I quite like the way the question is phrased, you are not asking me for a prediction but rather a scenario. I provide daily forecasts for the 209 countries and territories around the world that report daily data on Covid-19, but we cannot predict beyond 7 days. Instead, we can look at possible scenarios for the start of the new school year, and I am going to suggest two, without knowing which one has the highest probability of happening.

Scenario 1 – Type "summer 2020“: after a summer break which every European will have been able to fully enjoy, both in July and August, the start of the new school year in September, with the mixing of holidaymakers and their viruses and variants, would then be complicated and cause a fourth wave of contamination fairly early in the season (September-October) reaching children and young people, as well as all the non-vaccinated. Depending on the proportion of non-vaccinated people over 50 and of younger people with underlying health conditions, we would see an increase in hospital admissions for complications of varying degrees, but which would still have the potential to saturate intensive care beds.

Scenario 2 – Type "Change of strategy by European governments“: the epidemic decline observed in June throughout Europe would be accompanied by a significant change of strategy by European leaders, whether explicit or not. Health authorities would henceforth ensure, throughout the summer, the systematic and exhaustive search for the chains of contamination, thanks to the notable decrease in the epidemic. They would dismantle them as soon as they were identified, thanks to strict, controlled and effective isolation and quarantine measures, and would also ensure effective and rigorous sanitary control at the borders, in particular of passengers coming from areas at high risk of importing variants. Here and there, unavoidable cluster outbreaks that slip through the cracks of this health watch would require brief, but strict, local lockdowns. Autumn and winter would probably see the epidemic pressure rise, but authorities would retain control over the pandemic and the waves would not exceed the resources deployed to maintain this control. Systematic sequencing of all positive cases would be possible because the virus circulation would remain sufficiently low and thus no room would be left for silent multiplication of variants in the territory. The continued vaccination, including now in children, would aim at ensuring a large vaccination coverage and the last percentage which would make it possible to obtain collective immunity would be particularly difficult and long to obtain and would require the deployment of important means (social marketing, incentives and strategies aiming at gaining the confidence of hesitant, socially excluded or isolated people in society, and whose access is particularly difficult).

Looking back at the last 18 months, which strategies have been the most effective in controlling the pandemic?
Three types of strategy have been implemented: mitigation (in Europe and America), also known as "living with it", characterized by a late reaction with strong measures when the curve is already high, essentially and as a last resort, to avoid overcrowding hospitals, particularly intensive care units. Suppression, also called "low virus circulation", advocated by the Japanese and Koreans, but also Finland, Norway and Denmark. Interventions are more pro-active, much more premature, as soon as the contamination curve rises (that the R persistently exceeds the value of 1). In Japan, for example, which has twice the population of France, the peaks of their waves have never exceeded 6,000 cases per day, which is lower than the levels of the decreases targeted by the authorities in France (less than 5,000 cases/day). And finally, the elimination strategy, or zero Covid, advocated in particular by China, Taiwan, Australia or New Zealand, Iceland, New Caledonia and two maritime provinces of Canada (Nova Scotia and New Brunswick). They implement interventions even earlier, as soon as they spot the slightest case circulating in their community.
In health terms, if we look at Covid mortality (or excess mortality), clearly the best performers are the zero Covid countries, with less than one death per 100,000 inhabitants since the start of the pandemic, then the suppression countries with less than 20 deaths per 100,000 and finally the mitigation countries with more than 80 deaths per 100,000 (and often much more, Germany 108, France 164, USA 182, UK 192, Belgium 220,)
In economic terms, the suppression or elimination countries have shown positive growth (China, Taiwan, Vietnam, around +3% in 2020) or are less impacted than the EU countries in mitigation (e.g. Japan, Korea vs. France or Italy).
In terms of social life, life has been less confined, schools closures have been less frequent, and barrier gestures have been required for less time in countries with elimination or suppression strategies.
One difficulty encountered by elimination countries and to some degree suppression countries is the closure of their borders, which they have most often instituted and from which they find it difficult to exit. Another problem is the slow roll-out of vaccination, which they have experienced, although these two points are not linked. The combination of these two elements makes it somewhat difficult for them to emerge from the crisis while the rest of the world is still experiencing intense circulation of the virus in some areas.

