A graphic showing a photo of people having a picnic, an arrivals and departures sign, and COVID-19 vaccines,
A graphic showing a photo of people having a picnic, an arrivals and departures sign, and COVID-19 vaccines,
12 min read

Coronavirus

What happened to other countries that opened up after hitting their vaccine targets?

As parts of Australia open up and the country fast approaches its major COVID-19 vaccination target, these are the lessons health experts say we can learn from other countries that have already reopened.

Published Monday 11 October 2021
By Isabelle Lane
Source: SBS News

Phase B of the Australian Government’s four-phase national plan begins once 70 per cent of the population aged 16 and over is fully vaccinated against COVID-19 - and we're almost there. 

More than 62.4 per cent of those eligible - that's more than 12 million people - have been fully vaccinated, and 82.4 per cent have received at least one dose.

The nation will reopen further and move to Phase C of the plan once the country hits 80 per cent, with international travel expected to resume for fully vaccinated people in Australia as early as November in some states. 

"It's time to give Australians their lives back," Prime Minister Scott Morrison said earlier this month.

But how are countries coping that have already followed a similar reopening plan?

Portugal 

  • Fully vaccinated: 84.7 per cent 
  • At least one dose: 86.9 per cent 

With a population of 10.3 million, Portugal has recorded at least 1.07 million COVID-19 cases and 18,034 deaths.

Portugal hit its target of delivering at least one dose of a vaccine to 70 per cent of the population (around 75 per cent of the 16+ population) on 6 August and continued its gradual easing of restrictions. 

Portugal has currently more than four out of five residents vaccinated and is leading the world on vaccination rates - second only to the United Arab Emirates. 

On 1 October, Portugal lifted nearly all of its remaining restrictions, including reopening bars, pubs and clubs that had been closed since the pandemic began in March 2020, with face masks no longer mandatory in hospitality venues and shops. 

In the week to 9 October, Portugal had an average of seven COVID-19 deaths and 573 new cases a day. 

Emulating Portugal’s high vaccination rate is “an achievable goal” for Australia, head of the Melbourne School of Population and Global Health, Nancy Baxter said. 

The nation has “basically vaccinated everyone that is eligible for vaccine; there's nobody left to vaccinate in Portugal, the vaccination rate is incredible.”

Diogo, 13, getting vaccinated in Lisbon in September.
Source: Getty

“They've had spikes, but now that they're really totally vaccinated, it's going to be very interesting to see what happens. They still have restrictions that they're lifting now … Then we're going to see what happens as they open in terms of how much of a threat COVID-19 is to them even with this very high vaccination rate.”

While Portugal did see a rise in cases over winter when the Delta variant hit, “they had enough protection in place through the vaccination program, but also didn't let that wave get away from them”, Deakin University chair of epidemiology Catherine Bennett said. 

“They were able to keep it under control … in a way, it's where Australia is now with having cases in the community in both New South Wales and Victoria and the ACT.”

Portugal shows that even if Australia does well in controlling COVID-19 over the summer, autumn and winter may pose challenges, Professor Bennett said. 

“You look to countries like Portugal, which did have early, quite good vaccination rates, and that helps you actually, you know, anticipate what we need to do,” she said. 

“What the early warning signs are, whether we have boosters in place at that time for people with waning immunity or frontline workers, all of those things will be in the planning because avoiding the wave is the best way to live with the virus going ahead.” 

Singapore

  • Fully vaccinated: 80.7 per cent 
  • At least one dose: 82.7 per cent 

With a population of 5.6 million, Singapore has recorded at least 124,000 COVID-19 cases and 153 deaths.

Singapore began easing some COVID restrictions in early August, including reopening restaurants on in-person dining for the fully vaccinated and allowing 50 per cent of workers to return to the office, with the nation achieving the milestone of fully vaccinating 80 per cent of the population by the end of the month. 

Despite its high vaccination coverage, after loosening rules further in September, the country reimposed some restrictions due to a surge in cases. 

In the week to 9 October, Singapore had an average of seven COVID-19 deaths and 3,196 new cases a day. 

