Emma Ross
Good morning, good after and thanks for joining us for the Chatham House COVID-19 Webinar series with our Distinguished Fellow, Professor David Heymann.
We’re back after a long hiatus, but we thought we’re at the point in the pandemic now that it might be useful to pick up a few threads of conversation that is going on out there. For those of you who haven’t joined us before, just a bit of context. Besides being our Distinguished Fellow, David heads up the Scientific and Technical Advisory Group on Infectious Hazards at WHO, after a long career as one of the world’s leading experts on epidemic control.
So, it’s almost two years since we did our first session in February 2020, shortly after the disease was first recognised to be a global threat, and what we’ve always aimed to do is offer credible information and analysis of what’s going on, facilitate discussion of primarily the key scientific aspects of the pandemic, and to share insights into the constantly evolving understanding of the virus and how best to respond to it. Normally, we have invited experts to join us to discuss specific aspects of the pandemic, but we’ve gone back to basics this time as it’s been a while, and I wanted to give you all a chance to have exclusive access to David’s knowledge and insights this time.
So, before we start, a bit of housekeeping and that is that the event is on the record as ever, and to ask questions, please write them in the Q&A function on the Zoom and please do up-vote questions that you like the look of because if they’re all up-voted, it tends to get more likely to be selected. So, we will dive in. So, David, thank you so much for joining us and being here with us today, well, we are us. I’m going to start just with something very general and that is, to get your take on where are we in the pandemic curve, you know, are we almost out of it? There’s a lot of talk of have we gone back to the beginning, are we almost finished, what is this going to look like across the various countries in the year and beyond? There’s talk of another six years and actually, have the measures we’ve put in place over the last two years, of all the heartache and cost and just everything we’ve done, has it really made a significant dent or was this virus always going to sweep through, you know, what is your take on what we’ve done and where we are, and where we’re going, generally?
Professor David Heymann CBE
Well, thanks, Emma, and it’s nice to join Chatham House again and speak with you today about the current pandemic. As, as you know, countries have had varied responses and that’s happening because, despite the fact that countries thought they were prepared for the pandemic that might come along, they weren’t. And so, it’s been building the ship as it sails, trying to deal best with the epidemics and the pandemic, and each country has chosen a little bit of a different way forward. Some countries have locked down and have zero tolerance of infection. We know that’s Australia, New Zealand, China. Others have allowed the virus to come in at a very slow pace or tried to keep it out and those have been many countries in Asia and others have let the virus come in at various speeds. Some have had some lockdowns to try to slow its entry into the country, but in general now, the countries that we know best in the Northern Hemisphere have varying stages of the, the pandemic. And probably in the UK it’s the closest to any country of being out of the pandemic, if it isn’t already out of the pandemic, and having the disease as endemic as the other four coronaviruses.
In fact, countries are now seeing population immunity build-up. That means, immunity against serious illness and death after infection if one is vaccinated or after reinfection if one has had the illness before, and that population immunity seems to be keeping the virus and its variants at bay, not causing serious illness or death in countries where population immunity is high.
Emma, I looked at the ONS in the UK, at their report, most recent report on population immunity and they estimate that about 95% of the population in England, and a little less in other parts of the United Kingdom, do have antibody to infection. Either from vaccination or from natural infection and that antibody, as I said, is keeping the virus at bay and it’s now functioning more like an endemic coronavirus than one that is pandemic. In fact, the people who are getting seriously ill, are those who have not had previous infection or have had vaccination, and if you look in the intensive care units, you’ll see that unfortunately, the majority of those people are not vaccinated.
Emma Ross
Okay, that, that brings me onto, well, first of all, just to pick you up, you said, “If it isn’t already out of the pandemic.” Is it your expert opinion that the UK is out of the pandemic and can a single country be out of the pandemic or by nature of a pandemic, it’s a global thing? Can one part of the globe be out of it and everyone else still battling?
