This document is intended to provide interim guidance on the risks that fully vaccinated individuals may develop or transmit
infection that will lead to severe COVID-19 disease in the context of the current epidemiological and vaccine
coverage situation in the EU / EEA.
COVID-19 vaccines authorized in the EU / EEA have been shown in clinical studies to be very effective in providing protection against symptomatic and severe COVID-19. Evidence from real-life use of COVID-19 vaccines has confirmed these findings from clinical studies and also showed high vaccine effectiveness against PCR-confirmed SARS-CoV-2 infection.
Limited evidence indicates that fully vaccinated individuals, if infected, are less likely to pass SARSCoV-2 to their unvaccinated contacts. There remains uncertainty about the duration of protection in such cases, as well as about possible protection against emerging SARS-CoV-2 variants.
The viral circulation in the EU / EEA currently remains high, and the cumulative uptake of vaccination in the EU / EEA is still low in the adult population aged 18 years and over, although higher in specific groups of the population undergoing the initial phase of vaccination. COVID program is targeted. -19 rollout of vaccines, such as people aged 80 and over and health professionals.
In the current context and given the available evidence:
- The risk of developing serious COVID-19 disease for a fully vaccinated person is very low in younger and middle-aged adults with no risk factors for severe COVID-19, and low in older adults or those with underlying risk factors.
- The risk of developing severe COVID-19 disease for an unvaccinated person who has been in contact with a fully vaccinated person exposed to SARS-CoV-2 infection is very low to low in younger adults and middle-aged adults with no risk factors for severe COVID-19, and moderate in older adults or individuals with underlying risk factors (limited evidence available so far).
The overall reduction in the risks of severe COVID-19 disease depends on vaccine uptake and vaccination coverage in the general population and is modulated by several other factors such as age and underlying conditions, vaccine characteristics, variants of concern, setting and the epidemiological situation.
To date, given the currently assessed risks, there are specific situations in which non-pharmaceutical interventions (NPIs) can be lifted:
- When fully vaccinated persons meet other fully vaccinated persons (very low / low risk), physical distance and wearing of face masks can be eased;
- When an unvaccinated individual or individuals from the same household or social bubble encounters fully vaccinated individuals, physical distance and face mask wearing can be relaxed if there are no risk factors for serious illness or a lower vaccine effectiveness in a person present ( e.g. immunosuppression, other underlying conditions);
- When tracing contacts, vaccinated contacts exposed to a confirmed case should continue to be managed according to existing ECDC guidelines. However, health authorities may consider conducting a risk assessment on a case-by-case basis and then classifying some fully vaccinated contacts as low-risk contacts. Factors to consider in such assessments include the local epidemiological situation in terms of circulating variants, the type of vaccine received and the age of contact. The risk of onward transmission to vulnerable persons from the contact person should also be taken into account.
- Requirements for testing and quarantining travelers (if implemented) and regular workplace testing may be waived or modified for fully vaccinated individuals, as long as there is no or very low circulation of immune escape variants (in the community in the country of origin, in the case of travelers).
- In the current epidemiological context in the EU / EEA, in public places and at large gatherings, including while traveling, NPIs should be maintained regardless of the vaccination status of the individuals.
- Countries considering relaxing measures for fully vaccinated people should consider the possibility of unequal access to vaccines among the population.
Examples from countries where vaccination coverage is higher and severe COVID-related outcomes and SARS-CoV-2 incidence have subsequently decreased, such as the United Kingdom (UK) and Israel, provide an indication of how population-level transmission can be reduced with careful implementation and slow introduction of public health prevention measures, while the roll-out of vaccinations is scaled up across the EU / EEA as soon as possible.