Singapore shows how the Delta variant has “really challenged so many countries”, Professor Bennett said. 

A man prepares food for temple workers in the Little India district in Singapore.
Source: Getty

“Just when you think you're getting to the point where you've actually used that time where you worked hard to control the virus to actually get vaccinated and then the [new variant] comes along and you still have to manage levels of illness and deaths from COVID that you haven't managed before.”

“But that's the reality of living with COVID.”

Singapore is interesting as it’s “more comparable to Australia than a lot of these other places [as] they've had relatively little COVID-19 in Australia and in Singapore”, Professor Baxter said. 

“They had good control of the pandemic in general, and they have got a very high vaccination rate … but as they opened, they’ve found cases are surging ... they're beginning to see pressure on the healthcare system.”

Singapore shows that COVID-19 is still “finding the unvaccinated”, including children, and that “there are also groups of people that are more vulnerable, even if they've been vaccinated”, Professor Baxter said. 

“Even if you've been vaccinated, you can still get COVID, you can still transmit COVID, it's less likely, but you can, and vaccines are very protective against hospitalisation and death, but they're not 100 per cent protective.”

Israel 

  • Fully vaccinated: 61.5 per cent 
  • At least one dose: 66.8 per cent 

With a population of 9.2 million, Israel has recorded at least 1.3 million COVID-19 cases and 7,897 deaths.

Israel initially lifted all restrictions in June once it had vaccinated 50 per cent of the population, but has since reimposed measures to contain the spread of COVID-19 following a surge in cases. 

In the week to 9 October, Israel had an average of 17 COVID-19 deaths and 2,340 new cases a day. 

While Israel’s vaccine rollout won praise in its early stages, at this point “almost 40 per cent of their population isn't fully protected, and at least a third has no protection,” Professor Baxter said. 

“COVID will find people who aren't vaccinated, that's what it'll do. So you have a big proportion of the population in Israel that's at risk of getting COVID, of getting sick due to COVID, and spreading COVID,” she said. 

People shop at a market in Jerusalem in preparation for Rosh Hashanah, the Jewish New Year, in September.
Source: Getty

“So I think that you're going to continue to have outbreaks in Israel, and ones that lead to hospitalisations, and even deaths, just because there's such a significant proportion of the population that isn't vaccinated. The numbers in Israel just aren't high enough. 

“I think that if you have under 70 per cent of your total population vaccinated, you're going to just be dealing with outbreaks, and needing to impose restrictions, and it's going to really strain your healthcare system.” 

Israel is really interesting, Professor Bennett said, as they were the first country to achieve high levels of vaccination thanks to a successful early rollout of the Pfizer vaccine, but that also means “they've now had the longest lag time since their second dose”. 

“So we are going to be watching Israel closely to understand about vaccine immunity being sustained, or if not, when you might need to look at boosters.” 

Denmark 

  • Fully vaccinated:  75.1 per cent 
  • At least one dose: 76.4 per cent

With a population of 5.8 million, Denmark has recorded at least 363,000 COVID-19 cases and 2,669 deaths.

Denmark became one of the first nations in Europe to lift all domestic COVID-19 restrictions on 10 September when 80 per cent of the population aged 12 and above had been fully vaccinated. 

In the week to 9 October, Denmark had an average of one COVID-19 death and 528 new cases a day. 

Denmark’s achievement of vaccinating 80 per cent of those eligible before reopening shows that while Australia’s target of 80 per cent of the 16+ population “sounds really good, it's not enough to the epidemic from spreading, and stop the strain on the healthcare system”, Professor Baxter said. 

On Copenhagen's central shopping street a sign reads "Good summer and good distance".
Source: Getty

“That 80 per cent is around 66 per cent of the total population, and a place like Denmark is well above that. We see in Denmark, they've been able to open, they still have a high number of cases ... but their hospitalisation and ICU admissions are manageable.” 

“It seems like the place in Europe with the best consistent control of the outbreak at this point of the pandemic.”