Professor David Heymann CBE
Well, you know, Emma, back in March of 2020, WHO Director-General announced that the coronavirus outbreak was a pandemic. There will not be – it will not be possible to make an announcement that the pandemic is over until all countries have completed what they need to do to make this virus more tame and to become endemic. And countries that are most advanced are those countries with the highest level of population immunity and UK is probably one of the highest levels of population immunity. So, some are already saying that it is endemic in the United Kingdom, that the United Kingdom has succeeded in transferring risk assessment from the Government, which was assessing the risk and locking down, to people who are doing their own risk assessments, either by doing self-testing when they go visit elderly people or some other means of trying to prevent transmission to others.
Emma Ross
Thanks, David. So, is the virus more tame now? When you said the countries have done what they can to tame the virus, there is some talk, you know, Omicron is less severe and I know you’ve had reservations about the way that’s framed, is the virus itself less severe or are people getting less severe disease, and I was hoping you could go into, first of all, is the virus less severe now and are we free of the risk of a nasty, deadly variant coming along in the future? Meaning any variants that come along now, we don’t have to worry about them because it’s all getting milder and, you know, petering out so it becomes a cold, and that this is us living with the virus? So, first of all, is the virus becoming more tame and less deadly? Less severe?
Professor David Heymann CBE
It’s a good question, Emma, and you know, people focus on the virus and the virus can’t operate in a vacuum. The virus operates in an environment where there are people and those people have certain behaviours that either help to transmit or decrease its possibility to transmit and also, the environment in which that virus emerges or resurges also is an environment where there is a certain level of immunity. Think back to the beginning of the pandemic when people were at greatest risk, were those who were elderly, those who had comorbidities. Today those people remain at greatest risk, but they’re at less a risk if they’ve been vaccinated or if they’ve been – had natural infection previously. Those people can anticipate either the people who are vaccinated or the people who have had natural infection, can anticipate that they might have an infection again, but that that infection will be held at bay by both the antibody in their blood and the T cell response that they generate when they’re exposed to the virus. And so, it’s very difficult to say in the UK that the Omicron virus itself is less virulent. It’s less virulent in a population, which has a high level of population immunity and is keeping it at bay. To really understand if it’s – the virus itself is less virulent, one must look in populations, which are still naïve, that have not had previous illness or vaccination, and there are very few of those people in the UK.
Emma Ross
So, does that mean we can’t really say it’s less severe or does it matter? Are we playing with semantics here, that, you know, you’ve got to find a an infection-naïve or, you know, whatever, antibody-naïve population, does it matter?
Professor David Heymann CBE
The issue is the other way around. The research that’s going on around the world, much of it in naïve populations, or more naïve populations, is showing that this virus appears to be less virulent. It’s not causing fewer infections, but it is causing less serious illness and that’s especially true in areas that have obtained this high level of population immunity.
Emma Ross
And does that mean that any variants that come after it, we can rest assured that they’re only going to be milder, that it’s not going to go the other way, or we’re going to get socked by some nasty, deadly one?
Professor David Heymann CBE
Absolutely not. We don’t know what’s in store for us. Resurgence will occur, variants will occur, and what we’re fortunate in, we have vaccines which can be modified very rapidly and put into production very rapidly to deal with an escapee, should there be a variant that escapes. We just don’t know. We can’t predict where variants will occur and we can’t predict what they’re virulence or their transmissibility will be. But hopefully, what we’re seeing now with the Omicron variant is something that we will continue to see with future variants. And eventually, hopefully, this will become like other viruses, other coronaviruses, one that resurges in the winter months when behaviour is such that people are indoors and closer together and transmit the virus more easily.
Emma Ross
But are you saying it might be a bumpy road and we might get a few more variants that are nastier?
Professor David Heymann CBE
Yeah, it could certainly be a bumpy road, we just don’t know.
Emma Ross
Okay and what about when you said levels of population immunity, that tend to result in less severe infections, so, you know, less of a threat to us, can you please address the whole question of waning immunity, whether that’s from vaccines or previous infection. How – you know, how long do we have this protection and are we going to be in – it seems like, we could be in this endless, endless cycle and especially if it’s not the virus itself that’s getting more mild, but the interaction with our immunity, if our immunity is not maintained, what does that mean for us?
