on the basis of the vaccines that are available. 

The reason has to do with supply and logistics.

The federal government distributes doses to cantons based on the delivery of the vaccines from the manufacturer and the number of doses received.

Reader question: Why can't I choose which Covid vaccine I get in Switzerland?

“It is the availability of the vaccine that will be decisive”, said Virginie Masserey, head of infection control unit at Switzerland’s Federal Office of Public Health.

Switzerland is also unlikely to allow residents to make a choice as to the vaccine they take 

"The choice will be made by a doctor or cantonal health authorities, not patients”, Masserey said.

“It's like all other vaccines. When you want to be vaccinated against the flu, you don't choose which vaccine to take, you get the one your doctor has at his disposal”, she added.

Spain

As of April 14th 2021, Spain has administered more than 11 million vaccine doses. Just over 3 million people (6.6 percent of the population) have received both doses; 7.9 million people (16.7 percent of the population) have received at least one dose.

The Spanish government’s focus so far has been on vaccinating priority groups - mainly based on health conditions, essential and high-exposure job roles and age (working down to a limit of 45 years of age for now).

The general consensus is that those who are registered with a public health doctor in their part of Spain do not need to contact or book an appointment as they will be contacted by their local health authorities when it’s their turn. 

However, regional health ministries have set up phone numbers that residents can call to find out information and to book an appointment if they are due the Covid-19 vaccine.

READ MORE:

• Spain’s updated Covid vaccine calendar: When will I get the jab?
• How is Spain's vaccine campaign going in each region?

Spain’s 17 autonomous communities are responsible for organising their own vaccine strategy, which is one of the reasons why there have been large regional disparities in the speed of vaccination campaigns since the rollout began on December 27th.

There has also been some confusion among Spain’s foreign population, especially those with private health insurance, as there is no central strategy for how those with no access to public health should get the vaccine. Some regions have asked their foreign population to make sure they are registered with the town hall or are offering temporary public health cards.

The vaccines available in Spain currently are the Moderna and Pfizer inoculations, given to all the priority groups, and the AstraZeneca vaccine, which after a temporary suspension and several policy changes following fears over its side effects is now being administered to people in the 60 to 69 age group. It is not possible to choose which vaccine you receive in Spain. 

In late March and early April most regions finished vaccinating their over-80s and are now inoculating those in their 70s.  

Germany

Germany has come under fire for its sluggish start to the rollout, which is partly due to EU-wide vaccine supply issues but also because of logistical and bureaucratic issues. All 16 states have their own different process for giving out appointments.

But the speed has been picking up after more doses arrived in April, and GPs were allowed to start giving out jabs. In total 17.8 percent of the population have received one dose, with 6.3 percent fully innoculated.

Nationwide a strict priority list is followed. Most states have completed the highest priority group (over 80s, people in care homes, health workers at high risk of getting Covid), and are onto group two which includes the over 70s, people with serious illnesses and primary school teachers. Some over 60s are also being vaccinated when there are enough doses.

At the moment residents in Germany are not supposed to be allowed to choose which vaccine they get because of limited supplies. This could change in future. But in Berlin, residents are allowed to choose which vaccine centre they go to which essentially means they can choose which vaccine they get. You can read more about people's experiences of getting the vaccine, being offered it and waiting for it in our story below.

 ‘I finally might be able to go home’: What it’s like to be offered a Covid jab in Germany

Germany is currently using the Pfizer/BioNTech, Moderna and AstraZeneca vaccines. It was expecting to start using the Johnson & Johnson vaccine but there is a delay on the EU rollout of this vaccine due to investigations into possible blood clots in the US.

As with other countries, there have been issues around AstraZeneca concerning possible links with rare blood clots. It's now only being used for the over 60s age group.

Denmark

Denmark was initially praised for making good early progress with vaccinations but has since been caught and overtaken by other EU countries, including much larger nations like Germany and France.

Over a million people in the country have now received at least a first dose of the vaccine, the health minister Magnus Heunicke said in a tweet on April 15th. Official figures show that 17 percent of the population have begun vaccination, while 8 percent are fully vaccinated.

But Denmark’s vaccination programme is becoming increasingly beleaguered.

On Wednesday, the country became an international outlier by deciding to completely withdraw the AstraZeneca vaccine from its programme despite having already given around 140,000 people a first shot. Concerns about rare but serious potential side effects were the reason for the decision.

That followed another blow to the Danish vaccination programme when Johnson & Johnson announced a delay to the rollout of its vaccine in Europe. Denmark had been banking heavily on the vaccine from J&J, having earmarked 8.2 million doses, more than from any other drugmaker.

Late winter estimates that the Nordic country would complete vaccination against Covid-19 in June have now been pushed back to early August, and public confidence in the timescale is waning.

Policy – Denmark split its population into 12 different priority groups, a number later refined to ten groups with various subsections, in order to prioritise vaccine distribution.

Broadly, older demographics and those in risk groups for serious disease outcomes have been given highest priority for vaccines. They are followed by healthcare and other essential sector workers and close or essential contacts of people in vulnerable groups.

READ ALSO: When and how can foreign residents get the Covid-19 vaccine in Denmark?

Vaccines – Two vaccines currently remain in use by the Danish Health Authority (Sundhedsstyrelsen), pending the outcome of the Johnson & Johnson delay. The remaining vaccines, from Pfizer/BioNTech and Moderna, constitute 77 percent and 8 percent respectively of the first doses the country has given so far.

Denmark will receive an additional 650,000 doses of the Pfizer vaccine in the second quarter, the country said on Wednesday, after the EU agreed with the company an earlier delivery of doses previously expected at the end of this year.