 

Denmark is a “really good example of a country where they did ease out of restrictions, they had good vaccination rates, good community compliance with the rules they did have in place”, Professor Bennett said. 

“When they felt that their case numbers were at a manageable level - and that their vaccination rate was sufficient to give them protection - they started easing out.” 

That “easing out” means Denmark’s hospitalisations are at “manageable levels”, and “that's absolutely the kind of model” Australia should follow, she said. 

The United Kingdom

  • Fully vaccinated: 67.2 per cent 
  • At least one dose: 73.1 per cent

The United Kingdom has been one of the countries hit worst by the pandemic. With a population of 67.2 million, it’s seen more than 8.12 million COVID-19 cases and 138,000 deaths.

The nation officially reopened on 19 July, dubbed ‘freedom day’, when the UK hit its target of offering all adults a COVID-19 vaccine. At the time, 68 per cent of the UK’s adult population was fully vaccinated. 

Fast forward to the week to 9 October and the UK had an average of 112 COVID-19 deaths and 35,671 new cases a day. 

“For a country that is 10 times the size of Sydney, say, in terms of the population, they have still got a lot of cases … which is the challenge,” Professor Bennett said. 

“If we're talking about managing easing out of restrictions, which we are in Australia, that's quite different to stepping away from restrictions as they did in the UK, where it was much more immediately open.”

“They've gone into that easing with relatively high case numbers. They had some lockdowns in place, but they weren't the lockdowns that we know of in Australia … so the cases weren't as well controlled even going into the period of easing.”

The other key difference between Australia and the UK is that “we're trying to be prepared for that next step”, Professor Bennett said. 

Governments in Australia are planning “to have all the things in place around how we're going to manage returning Australians coming back, how we're going to manage monitoring people's vaccination status, as we take those steps out using vaccination as a way to mitigate risk as we move more in a measured way to opening up.”

Professor Baxter described the management of the COVID-19 pandemic in the UK as a “cautionary tale” for Australia. 

“We've seen how many lives have been lost, how it's affected the entire healthcare system. And how much suffering there is. There’s a huge amount of long COVID in the UK as well,” she said. 

“That they're open with 33,000 [new] cases a day, you know, that shouldn't be kind of what we want to achieve.”

The United States 

  • Fully vaccinated: 56.8 per cent 
  • At least one dose: 65.8 per cent

With a population of 329.5 million, the US has recorded at least 44.3 million COVID-19 cases and 713,000 deaths.

Pandemic restrictions are determined by individual states, but many have reopened, including New York which removed restrictions when it achieved 70 per cent vaccination among the adult population on 15 June. 

In the week to 9 October, the US had an average of 1,878 COVID-19 deaths and 96,950 new cases a day. 

“Many of the pandemic responses became highly politicised in the United States,” Professor Baxter said. 

“So initially, it was mask-wearing, and then it became the vaccine, where your likelihood of having received the vaccine depended on your political party affiliation. I think that has just dramatically affected the public health response and how they’ve fared since.” 

The US shows that easing restrictions when “you haven't got your vaccination rates at a level that's going to protect you, then you really are struggling”, Professor Bennett said. 

“You're trying to do everything, at the same time, keep people motivated about vaccination, managing the actual cost and impact on your hospitals in certain states where the rates are really high, and not actually having that protection at the population level.” 

What happened to other countries that opened up after COVID-19 vaccine targets?

In contrast to the US, Australia is on track to “achieve high rates of vaccination” before reopening, which will “allow us to manage the disease in our community, and to avoid having a super spreader event post-opening up”, Professor Bennett said. 

“That also matters to how other countries see you. France won’t accept people from the US now who aren't fully vaccinated,” she said. 

“We will have very few people who are in that position of not being fully vaccinated so the ‘safety tag’ that's given to Australia will be much higher because we are fully vaccinated and able to contain outbreaks going ahead.”

Read more from the Vaccine in Focus series. 

Vaccination data via Our World In Data. COVID-19 case numbers and deaths data via Johns Hopkins Coronavirus Research Center. 


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