Marc Vandepitte writes: When the vaccination campaign got underway at the end of 2020, we expected to have a normal life again in the foreseeable future. However, that was without reckoning with new, worrying variants. Today, a successful vaccination campaign in itself is no longer a guarantee of victory against the virus. We will probably have to learn to live with corona for a long time.i
The favorable prospects we had at the end of last year were based on the expectation that vaccines would allow us to build up herd immunity fairly quickly, either through vaccination or past exposure to the virus.
Herd immunity makes the virus disappear on its own. Initially it was thought that inoculation of 60 to 70 percent of the population would be sufficient for this. But with the new variants and taking into account new insights, we realize that the percentage will have to be a lot higher. We should even take into consideration that we will never achieve herd immunity.
For one thing, infection-induced immunity declines over time. This is also the case with other coronaviruses. Studies indicate that current infection-induced immunity lasts for at least six months, and at least eight months in people who have developed severe symptoms. Afterwards, immunity may weaken and disappear. In addition, findings from South Africa and Brazil have shown that previous infection offers little immunity to the new variants.
This means vaccination is left as a way of acquiring permanent herd immunity. But here there are at least five obstacles.
The limits of vaccination
First of all, some variants behave almost like new viruses, against which vaccines offer only partial protection. Governments’ clumsy corona approaches, especially in the West, have resulted in 136 million people being infected to date. This uncontrolled spread increases the risk of new mutations that current vaccines do not protect against.
Second, it is believed that the protection of the vaccines is not permanent. People are still in the dark about this, but experts believe the vaccines provide protective immunity for six months to two years. That is why boosters are already available to ensure lasting protection after six months. In Israel, the validity period of a vaccine passport is also six months.
Third, it is not certain whether and to what extent the vaccines will stop the infection itself. It is suspected that they prevent the transfer to a large extent, but there is still no definitive answer. That is not an unimportant detail. “Herd immunity is only relevant if we have a transmission-blocking vaccine. If we don’t, then the only way to get herd immunity in the population is to give everyone the vaccine,” said Professor Bansal of Georgetown University in Washington DC.
Fourth, not enough people are being vaccinated. With the current variants, at least a good 80 percent of the population must be vaccinated to achieve herd immunity. Only a handful of countries currently reach the 80 percent willingness to be vaccinated mark. Moreover, you still have to deduct all youngsters under the age of 18, because they will probably not be able to get a vaccine until 2022 at the earliest. This is about at least one fifth of the population.
Finally, there is the slow and chaotic roll-out of the vaccines. Given the urgency, we could and should have put companies to work, as in a war economy. Instead, production was left to a few pharmaceutical giants. As a result, the vaccine campaigns are running far too slowly.
At the current rate of vaccination, the effect of the vaccines will be finished sooner than they can be administered to the entire population. In the rich countries we may get vaccinated against the newest variants several times a year, but the question is whether this will be fast or complete enough to achieve herd immunity.
The situation is much worse in the poorer countries because the distribution of the limited supply of vaccines is very uneven. Rich countries, which account for 20 percent of the world’s population, have bought up 55 percent of all vaccines. Chances are high that many people in poor countries will have to wait for their vaccine until 2023 or 2024.
This vaccine nationalism is shortsighted. Even for a country with high vaccination coverage, the potential for new outbreaks remains if neighboring countries have not done the same and the populations can mix. The world is four to six times more likely to get a new variant from an under-vaccinated country than from a vaccinated country. “No one is truly safe from Covid-19 until everyone is,” said experts from the Lancet Commission on COVID-19.
Every day there are almost 700,000 new infections worldwide. With such a high rate of infection, new worrisome variants will inevitably emerge that will spread and against which vaccinations or previous infections will not provide immunity. The longer that situation persists, the more we may expect such variants. According to experts at the Lancet Commission, we are in a race against time to get global transmission rates low enough to prevent the emergence and spread of new variants.
Vaccine arrogance is misplaced. According to the experts, a successful vaccination campaign in itself is no longer a guarantee of victory against the virus. Chile is a good example of this: today 60 percent of the population has already received a first dose of vaccination, but the number of infections is still increasing. In a population of 19 million, there are 7,000 new infections and 100 COVID deaths every day.
That’s why experts at the Lancet Commission argue for a “maximum suppression” of COVID-19. It is vital to significantly reduce the number of infections, not over time, but as fast as possible. This means combining vaccination with known measures such as limiting social contacts, maintaining strict safety measures (mouth masks, hand hygiene, safe distance, better ventilation, etc.), fast testing, accurate and fast tracing of contacts.
Taiwan, China, Australia, Vietnam and New Zealand have shown that it is possible to almost completely eradicate the virus. Regions where the virus is raging continue to act as breeding grounds for resistant variants. In this way we will never subdue the pandemic.
In addition to the strong reduction in the number of infections, a number of other things are needed, according to the experts. First, we need to distribute vaccines fairly worldwide and accelerate vaccine programs in all countries. That will not be possible without the removal of patents and without production planning. Second, surveillance programs are needed that enable us to detect new variants based on DNA sequencing techniques. Third, international research is needed into the effectiveness of vaccines on existing and new “variants of concern”. There is still a lot of work to be done in these three areas.
A common pattern of contagious diseases is that they become more contagious over time but less potent. After all, if the host does not die, this provides an advantage in the natural selection of the virus. This is apparently not the case with the current virus. The known variants so far are more contagious but no less dangerous, on the contrary.
If that trend continues, and given that we cannot achieve group immunity in the current constellation, we are likely to face a permanent cycle of outbreak and relapse. As with the flu, the seasonal factor may also play a role here. Especially in the winter periods, we can expect new outbreaks for the time being. According to top virologist Peter Piot, in the absence of masks and keeping a safe distance next winter, the reproduction rateii could even be higher than during the previous winter. That is, despite the protection of vaccination.
That is why Piot advocates making face masks mandatory during peak months, promoting teleworking and digital education (for larger groups), and motivating people at risk (e.g., over 65 years old or with a health problem) to avoid attending large events or public settings such as bars, restaurants, etc. He also advocates increasing the capacity of the IC units during the winter months.
The new normal
Eradicating an infectious virus is not self-evident. The smallpox virus pandemic is one of the few to have been completely overcome in the past. Like the flu virus (Influenza A), Covid-19 will probably never be completely eradicated.
The good news is that very efficient vaccines have been found quickly. As Israel shows, they cause fewer infections and significantly fewer hospitalizations or deaths.iii As a result, lockdowns may be avoided from now on. But as we saw above, vaccines alone will not get us there.
All in all, the question is not how soon we will return to normalcy, but what kind of normalcy that will be. The new normal will in any case – for the time being – be one without herd immunity and therefore with the necessary precautionary and protective measures. In the long term, COVID-19 could then evolve into an endemic diseaseiv such as the flu.
We had better prepare ourselves, but also our society, to dealing with this as well as possible. We seriously messed up the approach start of the corona crisis. It would be unforgivable to screw up the rest of the crisis too.
Translation: Dirk Nimmegeers
ii The reproduction factor is the average number of people who infect a carrier of the virus.
iv In an endemic disease, outbreaks are fairly constant in number and remain local.