What are the main lessons from this health crisis?
On this point, I will invite you to refer to the book I wrote on the subject ("Covid, le bal masqué", published by Dunod). Indeed, in the last chapter (epilogue), I try to draw 10 lessons from this crisis and I present them in detail. It would be a bit long and redundant to do it again here.

Like all over Europe, Austria started the vaccination process late December - early January with the older age group. There was a shortage of vaccines at the beginning but, by the end of May, more vaccines were available.

3,5 million people have already been vaccinated at the beginning of June and politicians are convinced that the country will reach herd immunity during the summer.

At the moment, with a population of 9 million, the country registers 300 new infections /day.

The role and involvement of private clinics during the pandemic was quite difficult. They were available and willing to treat covid patients, but the demand was low.

In 2020, there was one private clinic which treated Covid patients and this year there are several private clinics which participate in the vaccination process.

Most clinics involved in the vaccination process carry out vaccination for larger private companies and can charge their services to the public sector.

Almost all private hospitals for rehabilitation in Austria are currently also treating long-covid patients.

There is an ongoing discussion between the Austrian association and the government regarding the differences between the public and the private sectors in the healthcare system. Currently the Austrian association is trying to eliminate the different treatment by additional Covid bonuses for employees depending on whether the employer is private or public.

Regarding the pandemic, the epidemiological situation in France has improved and the lifting of the lockdown measures is being done gradually.

The private health sector remains mobilized and is taking part in the vaccination campaign. An important issue is to continue to take care of patients with pathologies other than Covid. The main concern today is the lack of health professionals for both the public and private sector.

From an operational perspective:

Regarding compensation, there is good financial support from the French government to the private health sector.

Regarding communication, the President of FHP, Mr. Lamine Gharbi is regularly active in the media.

The German National Covid-19 Vaccination Strategy consists of two phases depending on the availability of quantities of vaccine: in a first phase vaccinations against Sars-CoV-2 will be carried out in vaccination centres to which mobile vaccination teams may also be assigned (Phase IA: Targeted, centralised vaccination; Phase IB: Expanded, centralised vaccination). As soon as the conditions allow and sufficient quantities of vaccine are available with suitable storage conditions, the aim is to transfer vaccination activities to the regular supply system (Phase II: Widespread, decentralised routine vaccination via medical institutions, general practitioners and company doctors).

Yet, as of June 7th prioritization was abandoned at federal level. On regional level prioritization may however still be valid, e.g., due to special local requirements.

Hospitals – regardless of their ownership – are no primary providers of vaccination in Germany. But private hospitals stand ready to support the vaccination strategy. For example, in Hamburg already exists a model project. Asklepios concluded a contract with the city Hamburg. If enough quantities of vaccine are available, seven Asklepios hospitals could vaccine more than hundred patients of psychiatry, geriatrics, oncology, and early rehabilitation daily.

However, hospitals are directly taking part in vaccinating their hospital staff. Vaccines are provided by the health care authorities directly to the hospitals no matter if they are public, private or non- government/not-for-profit organisations and not matter the mandate of supply. In this way a very fast vaccination of hospital staff is possible. Usually, hospitals receive early information on how many vaccines and in which quantity will be available. So they know beforehand, when they will receive the vaccines and in which quantity. This is very helpful to prepare the vaccination process. Nevertheless, it is experienced that every time, vaccines are available, they are not spent completely. With the permission of the health authorities, hospitals may use these vaccines on people who are not members of the staff in order to avoid that those vaccines expire unused.

As of June 17, 24.657.569 persons of the population (29,6 %) have received a complete vaccination. 41.662.903 persons (50,1 %) have received their first shot (see: https://impfdashboard.de/).

Vaccinations in Greece are progressing rapidly based on the age. It is estimated that by the end of June, the ages 18-29 would have been vaccinated.

Until now, 5,000,000 vaccines have been given and those who have received both doses are estimated at 2,000,000. In the European Union, Greece is 4th in vaccinations and 5th in those who have been fully vaccinated.