Professor David Heymann CBE
Yeah, well, in vaccinated persons, waning immunity is being addressed in many different ways. It’s – number one, in the laboratory, bloods that come from people who have been vaccinated are separated into a serum in the blood, and the red blood cell component, that serum is then – has – contains antibody and those antibodies are used in the laboratory to see whether they can neutralise the live virus. And if they don’t neutralise the virus in the same titer, as it has done previously, then you could say that there’s a decreasing in the immune – in the antibody response to the virus. But we don’t know what’s going on in the human in the T cell response. At the same time, we know that vac – that vaccines do not prevent against infection in all cases, but they do prevent against serious illness if someone is infected after vaccination.
What we can look at also is to see whether there are more people who are vaccinated if there are more re-in – if there are more infections in people who are vaccinated than there were previously. That’s another indicator of how the vaccine may be working, but these vaccines do not prevent infection. And that’s been a big misunderstanding by many in the – many Journalists, by many Scientists in fact as well, who have talked about obtaining herd immunity with this pandemic. Herd immunity means that people are protected against a future infection, either by vaccine or because they’ve had the disease previously. And if that’s the case, as it is for measles, for example, vaccine prevents against infection, vaccine and disease prevents against infection in the future.
If this disease were acting like that and if our vaccines were acting like that, we could talk about herd immunity and stopping transmission. But we can’t. We have to live with transmission with the current vaccines. Hopefully there will be vaccines in the future that can prevent infection and sterilise – sterilising immunity, but that isn’t occurring at present. So, we need to live with this virus and keep it performing at a low level of disease in humans and to do that, we have to make sure that people get vaccinated.
Emma Ross
So, so are you – you seem to be making a distinction between herd immunity and population immunity, is there a difference? What is it?
Professor David Heymann CBE
There’s a big difference. Herd immunity means that you’re protected against infection from either disease or vaccine and that eventually that protection, if it were raised to a level maybe above a certain percentage, transmission would stop in that area where the herd immunity has occurred.
What’s happening with this vaccine is, it doesn’t prevent infection and you can get infected after vaccination and disease doesn’t prevent reinfection. So, what we hope for is maintaining a level of virulence of the virus that’s low because of the population’s immunity, either from natural infection or from vaccination.
Emma Ross
Okay, and you said there’s been a lot of confusion about this. Are there other aspects of – ‘cause we haven’t convened, you and I, for quite a long time and, you know, things have moved on, conversations have moved on, and opinions have been formed. What other areas do you think there’s a lot of confusion around? So, there’s been confusion about whether the vaccines – whether we should expect them to be protecting us from infection ‘cause there are – there is talk, well, it only protects you for - after ten weeks, you know, your protection from infection wanes, so does it mean we have to keep giving boosters every month? There’s all that kind of conversation going on. Where are you seeing that there’s a lot of confusion that’s going on out there, on what aspects?
Professor David Heymann CBE
Well, if you remember early on, there was this great concern that people who were asymptomatically infected were transmitting the infection as well. What people begin to understand now is that this really is no different than many other viral infections and there is transmission one or two days before the onset of signs and symptoms. The big issue today though, is – is long COVID, not understanding completely what really is happening when people end up with a long period of fatigue and what they call brain fog, or they have cardiac arrhythmias, arrhythmias of their heartbeat or other issues that may have occurred, as a result of having had infection, what these mean in the long-term.
We know that other viral infections such as mononucleosis, for example, also have a long period of convalescence and fatigue afterwards. But that’s the real concern today, and we believe that vaccines prevent people from having long COVID if they get infected after vaccination. It’s not yet 100% clear, but more and more evidence is building up that vaccines do in fact have an impact on long COVID and make it less likely in persons who get infected after vaccination will have long COVID.
So, we’re beginning to learn many things, but remember, we’re only now one year into the use of vaccines and the amount of information that we know already, that we have already is quite amazing, but the long-term benefits of vaccines will only show up in the long-term.
Emma Ross
Okay, and with levels of population immunity across the world, from either a vaccine or infection and given that it spreads so far and wide, what’s your take on how important is it to have universal access or shared vaccines across the world and developing countries that haven’t had as many vaccine access? Is that still a major issue, now that they may have built up a bit of population immunity, whoever hasn’t had it, is it as important for them as it was earlier? I mean, easy to say from a country where we’ve had boosters, but is that still as live an issue as it was and where should we be in our take on that and our approach to this?
