At the outbreak of World War 1 in August 1914, enthusiastic patriots on both sides were assured it would be over by Christmas. At the declaration of the COVID-19 pandemic in January 2020, there was a general assumption that life would be back to normal by Easter. In neither case did events pan out that way. War-weariness and its modern equivalent, pandemic-weariness, have set in.
It's a comparative analogy used by noted infectious disease experts, Burnet Institute Director Professor Brendan Crabb, Scientia Professor of Respiratory Medicine, University of New South Wales, Guy Marks and Professor of Global Biosecurity at The Kirby Institute, Raina MacIntyre in their article in Health Policy Watch.
With predictions from some quarters of a "reprieve" after the peak of the Omicron crisis passes, the expert trio propose a "vaccine plus" strategy that is based on three pillars - current and new tools, embracing the central importance of preventing airborne transmission and a major shift in attitude to equity.
While COVID-19 cannot be eradicated, the authors write that we can stop sustained community transmission. This status is known as "elimination"30633-2/fulltext ""). In this situation outbreaks may still occur, but they do not become overwhelming.
Mobilising current and new tools
"Moderna and Pfizer have indicated that their new Omicron-specific vaccines will be ready to present to regulators in March this year. The current rapid spread of Omicron may be due to immune evasion rather than any innate increase in transmissibility.
"If this is the case, then an Omicron-matched vaccine would have substantial impact. So, although widespread natural infection can induce an immune response, it will not produce sustained widespread protective immunity and does result in substantial harm. > Vaccination is the only route to achieving herd immunity, and the pipeline is dynamic with many innovations to come."
"We may not even have all the right tools just yet although some are on the way. Easy to administer tools (such as nasal sprays) as well as transmission blocking vaccines which are on the horizon and pan-coronavirus vaccines that are active against current and future variants and are currently in pre-clinical evaluation would greatly improve the feasibility of progress towards elimination.
Many minds and skillsets will need to come together to consider the biology, epidemiology and technological solutions."
Preventing airborne transmission "Some slippages in either the effectiveness of vaccination (such as the level of neutralising antibodies, population coverage due to refusal to accept the vaccine, etc) can probably be accommodated by implementation of additional measures to reduce airborne transmission.
"These measures include universal use of well-fitted N95 masks indoors and in close-contact outdoor environments, effective ventilation and filtration of indoor environments, and effective implementation of testing, tracing, isolation and quarantine (TTIQ) procedures using sophisticated AI-enabled tools."
"A tragic consequence of the sluggishness of national and international health authorities in accepting the singular importance of airborne transmission of the virus is that, two years into the pandemic, these simple and effective non-pharmaceutical interventions, and other actions to promote safe indoor air, still have not been universally adopted."
A major shift in attitude to equity. "Massive numbers of people affected in non-immune populations, together with chronic infection in some immunosuppressed individuals, increase the risk of new variants emerging.
"Natural selection, the biological basis of evolution, means that variants that are "successful" will be even more transmissible than the current dominant strains.
"Whenever uncontrolled transmission is occurring somewhere in the world, new SARS-CoV-2 variants that can escape from existing immunity and cause a further global wave of COVID-19 disease will continue to arise across the world."
"The only sustainable solution is to reduce the number of people getting COVID-19 and to do it everywhere."
Even reducing the global burden by half would substantially reduce the likelihood of a new variant of concern appearing in a given time period."
"Clearly, the backbone of the response needs to be effective, equitable and acceptable vaccination regimens. Work will need to be done to optimise vaccine effectiveness and to overcome major barriers to distribution, including supply, cost and acceptance. It is worth noting that humanity lived with smallpox for centuries.
"Only a concerted global effort to vaccinate the world resulted in smallpox eradication and that took 20 years to achieve."
We must act now "A commitment to reducing numbers is our only way out.
"The longer we wait to shift gears and raise ourselves from our pandemic-weariness, the harder it will be."
We need to look beyond the current wave.
Rather than cross our fingers with a one-dimensional-vaccine only strategy, and a grossly inequitable one at that, we need to do the hard work to end the pandemic. The benefits of an elimination approach will come much quicker than people think; just halving COVID-19's impact would change the world."
Read the full article at Health Policy Watch
