BRUSSELS >> The calls began in December, as the United States prepared to administer its first batches of COVID-19 vaccine. Even then, it was clear that the European Union was a few weeks behind, and its leaders wanted to know what they could learn from their American counterparts.

The questions were the same, from President Emmanuel Macron of France, President Ursula von der Leyen of the European Commission, and Alexander De Croo, prime minister of Belgium.

“How did you do it?” Dr. Moncef Slaoui, the U.S. vaccine czar, recalled being asked on the calls. “And what do you think we missed?”

Since then, the rollout gap between Europe and the United States has widened, and some of the countries hardest hit early in the pandemic are facing a deadly third wave of infections. France, large parts of Italy, and other regions are back in lockdown. Roughly 20,000 Europeans die of COVID-19 each week.

The continent was dealt a further setback when a scare over blood clots and brain bleeds led several countries this week to temporarily halt the distribution of the AstraZeneca vaccine. Most of them resumed using it Friday after Europe’s top drug regulator vouched for its safety, but public confidence in the shot has been badly shaken.

Vaccine salvation remains, for now, tantalizingly out of reach. Only about 10% of Europeans have received a first dose, compared with 23% in the U.S. and 39% in Britain.

There is no single culprit. Rather, a cascade of small decisions have led to increasingly long delays. The bloc was comparatively slow to negotiate contracts with drugmakers. Its regulators were cautious and deliberative in approving some vaccines. Europe also bet on vaccines that did not pan out or had supply disruptions. And national governments snarled local efforts in red tape.

But the biggest explanation, one that has haunted the bloc for months, is as much philosophical as it was operational. European governments are often seen in the U.S. as free-spending, liberal bastions. This time, though, it was Washington that threw billions at drugmakers and cosseted their business.

Brussels, by comparison, took a conservative, budget-conscious approach that left the open market largely untouched. And it has paid for it.

In short, the answer today is the same as it was in December, Slaoui said. The bloc shopped for vaccines like a customer. The United States basically went into business with the drugmakers, spending much more heavily to accelerate vaccine development, testing and production.

“They assumed that simply contracting to acquire doses would be enough,” recalled Slaoui, whom President Donald Trump hired to speed the vaccine development. “In fact what was very important was to be a full, active partner in the development and the manufacturing of the vaccine. And to do so very early.”

‘Not Equipped for a Gunfight’

The European Union trailed the U.S. and Britain from the start.

Washington had already spent billions on clinical trials and manufacturing by the time Europe decided to pool its resources and negotiate as a bloc. In mid-June, the European Commission, the bloc’s executive branch, announced a joint vaccine purchase with a $3.2 billion pot.

In Washington, Operation Warp Speed, the Trump administration’s vaccine program, had a $10 billion budget. European officials say it’s unfair to compare the two figures because neither amount is a complete picture of all the money spent on vaccines. But there is no dispute that in Washington, officials had decided that money was no object if vaccines could avert the economic cost of a lockdown. Europe, on the other hand, was on a tight budget, so its negotiators chased cheaper doses.

“Pricing has been important since the beginning,” Sandra Gallina, the EU’s main vaccine negotiator, told lawmakers in February. “We are talking about taxpayers’ money.”

Europe’s first deal, with AstraZeneca, came in August, months after the U.S. And while Europe negotiated as a powerful buyer, it lacked the wartime procurement powers that the Trump administration had used to secure raw materials for companies.

That meant that the bloc was not first in line for the doses.

The United States made the negotiations easy — its critics say far too easy — by signing away any right to intellectual property and absolving the drug companies of any liability if the vaccines disappointed. Washington paid for the development and the trials; the companies had essentially nothing to lose.

Drugmakers expected the same concessions in Europe, but the back and forth over liability was the major stumbling block, Gallina said. European negotiators had to reconcile disparate liability laws across multiple countries, finding common ground among 27 leaders.

“In a crisis, it always becomes clear that the EU is not a country,” said Jacob Kirkegaard, of the German Marshall Fund. He said the bloc approached vaccine procurement like a contract negotiation when in fact “it was a zero-sum game with limited supply.”

“It was not equipped for a gunfight,” Kirkegaard said.

The Wrong Horses

European institutions are, by design, risk-averse. One of the founding tenets of the European Union is called the precautionary principle: The bloc errs on the side of caution when risks are unclear.

That, some analysts have said, hurt the bloc. German leaders argued for a heftier bet on vaccines from Pfizer-BioNTech and CureVac, but they were based on unproven messenger RNA technology and were more expensive. The bloc had just settled a thorny economic rescue package, and there was little appetite for more risk or spending.

It did not help that Europe backed the wrong horse in some cases. It spent billions on a vaccine candidate from French drugmaker Sanofi and Britain’s GSK that was delayed more than a year after disappointing results.

Europe lost even more time because its medical authorities were slow to approve the AstraZeneca vaccine, seeking to assure the public that it was safe. That “cost us two to three weeks of delay,” von der Leyen said this week.

The bloc fell further behind when national authorities in Germany, France, Italy and elsewhere raised concerns about dangerous clots and bleeding, and temporarily suspended use of the vaccine. Although the World Health Organization and European regulators reaffirmed its safety, the damage was done. Only 1 in 5 French people now trust the AstraZeneca vaccine, according to a poll by the Elabe Institute published Tuesday.

Now Europe is striking a more aggressive tone about protecting its interests. Italy blocked a small shipment of AstraZeneca vaccines to Australia this month. Von der Leyen upped the ante this week, threatening to use an emergency mechanism, last used during the 1970s oil crisis, that would allow the bloc to seize production of vaccines.

“It is hard to explain to our citizens why vaccines produced in the EU are going to other countries,” von der Leyen said.

A Lack of Flexibility

Early this month, Toon Vanagt, a Belgian tech entrepreneur, accompanied his 77-year-old father to a vaccination center north of Brussels. Vanagt, 47, was not eligible for the vaccine, but a worker offered him a leftover shot, which he gladly accepted.

Millions of Americans have been vaccinated this way, and software companies have rushed to link patients with doses that would otherwise expire. But in Belgium, when Vanagt tweeted that he had been vaccinated, it became a mini-scandal. Health officials rebuked the vaccine center, which quickly apologized: “A minor communication problem, very quickly rectified.”

Belgium’s rollout is one example of the continent’s rigid approach to following vaccination guidelines. In a country where nursing home infections led to one of the highest per capita death tolls, the policy was intended to strictly prioritize the neediest residents.

Many European countries are also stockpiling doses to guarantee that everyone who receives a first injection will receive the second dose on time. The United States and Britain have been more flexible, erring on the side of giving more first injections.

“In the U.S., there is a much more flexible, liberal system and you just vaccinate people who come along. Same in the U.K. And it can go quicker. Here it is quite regulated,” said Steven Van Gucht, the Belgian government’s top virologist, who said it was too soon to know which system is better.

Administrative hiccups have exacerbated the problems. In Frankfurt, Elke Morgenstern was escorted out of a vaccine center because she enrolled using the wrong online application. “It was embarrassing,” said Morgenstern, adding that she qualified for a vaccine because of a preexisting condition.

Because of the AstraZeneca shortages, she cannot book another appointment before May.

“It is a catastrophe how they are handling things here,” she said.

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