Professor David Heymann CBE
Well, equitable distributions of the benefits of health research need to be made available around the world ‘cause, you know, there needs to be equity in the advances in public health and in development of vaccines and in drugs and diagnostic tests. That’s just a basic fact for the pandemic and for all diseases, we need to strive towards equity, and with this pandemic, we need to strive towards equity in vaccines, in diagnostic tests, in oxygen, in other disease – in hydro – hydroxycortisone and also in the antiviral drugs. So, we need to make sure that these can be more equitably distributed, but it’s not a one-way street. It’s not a group in London or in Geneva saying, “You need the vaccines.”
It’s also an effort by countries to make it – make the environment right, so that they can give the vaccines to the people who need them. You know, in most lower and middle-income countries, adult vaccination is unheard of. Children are vaccinated very well, but adults are usually not vaccinated. This doesn’t occur in the Northern Hemisphere in our countries, for influenza, for different infectious diseases, but in lower and middle-income countries, it’s a new challenge, so they have to develop the system to get those vaccines out, as well as just getting the vaccines. And so there needs to be a pull of vaccines into countries within an absorptive capacity in those countries, so that they can use the vaccines and get them to the people who need them before they have an expiration.
Emma Ross
Okay, that sounds good. I’m going to move to questions now to get started on that, ‘cause there are a lot of questions coming in and I’m going to start – I’m not sure – oh yes, it’s one of the most up-voted questions and it’s on Sub-Saharan Africa, there are a couple of questions, two on that, but for the first part, this is from John Radford. “I’m particularly interested in Sub-Saharan Africa which, despite being almost unvaccinated, at less than 10%, do not seem to be seeing a lot of deaths compared to the population. What’s going on?”
Professor David Heymann CBE
And that still remains a question, John, and others who have put that question out. It’s just not understood yet what’s going on in Africa, but there are many hypotheses. One of those hypotheses is that they have a higher level of immunity to coronaviruses in general and that that immunity is cross-reacting with the current virus. There’s also the fact that populations in Sub-Saharan Africa are quite young, 18 years being the median age in Sub-Saharan Africa, above South Africa. At the same time, there’s also some behavioural elements, which might be important in this. For example, elderly people tend to stay in the villages where they raise their families, rather than moving to the urban areas and so urban areas don’t have the same level of elderly people as in many other parts of the world.
There are many hypotheses, nothing is really understood, but certainly, Sub-Saharan Africa does need vaccines for certain people for – definitely for its health workers right now, to make sure that they’re protected, and for the populations that they will begin to identify that are at greatest risk of infection. Some countries though, in discussions that I’ve been involved with have said, “We would prefer to have a vaccine for malaria, which is killing our children, than a vaccine for COVID-19, which we don’t see having the same impact in our countries as in other countries.” So, it’s a matter of getting governments to understand also whether or not they need these vaccines and if they do feel they need them, how they should be delivered.
It’s very risky in fact to say, “well, we’re going to make you vaccinate your people in order to protect us from any eventual viral variants that may occur because the vaccine is transmitting and reproducing greater in your country than in ours.” That could also be a very detrimental issue if lower and middle-income countries say, “Why are the northern countries so interested in having vaccines in our countries to vaccinate our people when we don’t feel they’re really necessary?” I’ve not heard African leaders say it’s not necessary. In fact, they’ve signed an agreement out of the African Union that they will get vaccines and there have been some contributions of vaccine to the African Union, but still, in all, it’s a matter of wanting to get these vaccines to the people who need them.
Emma Ross
And have you seen any evidence that they’re not really that keen on wanting them? Is this what’s going on, a bit of a push or is there a pull? How much pull is there?
Professor David Heymann CBE
Well, there certainly is a political declaration out of the African Union that African Heads of State want vaccines in their countries. Some have used the COVAX facility to get those vaccines, others have procured bilaterally with pharmaceutical companies. Others have had gifts from various countries, including the UK, United States, China, Russia and other countries. So, there are many sources of vaccines out there and countries are getting those vaccines, as appropriate, and they’re doing right in pulling those vaccines into their countries. It’s not just a matter of forcing them on countries, it’s a matter of countries creating the desire to get them as well.
