Weekend Herald

Both ma­jor par­ties rest­ing re­cov­ery hopes on a shot in the dark

With much un­cer­tainty around tim­ing and ef­fec­tive­ness of a Covid jab, NZ needs to find a plan B

- Kate MacNa­mara Health · Medical Activism · Anti-Vaccers · Medicine · Vaccines · Alternative Medicine · Medical Treatments · Charles Dickens · New Zealand · World Health Organization · Tedros Adhanom Ghebreyesus · California · University of California, San Francisco · San Francisco · University of California, Santa Barbara · Financial Times · U.S. Food and Drug Administration · Donald Trump · United States of America · Wilkins Micawber

Since we can­not pre­dict the like­li­hood of a silver bul­let vac­cine, it would be sen­si­ble to pre­pare for the al­ter­na­tive.

Com­ment:

There’s some­thing quite like­able about Charles Dick­ens’ char­ac­ter Wilkins Mi­caw­ber. He’s knee- deep in debt, blindly op­ti­mistic and peren­ni­ally of the opin­ion that “some­thing will turn up” to solve his prob­lems. But you wouldn’t want him run­ning a coun­try.

It’s a pity, then, that New Zealand is en­dur­ing an elec­tion cam­paign pop­u­lated al­most en­tirely by Wilkins Mi­caw­bers. Covid- 19 is the defin­ing is­sue and ev­ery main party’s plan to save us from self- im­posed iso­la­tion through a heav­ily shut­tered bor­der is a vac­cine. It hardly seems to mat­ter that de­vel­op­ing that vac­cine is be­yond our con­trol and en­tirely un­cer­tain.

What will hap­pen if there is no vac­cine? Or if a vac­cine or vac­cines take years to emerge? Or if ef­fi­cacy is too lim­ited to achieve herd im­mu­nity? No ma­jor party is yet pre­pared to tell the elec­torate that the ben­e­fits of iso­la­tion have lim­its, and that we can­not sen­si­bly re­main holed up be­hind our con­sid­er­able moat in­def­i­nitely. Nor has any party been hon­est enough to talk to New Zealan­ders about the al­most un­doubt­edly er­ro­neously high Covid19 mor­tal­ity fig­ures ( fre­quently un­dif­fer­en­ti­ated by age and ex­ist­ing ill­ness) pro­duced by epi­demi­ol­o­gists’ mod­els early in the year.

It seems the pop­u­la­tion’s fear, now thor­oughly fanned, is too po­lit­i­cally dan­ger­ous to douse. That gives hope for a vac­cine tremen­dous po­tency, and it also has the ef­fect of sidelin­ing any sen­si­ble dis­cus­sion of how to pro­ceed with­out one.

Should it bear re­peat­ing, the prob­lem with the sta­tus quo elim­i­na­tion track is that all- but- closed bor­ders shave 5 per cent off our an­nual GDP, by Trea­sury’s re­cent es­ti­mates. And that fig­ure fails to cap­ture other myr­iad losses, from fam­ily sep­a­ra­tion ( New Zealand cur­rently bars most for­eign­ers from en­try) to the hand­brake on New Zealand busi­nesses, par­tic­u­larly those that aim to grow abroad. At higher alert lev­els, the cost is con­sid­er­ably higher.

Such is the un­dif­fer­en­ti­ated think­ing of New Zealand politi­cians that there is broad agree­ment: we must wait for a safe and ef­fec­tive vac­cine to de­liver us from this limbo.

As a plan, its defin­ing char­ac­ter­is­tic is hope. In fact, that’s the word the World Health Or­gan­i­sa­tion’s direc­tor- gen­eral

Te­dros Ad­hanom Ghe­breye­sus used this week: “There is hope that by the end of this year we may have a vac­cine.” He said it twice: “There is hope.” Good. We all know the world’s clever peo­ple are look­ing for a vac­cine, that there are over 140 can­di­dates in the pipe­line, and that these projects have money to burn.