Until today, vaccinations were given in State health units, but vaccinations will also take place in Private Clinics, Private Diagnostic Centers.

This will help in the faster creation of the immunity that we all seek to prevent a new wave of the pandemic so that we return to normality by September.

The Greek government officially designated the members of the Hellenic Private Hospital Association (HPHA) to become COVID-19 vaccination centers. Initially for their employees, doctors, and external service providers.

Hospitals provided a detailed list of people to be vaccinated, to the Ministry of Health. Vaccines, tablets for registering people approved for inoculation and the administration of doses, arrived at the respective private facilities. The vaccinations were carried smoothly, and faster than scheduled.

The COVID-19 pandemic challenge gave the opportunity to the Ministry of Health to test, evaluate, and grade the private healthcare providers. HPHA Hospitals are participating in the vaccination of the general population.

Acknowledging their contribution, the Ministry of Health, extended the private sector vaccination mandate to include oncology and dialysis patients in its care.

Members of the Hellenic Private Hospital Association have contributed with:

A gradual return to normalcy is now expected.

On December 2, 2020, the Minister of Health, Roberto Speranza, presented the Guidelines of the Strategic Plan for the Covid-19 vaccination, prepared by the Ministry of Health, the Special Emergency Commissioner, the National Institute of Health, Agenas, and AIFA. The Plan provides for:

Many of the health and social-health facilities associated with AIOP have already administered the vaccine to their health workers in different Regions at different times, notwithstanding the great difficulty in obtaining the vaccine.

The National President of AIOP, Barbara Cittadini, has been engaged in and continues to have various discussions relating to policy in order to understand to what extent the associated facilities may offer their services to the country and be part of the "system" along with the entire Health Sector, in order to provide the Covid-19 vaccine throughout Italy.

With the appointment of the General Francesco Paolo Figliuolo as the new Covid-19 Emergency Commissioner, the National President of AIOP reiterated that the network of health facilities associated with AIOP, situated throughout Italy, is ready to assist with increasing the number of vaccines.

These healthcare facilities are already operational and ready to become vaccination centres for the people of Italy. Since a large amount of vaccine doses is expected to arrive in Italy in the next few weeks, the Commissioner's organization has asked for indications regarding which facilities may be relied on and to what extent, in order to map out each one's operational potential and to deliver the appropriate quantities of vaccines to be administered to the general public.

Specifically, the Commissioner's organization asked AIOP to provide information for each Region on:

The survey carried out to determine which facilities could become vaccination centres and the number of vaccines - daily or weekly, in case they are only able to schedule vaccinations on certain days of the week - that each facility will be able to administer, using its own internal resources, indicates that approx. 200,000 vaccines may be given nationwide weekly at the beginning and that this number could subsequently double in size. Subsequently, a specific Agreement with AIOP at the national level will constitute the reference framework to be applied by means of operational agreements with the regional offices.

The involvement of the AIOP associated facilities with vaccination activities would make it possible to immediately increase the number of daily vaccines given, scrupulously following the indications relating to the need to give priority to specific categories and operating in complete safety.

Patients have always been and must continue to be the focus of attention and the priority for those operators whose mission it is to "provide care and help others", especially during this emergency period.

Administering the vaccine as soon as possible is an ethical and deontological choice for AIOP, one that provides security not only to healthcare workers and the most at-risk patients, but also to all other citizens, helping the country to recover quickly and return to a long-awaited normalcy.

This is an opportunity that offers further witness to the importance of increased integration of the public and private components of the NHS for the benefit of all Italians.

In Poland, the worst moment during the pandemic was at the end of March this year with 900 people dying every day and with 35 000 new cases daily.

Now the situation has improved. At the end of May, the country registered 572 new infections and 99 deaths daily.

There are still at the moment 2,8 million active cases and 75 000 people have died.

The vaccination process started in January this year and so far, out of a population of 38 million, 21 million people have been vaccinated (of which 7 million with the 2 doses). 27% of polish citizens are safe. Health professionals and older people were vaccinated in the first phase.