Emma Ross
Okay, so, I’m going to do another question from Sub-Saharan Africa, and this is from Richard Kock adding to the question on Africa that we’ve just started just now. “I’m aware of some cities in Africa with zero-prevalence data suggesting more than 80% zero conversion in the context of vaccination of less than 10% of the population, suggesting most antibodies were naturally derived. CFR” – CFR is…?
Professor David Heymann CBE
Case fatality ratio.
Emma Ross
…case fatality ratio in these countries reported are extremely low, in the low hundreds, so even if reporting is really low, this is extraordinarily different to the UK, Europe, USA, and some other so-called developed economies, but also, some low-income countries like Peru.” Similar question, but what’s your comment on that?
Professor David Heymann CBE
Well, my comment is, and Richard has said it clearly, there is a level of population immunity now, likely from natural infection, that hopefully will protect people from serious illness moving forward. It may be that because the populations are young, they haven’t had serious illness yet they’ve been infected. They haven’t identified this as being SARS-Coronavirus-2, they maybe thought they had a common cold or some other illness, and now they’re protected against serious illness and death. Whether or not vaccines will add any benefit to that is not clear, but certainly vaccines are a tool to fight this infection and should be made available if countries really want them and want to use them properly.
Emma Ross
Okay, I’m going to move away from that to an up-voted question from Mehtab Currey. “I’ve just heard about a new variant called Deltacron. Would like to know more about it, please.”
Professor David Heymann CBE
Well, I can’t give specifics on Deltacron, but I can say that the last time I was at a meeting at WHO, which was about ten days ago, there were actually over 22 variants that WHO is following and these are called ‘variants of interest’. And they are variants of interest because they’ve been able to transmit from person-to-person at a certain level, but haven’t really had the facility of transmission as have other variants. So, there will constantly be Deltacrons or whatever comes up. Remember, the new variants that will develop will develop on existing variants today because they’re the dominant strain in the country, they’re the dominant virus. So, we would expect to see what – that there will be mutations on top of Omicron that will change it in some way or another, and that’s the base that mutations will be occurring on from now into the future, in many countries.
You’re muted, Emma.
Emma Ross
Oh, sorry. The most up-voted, I apologise to our guests that I had it on most recent, while the most top voted is from Angela Napolitano and that is, “How do you imagine a long-term government plan to live with COV-19?” So, this is, “we’ve got to learn to live with the virus,” is something you had said a long, long time ago, in the face of lockdowns and stuff, what – I guess, what does that really look like and mean now? I mean, it’s a phrase that’s bandied about, but I think a lot of people don’t really understand what’s meant by, “got to learn to live with it.” Does it mean, do nothing? What does it mean?
Professor David Heymann CBE
Well, I think the UK, for example, has been living with the virus since late summer this year, and what that means is that people are vaccinated and willing to get vaccinated, if vaccines are made available, that people are protecting others in closed spaces by wearing masks, even if they’ve been vaccinated because they can still transmit if they get infected after vaccination, and it means, in addition, having good systems to detect when things go bad. And the UK is keeping constant watch on hospital admissions, on admissions to the intensive care unit and they’re beginning to modify their testing strategies as well. So, all of these will be building the ship, if you would again, of building the ship as it sails within the UK, developing as they go along new guidance, which will eventually end up in living with the virus.
We live with tuberculosis, which is a bacteria, we live with HIV, which is a virus, we live with many infections and we just need to learn how to do our own risk assessment for this infection and hope eventually, within the next years, that this becomes an endemic coronavirus, like the four other coronaviruses, which is held at bay either by population immunity or because the virus itself has become less virulent.
Emma Ross
So, does learning to live with it mean, get the government out of it and everyone do what they can for themselves and what they think they want to do? Is that the bottom line of what “living with it” means?
Professor David Heymann CBE
No, governments need to…
Emma Ross
Phasing out government and what’s government’s role?
