Debate: can big countries eliminate coronavirus without a vaccine?
Description Four experts on whether immunity without a vaccine is a realistic
goal Credits Olga Maltseva/AFP/Getty Alt Text A coronavirus vaccine research lab
in Russia Four experts on whether immunity without a vaccine is a realistic goal
In Depth The Week Staff Monday, July 13, 2020 - 10:14am Angharad Davies, Swansea
University; Andrew Lee, University of Sheffield; Jimmy Whitworth, London School
of Hygiene & Tropical Medicine; Lakshmi Manoharan, University of Oxford The UK
should change its Covid-19 strategy to try to eliminate Covid-19 even without a
vaccine rather than simply managing the disease, according to Independent SAGE,
a group of scientists set up as an alternative to the government’s advisory
body. New Zealand has effectively managed to eliminate the virus, but can states
with much larger, denser populations that have experienced much bigger outbreaks
hope to do the same? Or is it more realistic to accept that the disease is
likely to continue to circulate at some level and plan for that? We asked four
experts for their views. Angharad Davies, clinical associate professor in
microbiology at Swansea University Elimination or near-elimination in the UK
would require ambition and huge effort, organisation and resource but I believe
it is possible. The effort would mean accepting fewer freedoms in the medium
term. Crucially, it would rely on trust in authority and willingness to comply
with restrictions. The incentive would be that, if we achieved elimination, we
could go back to a state closer to normal, and a healthier local economy even
without a vaccine. The effort would have to be sustained until then, and if no
effective vaccine transpires – which is possible – then the question is how long
this approach could justifiably continue in the face of a virus endemic
globally. Lakshmi Manoharan, medical epidemiologist at the University of Oxford
Suppressing the virus to a low level before allowing economic and social
activity to resume as normal is important. Doing otherwise will risk the
possibility of the UK having to go in and out of lockdown numerous times. That
would be more harmful for society and the economy, compared to implementing more
stringent measures in the short term. Recent studies have shown that the number
of people with Covid-19 antibodies in coronavirus hotspots such as Wuhan and
Spain is still low. This means that despite high numbers of cases and extensive
community transmission, the majority of the population is still susceptible to
the virus. Allowing economic and social life to resume while this is the case
and in the absence of a vaccine may lead to a larger second wave of infection.
The emphasis should be on strong measures such as border quarantines and a
robust test, trace and isolate system to reduce infection rates before relaxing
economic measures, opening schools and allowing “air bridges”. We need to focus
on reducing the amount of community transmission first, which allows for spread
of infection into our most vulnerable populations. Jimmy Whitworth, professor of
international public health at the London School of Hygiene and Tropical
Medicine See related Coronavirus: the vaccines on trial - and when they may be
ready Coronavirus: why antibody rates vary so widely from place to place Herd
immunity doubts as Spanish study finds just 5% of population have Covid
antibodies We need a sense of proportion in countries that have reduced the
total mortality rate to normal levels, as the UK has now done, showing that the
first peak of the epidemic has passed. Once the number of new cases is under
good control (one new case a day for every million of population is reasonable)
we can allow social and economic life to resume. We can also shift more
attention to general physical and mental health. We need to continue to maintain
some physical distancing measures, combined with effective testing and contract
tracing to prevent the inevitable clusters expanding into a second wave. But to
try to eliminate all cases, and to sustain a zero-Covid state, would take
enormous resources. This would produce diminishing returns as the number of
cases goes down – and other aspects of life would suffer. We have seen this with
countries attempting polio elimination, where routine health services may
suffer, and with malaria elimination where the cost of averting each case
rapidly increases as the number of cases goes down. Getting the number of cases
down to manageable levels might eventually lead to zero cases temporarily, but
we do not currently have effective measures to keep it at zero. In particular,
border quarantines are not likely to be effective unless rigorously and
universally applied with consequent disruption of all business travel, tourism
and international trade. Border quarantine won’t be effective unless it is
universal. Nick Ansell/PA Wire/PA Images Andrew Lee, reader in global public
health at the University of Sheffield Elimination of Covid-19 in high-income
countries is both possible and realistic. Ebola elimination was achieved in
parts of Africa through disease control measures rather than a vaccine,
including disease surveillance, infection control, changing social norms (for
example around physical contact) and public communications. This demonstrates
elimination is possible even in low and middle-income countries with fewer
resources. The key determinants, as with all infectious disease control
programmes, are the political and societal will to achieve this. Because it
requires a multi-pronged approach, it needs resourcing, leadership and
commitment to deliver. So the question becomes: “What are we prepared to pay or
sacrifice to achieve this?” But in our interconnected globalised world it is not
enough to eliminate the virus in just a few countries. Countries where the
disease is endemic act as reservoirs of infection and can reinfect others. This
is a global health threat that requires global leadership and coordinated action
if we are to eliminate it. Angharad Davies, clinical associate professor at the
Swansea University; Andrew Lee, reader in global public health at the University
of Sheffield; Jimmy Whitworth, professor of international public health at the
London School of Hygiene & Tropical Medicine; Lakshmi Manoharan, medical
epidemiologist at the University of Oxford This article is republished from The
Conversation under a Creative Commons license. Read the original article. UK
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