Perspective

“The pandemic is not over until it's over everywhere” - leading epidemiologist


The development of a vaccine against Covid-19 has been “unprecedented in the history of science,” says Professor Peter Piot, of the London School of Hygiene and Tropical Medicine. Professor Piot, who fell ill with coronavirus himself in May this year, was addressing an audience of Cazenove Capital clients.

Peter pointed out that within approximately one year since the first recorded case of Covid-19, we now have three vaccines with proven efficacy. “Normally, this kind of progress takes a decade.”

The success is in part due to an incredible degree of collaboration – both between the public and private sectors and between countries, he explains. This hasn’t always been the case. During the SARS epidemic, Peter recalls, there was far less willingness to share information. The recent rise in coronavirus cases has also helped speed development. “The US, where cases have sadly been surging, has at least provided an ideal vaccine testing ground”, he said.

The importance of 70%

In the very short term, there will not be enough doses of any of the vaccines to inoculate everyone. Countries will have to prioritize. In most cases healthcare and care home workers will be first, followed by the elderly.

Ultimately, around 70% of the population will need to be vaccinated to reach “herd immunity” and prevent transmission, suggests Peter.

We should not underestimate the logistical challenge. As the experience of “test and trace“ in the UK shows, it is unwise to assume that all governments are able to effectively handle logistical challenges of this scale. While some – especially in Asia – set up very effective test and trace systems, others floundered.

There is also widespread concern about the safety of drugs that have been developed so quickly, Peter cautions. Overcoming such concerns will be key to the success of a vaccine programme.

Peter points out that there will have to be a high degree of international co-ordination around vaccine distribution. In an inter-connected world, “the pandemic is not over until it's over everywhere.”

Choice will help distribution

“It is very good news that we already have the option of different vaccines,” Peter says. While more effective, vaccines developed by Pfizer/BioNtech and Moderna are also more expensive than the alternative developed by AstraZeneca and Oxford University. This gives more choice to countries that may be facing budget constraints.

Storage is another complicating factor. Pfizer/BioNtech’s vaccine must be stored at minus 70 degrees celcius. This is not an insurmountable obstacle, but it makes distribution harder.

The availability of different options is also medically important, especially as many questions about the vaccine – and the virus itself - remain unanswered.

“We do not yet know whether the immuno-compromised be able to take any of these vaccines,” he warns. “One may be more suitable than others.”

There are also question marks about the extent of the vaccines’ efficacy. We know that they prevent people getting ill – but not whether they actually stop transmission of the virus. We also don’t know how the vaccines will cope with virus mutations.

Research and support still required

There has been progress in the treatment of Covid-19, but it has been less dramatic than the success in vaccines.

The single most significant breakthrough is still the UK’s development of treatment using the steroid dexamethasone, which has cut mortality by around a third. Peter thinks that new treatments based on monoclonal antibodies look promising, but further testing is required.

There is also an urgent need for further research into “long Covid”, as the protracted forms of the viral infection are termed. The latest figures suggest that 5 – 10% of those who contract the virus go on to develop some form of this longer-lasting condition. It often impacts younger people, who may have had a mild initial infection but then struggle with fatigue and other symptoms for many months afterwards.

Preparing for the next pandemic

This is the time to start preparing for the next pandemic, argues Peter. “There will be others,” he warns.

“We can use the current crisis to be better prepared for the next one.” While it is in the news, there is a much better chance of securing funding for the long-term investments we to need to make in health care systems around the world.

Asia serves as a case study in the benefits of preparedness. “They really learned the lessons from SARS and have handled this pandemic so much more effectively.”

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