Covid Corona CSH


The future of Covid-19 in Europe

The pan-European initiative to contain COVID-19—with CSH participation—issued a new statement about the future of the pandemic in the journal The Lancet.


As many parts of Europe experience another wave of COVID-19, this time driven by the Delta variant, people are, reasonably, asking what the future holds. We brought together 32 leading scientists from 17 European countries, including CSH scientist Peter Klimek, CSH External Faculty member Matjac Perc, and CSH Assoc. Faculty Eva Schernhammer—covering various aspects of the pandemic, to see if we could reach agreement on what might expect to happen in the months and years ahead.

The experts identified three critical questions we need answers to:

(1) Will we be able to achieve high levels of immunity in our populations, in particular through high and sustained rates of vaccination?

(2) What is the likelihood of seeing new variants emerge that are more transmissible or can escape our existing vaccines?

(3) How will people respond to changing situations, in particular what will determine their willingness to maintain precautions?

Taking these questions into account, we highlight potential future scenarios and continuing challenges over three time periods.


Too many people across Europe remain unvaccinated and the Delta variant continues to spread.

We anticipate the current resurgence of infections and argue strongly against premature lifting of restrictions. Although efforts to drive cases down are helped by the good weather, and the vaccination programmes are contributing towards reducing the likelihood of serious illness and death, there is no room for complacency.


We risk repeating what happened in 2020. The move to indoor activities and the climate in the colder months is bound to accelerate the spread of SARS-CoV-2. Experience should have taught us that, by the time we see rising cases, we have already failed to control the spread of infection and it will be necessary to reimpose restrictions, preferably earlier rather than later.

We were very fortunate that we were spared the usual seasonal influenza in 2020, mainly because measures to reduce COVID-19 infections also worked against influenza. But if more people mix in public again, we are unlikely to be as fortunate this year. Of course, the level of vaccination is much higher this year. But as we are already seeing, vaccinations alone won’t be enough to control the pandemic.

A crucial question is whether to vaccinate children. A growing number of countries are doing so, but evidences are still evolving, and to vaccinate children may provoke controversy in some countries.


Looking further ahead, one of our main concerns is the impact on health services for people with other diseases.

Many countries have built up large backlogs of unmet need and many important activities, such as screening and early detection of cancer have fallen behind. There will be a legacy of mental ill health, with young people, health and other frontline workers, and those already suffering from social disadvantage and discrimination most at risk. Governments cannot go back to the situation before the pandemic, with failed policies that created the conditions that allowed COVID-19 to spread. But SARS-CoV-2 will still be around and it will be essential to ensure that every person in the world who chooses so can be vaccinated. The alternative is allowing the virus to continue to spread and produce ever more variants.

It now seems unlikely that we will achieve eradication of the virus, given the challenges of achieving high vaccination coverage, virus evolution, and incomplete immunity against infection, or even possible reservoirs of infection in animals. However, by complementing immunization with moderate changes, such as better ventilation and a habit of wearing face masks in certain environments, it should be possible to break transmission chains most of the time.

We have already seen important advances in COVID-19 treatment and can expect more. Yet, as with vaccination, the world must confront the challenge of how to ensure that everyone, everywhere, can benefit.


We will only succeed in controlling this pandemic if our messaging is clear. Too often we have failed. Those in authority must set out clearly why certain measures are necessary, on what basis decisions are made, and what the consequences are for the many different groups within society.

We need to accept that the policies we have pursued have often been unpopular. No one wants more lockdowns with their associated economic and psychological burdens. The situation is made worse when there is an erosion of trust. We need to work hard to ensure that policies to mitigate and recover from the pandemic include democratic engagement. Aside from the political imperative to do so, advice is more likely to be listened to if people trust what they are hearing.

It is clear that the COVID-19 pandemic has disproportionately affected some groups in ways that extend well beyond the disease itself. Financial assistance and psychosocial support are crucial, especially for economically and socially disadvantaged groups. Parents and children have also been hit hard. We must also remember the needs of healthcare workers, many of whom have experienced severe stress with consequences for the sustainability of our healthcare systems.

An overriding message from this expert group consultation is the need for international cooperation based on solidarity. No one is safe until everyone is safe. And this means that we need to coordinate responses across borders; travel bans within Europe may have been necessary but ultimately they are a sign of policy failure. And we need to recognise our place in the world, working to ensure that everyone has access to vaccines wherever they live.

For all these reasons, the experts call for a pan-European coordinated approach to tackle—and ultimately, recover from—the pandemic, with an emphasis on One Health and global public health. 


E. N. Iftekhar, et al., “A look into the future of the COVID-19 pandemic in Europe: an expert consultation”, The Lancet (July 29, 2021)

Previous call: “Action plan for a pan-European defense against the new SARS-CoV-2 variant”, The Lancet (Jan 21, 2021)

Webpage of the initiative incl. statement in other languages:


E.N. Iftekhar, V. Priesemann, et al.
The Lancet Regional Health – Europe
Priesemann V,Balling R,Brinkmann MM,Ciesek S,Czypionka T,Eckerle I,Giordano G,Hanson C,Hel Z,Hotulainen P,Others
The Lancet
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