Professor David Heymann CBE
Government’s role are developing the policies moving forward on vaccination, on making sure that there’s a system of surveillance to detect when outbreaks are occurring, also to detect what’s going on in hospitals. We have that system for influenza in the UK and in most countries in the world, there’s surveillance, which is called Influenza-like Illness Surveillance, which is collecting specimens of the virus from certain people who have influenza-like illness to determine whether it’s influenza or another infection, and this system is perfectly engineered now to be also looking at the coronavirus situation. So, there are systems in place and that’s the responsibility of the government. Obtain the vaccines necessary, keep the surveillance systems up, so that the vaccines can be modified if necessary and help people understand how they can do their own risk assessment and risk management, which is protecting others from getting infected.
Emma Ross
Okay, so when you say, “Government’s role is policies” obviously, but you haven’t mentioned government role on policies of “you must wear a mask” or “restaurants mustn’t open,” you know, bar – table service only, those are policies. Are we saying that, in the “learn to live with it” or travel – you know, you’ve got to do a test when you come back from, you know, any country, those are also policies? Are you saying that, in a lear– we’ve learnt to live with it scenario, that kind of stuff government doesn’t get involved in?
Professor David Heymann CBE
Well, we may want to follow the model that some Asian countries used early on, where governments did do a good job of investigation about breaks – small outbreaks, understanding where transmission was occurring and then shutting those places down for a time. Many times, they shut down a nightclub area for a time and then opened it up again, did good surveillance, good at watching over what was happening to make sure that if happened they would shut it down again. That maybe the role of governments moving forward, it may not be. It depends on the situation, but having good disease detection systems in place, both at the community level, at the hospital level, at the national level are very important in learning to live with this virus, and I can’t say what the final formula will be in any country. This will just evolve over time, but, you know, the UK is making an effort to live with the virus now in many different ways.
Emma Ross
Okay, well, here’s – so here’s a follow-up related question from Carla Adam at The Washington Post. And that is, “How does the UK’s “learning to live with COVID” strategy compare to what’s going on in other countries?”
Professor David Heymann CBE
Well, the UK, from the very beginning, made a massive number of self-testing kits available to the general population, and just as an example, at Christmastime or during the holiday season, when my wife and I would go to a household where there were people who might be at risk of infection or we didn’t want to transmit infection, we did a rapid test on ourselves before we went to make sure we weren’t carrying the virus into someone else’s home. This has been going on in the UK for the past six months. People are self-testing, they’re knowing when they’re infected, and they’re doing that risk assessment. This is not happening in many, many other countries, but it is certainly happening in the UK, and that’s one of the strategies that, in my view, has been quite successful in helping people do their own risk assessment and then managing that risk appropriately.
Emma Ross
So, is any other, just to press you on this, is any other country coming close? Who else is coming second close in learning to live with the virus other than the UK? Have you seen anything model-ish anywhere else?
Professor David Heymann CBE
Various countries have adopted various models. In Thailand, where they rigorously kept the virus out at the start, they’ve now begun to let the virus come in slowly, as has occurred in the UK, it’s come in more slowly than it would have if you just open all the floodgates and let it out. They’ve now begun to let it come in and to build up a population immunity, but they didn’t do that until they had their population vaccinated at over 90%. That’s what the plan appears to be for New Zealand and for Australia as well. When they get their vaccination coverage at a level that they’re happy with, they will allow the virus to slowly enter the country.
What is important though is that every measure is taken that’s possible to make sure that the virus doesn’t overwhelm populations, and we really can’t determine what’s going in a country by looking at what they’re recording as cases. I know we talked about this last year, Emma, and what’s reported as cases is just a mixed bag of screening test results from school programmes, screening test results from self-testing of individuals, results from testing and diagnosis in hospitals. It’s a mixed bag and it isn’t really a good indicator of what’s going on in a country. What’s a good indicator, as Richard Kock pointed out earlier, is what the antibody level is in the city, or what the antibody level is in the country and that indicator is well known in the United Kingdom. I don’t know if it is well known in certain states in the US or not.