The impact of Covid-19 on private hospitals:

The private sector plays an important role in the vaccination process. In big cities big vaccination points are established in conference halls and there are also other smaller vaccination points.

The Polish government is presenting a new referendum regarding public hospitals to help use EU funds. It is not clear now how much of this money will come to private hospitals.

During the pandemic, the private sector contributed with:

90% of the workforce has been fully vaccinated.

There were some problems because the Polish Minister spoke on TV about the lack of participation of private hospitals during Covid. There is a constant battle between the Polish Association of Private Hospitals (OSSP) and the Ministry of Health, but the reality is that the private sector was very much active in the fight against the pandemic.

In terms of the pandemic, January and February were the worst months in Portugal since the beginning of the pandemic and the Portuguese health system was under maximum pressure, almost reaching its limits. Under these conditions, the private sector was called in and contributed plenty during the first trimester of 2021. Now the situation is quite under control with an average of 66 cases per 100 000 inhabitants.

Regarding the vaccination process in Portugal, 23% of the population has been fully vaccinated and 43% have received one dose of the vaccine. The process itself is going very well, with an average of about 100 000 people vaccinated per day.

90% of the staff in the private health sector have been vaccinated but private hospitals were not mobilized to participate in the vaccination of the general population so it feels that more could be done if the Ministry of Health says the involvement of the private sector is needed.

In terms of treatment of COVID-19 patients, the private sector could have done more but it did a lot in terms of patients with other pathologies.

The 2020 activity decreased by about 12% for surgeries, 14% for outpatient consultations and about 40 % for emergency episodes so it was a very tough year for the private sector, but it started 2021 stronger and the private hospital sector has recovered faster and better than the public sector.

Regarding the vaccination process, Romania is currently at stage 3 which includes the vaccination of the general population.

In some cities, people can just walk in and ask to be vaccinated, without any previous scheduling. There are even drive-through centres, in addition to vaccination centres.

4,4 million people have been vaccinated which represent 27,4% of the population.

Even if vaccination is currently slowing down, Romania is still the first country in the EU to start vaccination for the 12-15 age group.

The private health sector has been involved in the fight against Covid-19, especially in the PCR testing process.

The private sector is also involved in the vaccination process but unequally at the regional level because its involvement depends on local decisions.

The sector also received financial support from the public authorities.

There is an ongoing discussion between the Austrian association and the government regarding the differences between the public and the private sectors in the healthcare system. Currently the Austrian association is trying to eliminate the different treatment by additional Covid bonuses for employees depending on whether the employer is private or public.

COVID-19 numbers are better every week in Spain with currently about 120 cases per 100 000 inhabitants. The situation is improving.

Regarding vaccination, the goal of the government is to have 70% of the Spanish population vaccinated by August. At the moment, Spain has about 38% of its population vaccinated with at least one dose.

Regarding the contribution of the private healthcare sector in the Spanish vaccination process, it was previously announced that the private health sector was going to participate in the vaccination of 56% of the Spanish population but, unfortunately, vaccination has been carried out primarily by the public health sector. Despite the willingness and availability of the private sector to participate in the process, out of 17 communities, only two are using the private sector.

The government establishes the vaccination process, but the autonomous communities can decide if they use the private sector or not. It is unfortunately a political issue and not an organizational one.

At the beginning of the vaccination process there was a shortage of vaccine, which the government used to explain the non-involvement of the private sector, but it is no longer the case.

The Minister of Employment made an agreement on vaccination with non-profit Mutual Funds.

The private health sector asked for a similar agreement, but the Spanish government chooses to use only the public resources.

In Switzerland, most actions during the pandemic were well coordinated between sectors. Some partnerships even increased. There is no discrimination.

Regarding the vaccination process, the Federal government organized the logistics, and the Cantons organized the distribution and defined priority groups.

One of the big private hospital groups plays a big part in the vaccination process.

At the moment, 20% of the population in Switzerland is fully vaccinated but it is about 80% for the age group of people over 70.