But there is also fear, and in­deed like­li­hood, that this hope will be met with dis­ap­point­ment. First, there is the in­con­ve­nient his­tor­i­cal fact that many vac­cine searches have failed even af­ter decades of ef­fort and bil­lions of dol­lars spent. HIV and Zika are prom­i­nent ex­am­ples.

As Richard Feachem, direc­tor of the Global Health Group at the Univer­sity of Cal­i­for­nia, San Fran­cisco, wrote re­cently in the Fi­nan­cial Times, there may never be a vac­cine.

He also laid out what prop­er­ties a vac­cine would need to largely ban­ish Covid. It will need to have a high ef­fi­cacy, for a pro­tracted du­ra­tion of pro­tec­tion, and a dos­ing sched­ule that is not too de­mand­ing. And it must be pos­si­ble to man­u­fac­ture bil­lions of doses, bear­ing in mind the risk of se­ri­ous sup­ply chain dif­fi­cul­ties, in­clud­ing the lim­ited sup­ply of in­gre­di­ents.

Ef­fi­cacy ( mean­ing that the per­son who takes the vac­cine is pro­tected from the dis­ease), should any vac­cine make it through tri­als, is a huge ques­tion mark.

The US reg­u­la­tor, the FDA, has said it will ap­prove a vac­cine for use even if it is only 50 per cent ef­fec­tive — mean­ing a prod­uct that pre­vents the dis­ease in half or more in­stances where it is ad­min­is­tered or it re­duces the dis­ease sever­ity by 50 per cent or more. That’s noth­ing like the vac­cines that erad­i­cated small­pox and that ef­fec­tively keep at bay dis­eases like measles and po­lio. Those have over 95 per cent ef­fi­cacy.

A lower ef­fi­cacy vac­cine would be use­ful, but the ex­tent of that util­ity would de­pend on many fac­tors in­clud­ing the pro­por­tion of the New Zealand pop­u­la­tion will­ing to roll up its col­lec­tive sleeve and be jabbed. Fifty per cent ef­fi­cacy across a pop­u­la­tion that’s 50 per cent in­oc­u­lated, for ex­am­ple, pro­vides 25 per cent im­mu­nity. Un­der such a sce­nario, it’s con­ceiv­able that herd im­mu­nity, whereby the old and the sick are well pro­tected, re­mains elu­sive.

Since we can­not pre­dict the like­li­hood of a silver bul­let vac­cine, it would be sen­si­ble to pre­pare for the al­ter­na­tive. That would re­quire the Gov­ern­ment, how­ever it is con­sti­tuted af­ter Oc­to­ber 17, to pro­vide a new reck­on­ing of the num­ber of deaths the coun­try would likely suf­fer if mit­i­ga­tion mea­sures were de­ployed to shield the most sus­cep­ti­ble. It should take ac­count of ad­vances in Covid- 19 treat­ment.

The Gov­ern­ment has been too fond of re­fer­ring to the virus “rag­ing be­yond our bor­ders”. The next one should be more hon­est: the virus, though spread­ing abroad, is demon­stra­bly los­ing its bite. As early as June, stud­ies showed that steroids like dex­am­etha­sone ( and other drug ther­a­pies and hos­pi­tal pro­to­cols) re­duced Covid deaths con­sid­er­ably in hos­pi­tal set­tings. Much as it galls Don­ald Trump’s op­po­nents, it is likely a cock­tail of drugs, in­clud­ing steroids, helped min­imise the sever­ity of the US Pres­i­dent’s Covid case.

There is rea­son for op­ti­mism. The im­prove­ments in treat­ment have been grad­ual, but they should help us to start pass­ing the bur­den of manag­ing Covid- 19 back to health sys­tems. At the same time, we can move to­wards eas­ing blan­ket re­stric­tions at the bor­der. In­cre­men­tal im­prove­ment is our best route back to nor­malcy, but hope for a vac­cine is blind­ing us to it.

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