We better prepare: Covid-19 will persist even after vaccination

                                   COVID-19 CONTINUITY OF LEARNING ...

 We better prepare

 Covid-19 will persist even after vaccination 

By Marc Vandepitte: When the vaccination campaign started at the end of 2020, it was hoped to be able to resume a normal life within a reasonable period of time. But there were no worrisome new variants. Today the success of a vaccination campaign is no longer a guarantee of having defeated the virus. We will likely still have to learn to live with covid for a while.

 Herd immunity 

 The favorable outlook we had at the end of last year was based on the hope that we could create group immunity quite quickly thanks to vaccines, either by vaccination or by past exposure to the virus (1). Herd immunity makes the virus disappear. At first it was thought that it would be enough to immunize between 60% and 70% of the population to achieve this, but with the new variants and based on new knowledge, this percentage will have to be much higher and the possibility is even considered that we never achieve herd immunity. 

First, infection-induced immunity decreases over time. This is also the case for the other coronaviruses. Several studies show that the current immunity induced by the infection is maintained for at least six months and in people who have had severe symptoms the duration is at least eight months, after which the immunity can diminish and disappear. On the other hand, the results obtained in South Africa and Brazil have shown that a previous infection offers a weak immunity against the new variants. This means that vaccination remains as a means of obtaining long-lasting group immunity. But for this we have to overcome at least five obstacles.

 The limits of vaccination

 First, some variants behave almost like new viruses, against which vaccines offer only partial protection. The mismanagement of governments, especially in the West, has caused 143 million people to be infected to date. This uncontrolled spread favors the possible appearance of new mutations against which current vaccines do not protect.

 Second, the protection offered by vaccines is not supposed to be permanent. We still know little about it, but experts assume that vaccines provide protective immunity for a period of between six months and two years, so it has already been said that you will have to be vaccinated again after six months to guarantee protection durable. In Israel, the vaccine passport is also valid for six months. 

Third, it is not known whether or to what extent the vaccines themselves prevent infection. They are supposed to prevent contagion to a great extent, but it has not yet been categorically established. It is not a trivial detail. "Group immunity is only relevant if we have a vaccine that blocks the spread. If this is not the case, the only way to achieve herd immunity is to vaccinate everyone, ”said Professor Bansal of Georgetown University in Washington DC. 

 Fourth, very few people are being vaccinated. With the current variants, at least 80% of the population should be vaccinated to have group immunity. Currently only some countries reach that 80%. In addition, all people under 18 must be discounted because they will probably not be able to be vaccinated before 2022, at the earliest. They represent at least one fifth of the population. 

 Lastly, the vaccination rate is slow and chaotic. Given the urgency, we could and should have put companies to work, as in a war economy, but instead, production has been entrusted to some pharmaceutical giants and, as a consequence, drug campaigns. vaccination have been much slower. 

Vaccine nationalism 

At the current rate of vaccination, vaccines will run out before they can be administered to the entire population. In rich countries we may be able to get vaccinated several times a year against the latest variant, but we can ask ourselves whether it will be fast enough or complete enough to achieve herd immunity.

 The situation is much worse in poor countries, because the distribution of the limited supply of vaccines is very uneven. Rich countries, which represent 20% of the world's population, have bought 55% of all vaccines. Many people in poor countries will likely have to wait until 2023 or 2024 to be vaccinated.

This vaccine nationalism has only a short-term vision. Even in the case of a country with a high vaccination rate, the possibility of new epidemics persists if neighboring countries have not done the same and if populations can mix. The risk of becoming ill from a new variant in a country with a low vaccination rate is four to six times higher than in a country that has been vaccinated. "No one is truly protected from covid-19 as long as not everyone is," said the experts of the Lancet Commission on covid-19.

 

 "Maximum suppression" 

 

Every day there are more than 750,000 new infections in the world. With such a high rate of infection, it is inevitable that new worrisome variants will spread against which vaccines or previous infections will not provide immunity. The longer this situation continues, the more likely it is that these variants will multiply. According to the experts at the Lancet Commission, we are in a race against time to make the transmission rate around the world low enough to prevent the emergence and spread of new variants. 

 

Pride regarding vaccines is misplaced. According to experts, a successful vaccination campaign alone no longer guarantees victory over the virus. Chile is a good example of this: currently 60% of the population has already received the first dose of the vaccine, but the number of infected people continues to rise. In a population of 19 million people every day there are almost 7,000 new infections and a hundred deaths from covid.

 

 Therefore, the experts of the Lancet Commission advocate a "maximum suppression" of covid-19. It is vitally important to reduce the number of infections significantly, not in the long term, but as soon as possible. It involves not only vaccinating, but also taking well-known measures such as limiting contacts, maintaining strict security measures (face masks, hand cleaning, safety distance, good ventilation, etc.), rapid detection, and accurate and fast tracking of all contacts.

 

 Countries like Taiwan, China, Australia, Vietnam and New Zealand show that the virus can be eradicated in practice. Regions where the virus is rampant continue to serve as a breeding ground for resistant variants, and we will never be able to stop the pandemic. 

 

 Experts believe that several things still need to be done in addition to greatly reducing the number of infections. First of all we must distribute vaccines equitably around the world and accelerate vaccination programs in all countries, but this cannot be done without abolishing patents and planning production. Second, we need surveillance programs capable of detecting new variants based on DNA sequencing techniques. Third, international research needs to be done on the efficacy of vaccines for both existing and new variants of concern. There is still much work to be done in these three areas. 

 

 Winter waves 

 

 Infectious diseases have the common characteristic of becoming more infectious but less potent over time. Ultimately, if the host does not die, it is an advantage in the natural selection of the virus. Apparently that is not the case with the current virus. The known variants are more contagious, but no less dangerous, quite the opposite. 

 

 If this trend continues, considering that we cannot get a group immunity in the current situation, we will probably have to face a permanent cycle of spikes and regressions. It is likely that, as in the case of the flu, the seasonal factor also plays a role in this case. New epidemics are to be expected, especially in winter. According to the famous virologist Peter Piot, next winter the reproduction factor (2) could be even higher than last winter if there are no masks and no safety distance, despite the protection provided by vaccination. That is why Peter Piot defends that masks are mandatory during the months in which there is a peak, encourage teleworking and online education (in the case of large groups) and encourage people at risk (for example, those over 65 years or with a health problem) to avoid large events or public environments such as bars, restaurants, etc. He also proposes increasing the capacity of intensive care units during the winter months. 

 

 The new normal

 

Eradicating a virus is not easy. Smallpox is one of the rare pandemics that was completely defeated in the past. Like the flu, Covid-10 will likely never be completely eradicated 

 

 The good news is that very effective vaccines have been found very quickly. As Israel has shown, they lead to a decrease in infections and a significant reduction in hospitalizations or deaths (3), which means that lockdowns can probably be avoided in the future. But, as we have seen before, vaccines alone will not be enough.

 

 In short, the question is not to know in how long we will return to normality, but what kind of normality it will be. At least for now, the new normal will be a normal without herd immunity and therefore with the necessary precautions and protective measures. In the long term, covid-19 could then evolve into an endemic disease (4) like the flu.

 

 Both we and our society have to prepare ourselves to face it as best as possible. At the beginning of the covid-19 crisis we failed cruelly, it would be unforgivable to do so again once the crisis has advanced. 

 

Original source: De Wereld Morgen. Translated from Dutch into French by Anne Meert for Investig’Action.