Covid-19 elimination

The British Medical Journal (BMJ) recently reported Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases and medical advisor to the US President, as stating that “we will likely get somewhere between control and elimination, more likely closer to control”

As long as there are anti-vaxxers we will not eliminate the virus as there will be large sections, and not merely clusters, of people who are not vaccinated and who can not only get the virus but transmit it to others and indeed form an environment in which more variants will occur. People should know that they are responsible for the deaths of people occurring due to a non-optimal uptake of the vaccine, whether they wish to believe it or not.

Conversely it is being shown also that most people who are being hospitalised with Covid-19 and its variants are those who were not vaccinated. Many of these died. For their own benefit and for that of others, it is worth reconsidering. Do not risk your lives and those of others. Our freedom is precious, but if it is causing death in other people we are morally, although not legally, responsible.

It should be noted that elimination is not eradication. By eradication one means a total “permanent reduction to zero”. Besides being impossible this is not warranted for a safe postCovid world. In countries where diseases, in the past, were eradicated, vigilance went down and invariably the microbe cropped up again. Small clusters of the virus will therefore keep us vigilant and able to formulate vaccines in time. This is what happens with the flu vaccine in a way. If the flue were to be eradicated completely, the vaccine programme would stop and when eventually another virus comes out there will be no herd immunity from past vaccinations, let alone the new vaccinations produced in time.

What we cannot afford is another Covid-like scenario with worldwide lock-downs, trucks carrying dead people and the Pope preaching to an empty, dark and rainy St Peter’s square. It was rock-bottom. We were all present of course, but in our homes. We still need to start comprehending the immensity of this virus and certainly we cannot afford to go back to the same conditions. Certainly, countries which put the rest of the world at risk have to have serious vigilance and cannot go on unpunished for trying to influence the large organisations. The fact that China is not accepting responsibility and indeed did not restrain the virus from going out of the country is certainly something of concern. Diplomacy has its limits. To add insult to injury, it was the country which financially benefitted and capitalised most – even making a vaccine – Sinovax – without getting the mandatory approval of the WHO, which helped it in the first place by not recommending the closing down of borders.

China is a very nice place; the Chinese even more so. I have been there and was treated very well. Many indeed capitalise on Chinese products because they are cheaper than Western ones. So, the Western capitalist businessman has also gained from Chinese communism. People do not live in misery and comments from westerners living there are all positive about the people and culture. Yet there remains a lot of public health issues which remain un-tackled. This is perhaps due to lack of serious democratic opposition, while we have to concede that out of the Communist countries it has been the most successful in forming relations and boosting its economy. However, it is rather more self-centred than other countries. The suspected cover around the Wuhan Institute of Virology (MIV), as reported in last week’s The Economist, are testimony to this. China would have done well to simply admit the possibilities and encourage investigations. The ones that did take place “allowed the Chinese hosts to frame the joint study’s work in the way which suited them best”. This, combined with the fact that the Chinese law does not allow publishing of Covid-related studies in scientific journals before being “reviewed by the government”, only harms a country which wants to foster faith in itself with the West. Contrast how the US government admitted that it could not rule out that civilians were also hit when a drone bombed a Taliban suicide bomber in Afghanistan this week.

Let’s face it, even in democracies we have corruption and nonideal situations, but at least we can understand each other more in emergency circumstances. The West does not follow an eachone-on-their-own situation. Countries, which produce vaccines and do not go through the scrutiny which Astra-Zeneca and others went through, are simply taking things into their own hands. Sputnik and Sinovax will remain a reminder of this – they did not foster trust. Even if they did the required studies, many will now doubt them to be skewed. I doubt the day will ever come when we will see what happened to the Astra-Zeneca vaccine happen in these countries. Sending non-WHO approved vaccines to developing countries is not reassuring at all. Now one has to be realistic. One cannot say they are not good vaccines – only that they have not gone through the clinical trials, albeit speedy, that the Western ones did. Countries move with different standards. If we cannot cooperate on these emergencies, one wonders about the emergencies which will inevitably arise due to climate change.

Therefore, the clusters here and there are certainly not worldwide groups as the anti-vaxxers are. The latter do not help to eliminate the disease. We will be faced with more expenses and more and more vaccination. Freedom or no freedom, there comes a time when one needs to think about others. It may hit you after all. Tacking a ride on the herd immunity is hypocritical as you are indirectly accepting the vaccination programme – only “let others take the risk and not me”. No country will have zeroCovid for a long time. Even with border restrictions and quarantine, as the BMJ continues to say. Australia was quoted as an example, but despite their setbacks, Australia and New Zealand remain healthy economically.

We have witnessed serious failures in the WHO in its global response. But at least the WHO was responsible enough to set up a panel itself; a panel which scathed it and said that its response was a week late, which could have prevented the disaster. Moreover, it seriously questioned its interpretation of the “Solidarity” policy in its guidelines on the response to the pandemic. Solidarity ought to come before the spread – solidarity with countries whose borders need to be closed. The WHO ought also to take a more serious approach which goes beyond diplomacy, as it inherently is, after all, a Public Health body that ought to admonish and at least to recommend the closing down of borders. Countries, which do not follow the advice, will have to face up to the scrutiny and sanctions of other countries who suffer on their behalf. Better have a policy of closing borders from now on until the viruses are better understood than to have the whole world suffer economically.

If this does not happen, I can see conspiracy theories being even further fuelled by blaming countries deliberately sending out viruses. It is mostly in the hands of the WHO now to have more binding guidelines. The WHO is not the place for diplomacy. Public health does not work that way. Better to control from the beginning than to eliminate.

Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee. This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.