By Dr. Amanda King MBBS (UWI), FRCP (Glas.), FACR, SLMM
A year ago, I wondered why China did not shut down travel to prevent spread of the newly detected coronavirus, SARS-CoV-2 or COVID-19, but, of course, it was Chinese New Year, and economic as well as political factors would have influenced decisions.
On 30 January 2020, The World Health Organisation Director-General declared the novel coronavirus outbreak a public health emergency of international concern (PHEIC), WHO’s highest level of alarm. He stated, “First, there is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn’t recommend limiting trade and movement.” That puzzled me as Dr. Tedros Adhanom Ghebreyesus knew that the virus had been identified in eighteen countries outside of China by that time, with170 deaths reported in China.1I thought WHO should recommend global travel shut down for several weeks. I expressed this to colleagues and friends who thought this preposterous and impossible.
Over the last year, we have observed the natural progression of a virus, as it travelled via human vector to all corners of the earth due to inaction, delayed reaction, and the vagaries of human nature and behaviour.
There has been a flurry of science thrown at COVID-19. Never have there been so many scientific articles about one disease in so short a time. Unfortunately, results of poor science have gained attention alongside proper scientific research, leading to mistrust and contributing to conspiracy theories.
Vaccines have protected generations from many potentially devastating diseases — smallpox, measles and poliomyelitis, to name a few. Smallpox was eradicated via this strategy. The Global vaccine action plan was to eradicate measles by 2020. However inadequate vaccination programs in some ”developing” countries and some choosing to refuse vaccination in “developed” countries have meant that we have failed to reach that target. In fact, measles was eliminated in the USA in 2000, according to CDC, but this is no longer the case, and it demonstrates that, due to global travel, if there is infectious disease in one part of the world it will spread to susceptible populations elsewhere. COVID-19 is now stalling vaccination programs and making it more likely that the incidence of measles and other vaccine-preventable diseases will increase.2.3.
Creation of a vaccine is therefore an obvious strategy to combat COVID-19 and there was no delay in this effort. There are now hundreds of vaccine candidates, some with mechanisms never used before. Vaccination programs have started. Many have the impression that vaccines are the answer. However, they are only one prong in the multi-pronged approach required to overcome this global pandemic. The rapidly conducted trials boast a 95% reduction in symptomatic COVID-19 for Pfizer- BioNTech4 and 94% for Moderna5. Oxford- Astra Zeneca efficacy is averaged at 70%.6 We await more data on the Cuban vaccine, Soberana 02, and other vaccines.
The United Kingdom hurried to start vaccinating with the Pfizer vaccine on 8 December 2020 and only three weeks later announced they would not follow the studied protocol of a second dose in 21 days. They would allow up to twelve weeks between doses, to“protect the greatest number of at-risk people overall in the shortest possible time.7 This rationale is bewildering and will fuel mistrust as there appears to be inadequate scientific evidence for it. Scientists have called for this decision to be revisited.8
As the CDC has stated, it takes a few weeks to build immunity after a vaccine, and we do not yet know how long immunity lasts with the current COVID-19 vaccines. It may be several months. The vaccine has been shown to protect one against severe infection, with the efficacy as mentioned above, but, until more is known, the recommendation remains that, vaccinated or not, one must take the precautions of masking, distancing and sanitising to protect oneself and others.9
Vaccination programs are effective if we achieve herd immunity. According to WHO, for measles, this requires 95% of the population to be vaccinated, for polio, 80%. The percentage is not yet known for COVID-19.10Herd immunity may be difficult to achieve even in richer countries where the vaccine is affordable and accessible, since people may refuse to be vaccinated. Polls in the US suggest significant reluctance to take a vaccine, even though this has improved slightly. National surveys conducted by the Pew Research Center on 12 648 adults in the US, reported that, in November 2020 60% of Americans said they would definitely or probably take a vaccine, up from 51% in September. This is a far cry from requirements for herd immunity.11An article in the Wall Street Journal, 22 January 2021, states that at the current pace of vaccination, all Americans should get their first dose of vaccine by January 2022 ( if they so choose). On the other hand, according to The People’s vaccine alliance and other sources, 90% of people in poor countries are unlikely to receive a COVID-19 vaccine in 2021 due to inequitable global distribution and hoarding by richer countries.12 COVAX and other initiatives are applauded, but providing vaccines for 20% of a population leaves a large unmet need.
