Beyond the pandemic
The battle between vaccine and virus
Getting ‘double-dosed’ appears to offer significant protection against even the most infectious forms of COVID-19, such as the delta variant that originated in India. This was one of the main themes of our Big Conversation with Sir John Bell (the Regius Professor of Medicine at Oxford University, and one of the driving forces behind the Oxford-AstraZeneca vaccine) and Tamsin Berry (a former UK government health official and now a partner at Population Health Partners). Sir John even suggested that a double dose may make people sufficiently resilient against the virus that there is no need for new vaccines or booster shots in future.
The power of a double dose however is also a kind of challenge: vaccination rates need to be improved around the world – and quickly – particularly in developing countries where the rates are practically zero. This will require collaborative action from global leaders, including at this week’s G7 summit in Cornwall. Failure to act will consign the world to a longer pandemic and the possibility of more (and more infectious) variants.
Here are the key takeaways from our wide-ranging conversation:
The bad news came first: we are closer to the start of the pandemic than to the end. This is because, on a global scale, the majority of people remain unvaccinated – particularly in the developing world, where almost no vaccines are getting through. It may take until the end of 2022 or the middle of 2023 for the disease to be under control globally. But, even then, it’s highly unlikely to disappear completely. Although most people will have immunity, the virus will still be in circulation and will come and go in waves, with some good years and some bad.
The delta variant, which originated in India, has made the situation worse. On current evidence, it is probably the most infectious variant – outstripping even that which originated in South Africa. And now it is spreading outside of India into other parts of Asia with largely unvaccinated populations, such as Bangladesh, Vietnam and Thailand. It is also likely to cause considerable damage in South America, not least because previous exposure to other variants – including the one that originated in Brazil – does not appear to confer protection.
China is also at risk from the spread of the delta variant. The country as a whole has low vaccination rates – perhaps less than 20 per cent – and the vaccines that have been used are not particularly effective. What’s more, many of the methods that the country previously deployed to prevent the spread of the virus, such as very severe quarantines, may not be enough against the highly transmissible delta variant, particularly in the country’s densely populated cities.
For proper protection against the delta variant, two doses of one of the major vaccines are probably necessary. This puts countries such as the UK and Israel in a relatively good position. In the UK, well over 50 per cent of the population has already been double-vaccinated, a proportion that will rise to 70 per cent quite soon.
This also means that developed countries are in a good position to withstand the threat of the delta variant, but they do still face significant challenges. The US, for example, where the vaccination programme has been largely well managed, also has the problem of vaccine hesitancy – mostly along party lines. In some Republican states in the south, levels of vaccine uptake are at only 25 per cent or 30 per cent.
The protection afforded by double-dosing means that it is even more important to distribute vaccine doses around the world. The problem here is not really one of supply: there are, in theory, enough doses to strategically vaccinate the world by the end of this year – thereby winning the race against the virus. The actual problem is getting those doses out of countries where they are surplus to requirements and effectively just sitting on shelves, and getting them into countries that may not have the infrastructure to vaccinate their populations quickly. Achieving this will require concerted, collaborative effort from world leaders. They should be identifying and removing barriers to vaccine redistribution, such as export controls on the requisite raw materials.
Will new, variant vaccines be required in future to deal with new variants of the virus? Sir John Bell revealed that there may be a simpler option: a booster shot of the original vaccine. Tests suggest that a third dose of the AstraZeneca vaccine serves to massively increase the desired antibodies. In fact, it’s even possible that a third dose isn’t required: a double-dose of the AstraZeneca vaccine offers a great deal of protection against all the extant COVID variants – including the delta variant. s Sir John put it, ‘Two doses might be enough forever.’
The vaccine science may be encouraging, but the therapeutic science hasn’t kept pace with it. This is understandable: antivirals tend to take longer to develop. But it is also undesirable: if a new variant strain of the virus were to prove resistant to vaccination, then antivirals and other forms of therapy would ideally exist as a backstop. The more encouraging news is that various drugs are now entering ‘phase 3’ testing, although there is still a long way to go in refining and improving these potential treatments.
No one should doubt the existence of long COVID. There is evidence that some COVID sufferers end up with inflammatory conditions that affect their internal organs, among other symptoms. And we do not yet know whether there are even longer-term effects: if, for example, COVID caused neurological problems in 10 to 15 years’ time, then that would be a massive
The biomedical sector was already expected to grow by about 3 to 4 per cent a year – before COVID took hold. The pandemic has now made this sector even more important, and demonstrated how it could grow faster in future. The crucial factor is collaboration – between governments, academic institutions, and pharmaceutical companies. This could lead to new biomedical capitals in future.
Could the virus have originated in the Wuhan Institute of Virology? Sir John Bell was sceptical of many of the theories, but did say that an accidental release may have been possible. But what can be done about it now? If the West were to enter into a geopolitical dispute with China, as some politicians seem eager to do, then it could be extremely counterproductive at a time when we need to be working together to overcome the pandemic.