No data on the vaccination of health professionals is available but it is estimated that 80% of health professionals that asked to be vaccinated have been fully vaccinated.

Today the country sees a drop in daily cases, hospitalization, and mortality rates and restrictions started to be lifted.

One area that has not been resolved yet is the fair compensation for the cost to the private hospitals of the reserve capacity and additional costs during March and April of 2020.

The Swiss Association of Private Clinics is publishing a press release on a study by PWC on the 2020 hospital activity and which shows that the loss of income and additional costs totals 1,3 billion EUR for all hospitals, public and private combined; this represents approximately 5% of turnover. Private hospitals in particular have not been fully compensated for these losses and demands have been made to remedy this.

The European Parliament and Council negotiators reached a provisional agreement on the increased cooperation of member states on health technology assessment (HTA) at EU level.

The key elements of the agreement are:

The European Parliament and the Council are now expected to endorse the content of the agreement.

Health technology assessment (HTA) is a research-based tool to support decision-making in healthcare. HTA assesses the added value of new or existing health technologies – medicines, medical devices and diagnostic tools, surgical procedures, as well as measures for disease prevention, diagnosis or treatment – compared with other health technologies. The HTA process is performed by currently about 50 European HTA agencies. The regulation proposed by the Commission in January 2018 aims to strengthen EU-level cooperation among Member States for assessing health technologies. In March 2021, the Council agreed, after three years of discussions, on a mandate for negotiations with Parliament.

More here. 

Last 17 June, Health First Europe (HFE), a non-profit alliance of patients, healthcare workers, academics, healthcare experts and the medical technology industry, held its annual General Assembly.

During the Assembly the HFE members voted for the renewal of the association's Executive Committee and our Secretary General, Ms Ilaria Giannico, was re-elected as one of the EXCOM members on behalf of UEHP for the third consecutive mandate. 
At UEHP we believe in this long-lasting partnership with Health First Europe which gives us the opportunity to cooperate at EU level on a number of subjects requiring cooperation, integration and coordination of care. 

Last 17 June Active Citizenship Network hosted the virtual award ceremony for the European Civic Prize on Chronic Pain.

The prize, which has reached its third consecutive edition, aims at highlighting existing good practices in several European countries in terms of struggle against chronic pain. This third edition allowed all actors involved to continue expanding the "agora" of operators of good practices on pain, encouraging the exchange of experiences among health professionals, healthcare providers, institutions, civic associations, and patient advocacy groups. Exceptionally for the III Edition, the prize recognized also outstanding initiatives that have been put in place, modified or updated to face and mitigate the COVID-19 pandemic consequences on chronic pain patients' life. 

The winners of the 2020-2021 edition are:

UEHP supports this initiative from its very first edition and is a jury member of the European Civic Prize on Chronic Pain organized by Active Citizenship Network. 

Last 17 June the European Alliance for Value in Health hosted its first public webinar to launch its position paper and discuss lessons from the crisis to realign health systems towards a more resilient and value-based foundation.

The importance of resilient health systems has been put to the fore by the COVID-19 crisis, and European institutions have taken several measures to improve the crisis preparedness of health systems at EU and Member State levels. But how is health system resilience currently defined in the health policy discussion, and are we interpreting this broadly enough?

The European Alliance for Value in Health argues that we should not only focus on measuring resources and capacity building needed for pandemic preparedness, but also look at health system resilience through a broader scope. Making health systems more value-based and person-centred would not only make them better equipped to deal with health challenges in normal times, but also make them more resilient during a future health crisis. This includes optimizing the prevention and management of chronic diseases which have been a key risk factor in terms of COVID-19 outcomes.

About the European Alliance for Value in Health

The European Alliance for Value in Health is a group of associations that represents a broad range of stakeholders including patients, scientific and professional societies, healthcare managers and professionals, hospitals, payers and industry. We are working together towards our shared vision for a Europe, where health systems are value-based, sustainable, and people-centred. By connecting different stakeholders, our mission is to facilitate health system transformation, share knowledge and best practices, and engage with policy makers and stakeholders at European, national, and regional levels.

Read more at: https://www.valueinhealth.eu/