COVID-19 has been mutating, as expected. The B-117 strain identified in the United Kingdom in September 2020, has been noted to spread 30-70% faster than the previous strain and a report published by the BBC on 22 January 2021 suggests it may be up to 30% more deadly, although it may be too early to say.13 It is expected to respond to the Pfizer and Oxford-Astra Zeneca vaccines, however there is concern about the two new variants in South Africa and Brazil. On 24 January 2021, the BBC reported 77 cases of the South African strain in the UK.14,15
I note all of the above to say that we have to keep learning from science and experience and we must be prepared to adapt strategies to suit.
Prevention is always the cost-effective, safe, humanitarian management strategy in public health.
We have witnessed in most countries the yoyo of increasing cases followed by reductions in numbers, best suppression with early decisive intervention, then increases in numbers again as restrictions are lifted. We can look forward to this for at least another year with our current approach.
Trillions of dollars have been spent on vaccines, treatment modalities including targeted monoclonal antibody development, as well as PPE, testing, tracing, hospitalisations, stimulus packages and other Governmental support across the world. Oxfam reports 11.7 trillion spent overall on COVID in 202016, and President Biden has already proposed a stimulus package of 1.9 trillion dollars for national COVID relief.17 Imagine what could be done if there was a “Thinktank” that thought through this problem on a global humanitarian scale and assigned monetary and human resource to create solutions for all.
There has been the argument of “lives vs livelihoods”, which I hope people realise is farcical since the two are inextricably linked. The countries that have had aggressive elimination strategies with early lockdowns and support for their population, e.g. New Zealand, Taiwan and mainland China, have suffered far less economically than other countries with suppression and mitigation policies.18
Education of this generation is also suffering and this will have an untold negative effect in the future, if not addressed promptly.
Do we not see that the only answer is a coordinated global approach? I believe we can eradicate the virus from the world if we all take decisive action at the same time. Until that time we must individually take all precautions– mask, distance, sanitise in an effort to suppress numbers. Elimination will only occur at this time if borders also close. We must expand testing, improve time from test to result, interpret tests appropriately, use technology to improve contact tracing, and use all resources across public and private sectors to help the fight.
I propose that all stakeholders come together– from international organisations, foundations, billionaires, businesses, social media platforms, to governments, NGO’s, public/private, villages, communities, individuals everywhere in this global village.
Almost everyone has access to a phone. Those who don’t must be provided with access to one or to an information stream.
We would plan for a shutdown of all travel and limit people to their homes, except for truly essential work with enforced protocol, for a period of six weeks.19,20 We could plan this from April to May 2021 perhaps, if we work quickly.
Every country would work out the budget required to support people during that month. Vulnerable people would be identified. Food, water, shelter must be guaranteed for those who cannot provide for themselves. Any infrastructure necessary would use a “koudmen” (individuals in communities volunteering to help each other) strategy as much as possible to reduce cost and engage and empower citizens and encourage volunteerism.
An educational program tweaked for various regions, utilising the genius of behavioural scientists and psychologists, should be rolled out immediately. The aim would be to show people the benefit of elimination. We should also encourage people to do a self-management program to improve self-efficacy. This should encourage healthy behavioural choices, including adherence to wearing masks.
Six weeks of global, coordinated sacrifice vs at least another year of uncertainty, illness, death, economic depression, which is already said to be worse than the 1930s.
COVID is but one pandemic. More pandemics are predicted and are more likely if any of us live in squalid conditions. This is the world’s opportunity to save the lives and livelihoods of the privileged with a cost-effective management strategy that will also improve the lot of the underprivileged.
I hope that if you agree you will use your voice, whatever volume you believe it is, your expertise, your contacts, to reach the people in positions to make this global collaboration a reality.
In the meantime, each of us influences our own little world. Let us be the change we want to see.
We can make this world a brighter place together. Let’s do it!
Thank you for reading.
- Home [Internet]. [cited 2021 Jan 25]. Available from: https://www.who.int
- Patel M. Increase in Measles Cases — United States, January 1–April 26, 2019. MMWR Morb Mortal Wkly Rep [Internet]. 2019 [cited 2021 Jan 25];68. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6817e1.htm
- Patel MK. Progress Toward Regional Measles Elimination — Worldwide, 2000–2018. MMWR Morb Mortal Wkly Rep [Internet]. 2019 [cited 2021 Jan 25];68. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6848a1.htm
- Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med [Internet]. 2020 Dec 31 [cited 2021 Jan 25];383(27):2603–15.
Available from: http://www.nejm.org/doi/10.1056/NEJMoa2034577 5. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al.
Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J
Med [Internet]. 2020 Dec 30 [cited 2021 Jan 25];NEJMoa2035389.
Available from: http://www.nejm.org/doi/10.1056/NEJMoa2035389
- Knoll MD, Wonodi C. Oxford–AstraZeneca COVID-19 vaccine efficacy.
The Lancet [Internet]. 2021 [cited 2021 Jan 25];397(10269):72–4.
Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620326234
- Revisiting the UK’s strategy for delaying the second dose of the Pfizer covid-19 vaccine [Internet]. The BMJ. 2021 [cited 2021 Jan 25]. Available from: https://blogs.bmj.com/bmj/2021/01/20/revisiting-the-uks-strategy-fordelaying-the-second-dose-of-the-pfizer-covid-19-vaccine/
- Iacobucci G, Mahase E. Covid-19 vaccination: What’s the evidence for extending the dosing interval? BMJ [Internet]. 2021 Jan 6 [cited 2021 Jan
25];372:n18. Available from: https://www.bmj.com/content/372/bmj.n18
- CDC Works 24/7 [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2021 Jan 25]. Available from: https://www.cdc.gov/index.htm
- Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID19 [Internet]. [cited 2021 Jan 25]. Available from:
- Intent to Get a COVID-19 Vaccine Rises to 60% as Confidence in
Research and Development Process Increases [Internet]. Pew Research Center Science & Society. 2020 [cited 2021 Jan 25]. Available from:
- Rich countries hoarding Covid vaccines, says People’s Vaccine Alliance.
BBC News [Internet]. 2020 Dec 9 [cited 2021 Jan 25]; Available from: https://www.bbc.com/news/health-55229894
- Welle (www.dw.com) D. UK COVID variant could be slightly deadlier, early evidence shows | DW | 22.01.2021 [Internet]. DW.COM. [cited 2021 Jan 25]. Available from: https://www.dw.com/en/uk-covid-variant-could-beslightly-deadlier-early-evidence-shows/a-56319288
- UK has 77 cases of South Africa mutant Covid as Hancock warns of other strains [Internet]. The Sun. 2021 [cited 2021 Jan 25]. Available from:
- Steinhauser G. The New Covid-19 Strain in South Africa: What We Know. Wall Street Journal [Internet]. 2021 Jan 25 [cited 2021 Jan 25]; Available
- Global cost of coronavirus: $11.7 trillion- Business News [Internet]. [cited 2021 Jan 25]. Available from: https://www.businesstoday.in/current/world/global-cost-of-coronavirus-thisis-how-much-covid19-pandemic-has-cost-the-worldeconomy/story/425100.html
- CNN TL and KL. Here’s what’s in Biden’s $1.9 trillion economic rescue package [Internet]. CNN. [cited 2021 Jan 25]. Available from: https://www.cnn.com/2021/01/14/politics/biden-economic-rescue-packagecoronavirus-stimulus/index.html
- Baker MG, Wilson N, Blakely T. Elimination could be the optimal response strategy for covid-19 and other emerging pandemic diseases. BMJ [Internet]. 2020 Dec 22 [cited 2021 Jan 25];371:m4907. Available from: https://www.bmj.com/content/371/bmj.m4907
- Why A 5-Week Lockdown Can Stop COVID-19 [Internet]. New England Complex Systems Institute. [cited 2021 Jan 25]. Available from:
- Six Week Strategy For Success In Saint Lucia Against COVID-19 [Internet]. St. Lucia Times News. 2020 [cited 2021 Jan 25]. Available from:
Note: The views and opinions expressed in this article do not necessarily reflect the policy or position of St Lucia Times.