Emma Ross
Okay, you seem to be a big fan and say it was a very good thing that, in the UK, we were all able to get, you know, lateral flow tests whenever we wanted and test whenever we were going to mix with others. There is talk that free lateral flows might be ending and we’d have to pay for them. Do you think that is unwise, bad idea, or you think enough-is-enough and we should pay for it now?
Professor David Heymann CBE
Well, I think that all of the – you know, you can’t do one thing in context, out of context. It’s never good to have to pay for the diagnostic test clearly, but if this disease becomes less and less severe, more and more endemic, then it may be that people don’t even need to test themselves in the future. So, you know, a gradual progression towards that hope is what we might be seeing and you know, a decrease in provision of tests by the government and purchase of tests at a reasonable fee is something that might be a wise strategy in countries. But exorbitant fees, which have been the case to date for people who have travelled internationally for testing, either self-testing or a PCR is something, which hopefully will disappear in the future, because this is a public health need and governments should control those prices if they can.
Emma Ross
Okay, so, could it be that the kind of withdrawal that we’re being primed for, of free tests, means that they think that it may not be necessary to test, or there may be no point because it’s so widespread, what’s the point in testing? What does it really mean?
Professor David Heymann CBE
I don’t want to try to out-guess the government, I don’t know what the reasoning is for that. You’d have to ask the government.
Emma Ross
Ok, I’ll let you off. I’ll let you off on that one. Okay.
Professor David Heymann CBE
Thank you, Emma.
Emma Ross
Going to go another up-voted question from Monica Bloch. “What is the justification for or against a fourth vaccination, i.e., a second booster as they’ve been doing in Israel?” So, is it necessary, what’s the justification, or for or against?
Professor David Heymann CBE
Well, what’s happening in the UK is that they’ve not recommend a booster, they’ve not yet seen a need for that, based on the epidemiology of the virus at present. The virus at present is being maintained at bay and they haven’t seen the need for a booster dose. Israel saw some indicators that, in the epidemiology, that they might need a fourth dose and they’re giving that fourth dose. There are many ways you can see whether or not a fourth dose might be required by looking at the ability of the bloods of people who have been given their third, or their third shot of their first booster to watch that blood and see when it decreases in its ability in the laboratory to a neutralise a living virus. That’s one way of doing it. And so, there are many ways to be looking at what’s going on.
In the UK, they’ve rightfully said they don’t yet have evidence that would require a fourth dose. And remember, as I said earlier, we’re only a year into this vaccine and we’ll learn as we go along what’s really needed. You can’t give the answers upfront. You have to give them from experience and evidence.
Emma Ross
Okay, having said I’d let you off on that political question, I’m not letting you off on this one. This question is from Ilona Kickbusch and it says, “So, where do you see COVID politics now?” So, I guess you can give a general answer of, has the global system grown stronger or weaker and what priorities do you see?
Professor David Heymann CBE
I don’t know what Ilona means by “the global system,” but clearly countries have not been willing to work together in harmonising their policies and strategies moving forward. They’re still working independently as countries doing their own risk assessment, their own risk management, and their own strategies to move forward. Whether or not this is what Ilona’s referring to, I don’t know, but certainly…
Emma Ross
Well, I would think it might be the global system for international co-operation. You know, we’re in this together, we’ve got to pull together. Has that grown stronger or weaker, as a result of COVID, and where are we in that whole story now at this point in the pandemic? Obviously, at the beginning, a free-for-all, every country for themselves, you know, have we made any progress or can we just abandon hope that anyone’s just going to work tougher on this?
Professor David Heymann CBE
You know, I haven’t seen any hope at present that people will continue to work together any more closely than they have in the past. And I’ve just looked recently at the ability of the ACT Accelerator to mobilise resources and it’s really quite pathetic, the amount of global resources that have been put into the ACT Accelerator, which is the way that we’re trying to make sure there’s more equitable distribution of vaccines, of diagnostic tests, and of therapeutics and oxygen. There’s been a pittance of resources put into that, which says to me that the world is not yet working together globally, through mechanisms that exist. They’re not working through the International Health Regulations at WHO, they’re not working through the ACT Accelerator as it was hoped they would do, and so, you know, in general, I think we need to see new developments. And I think it’s very – the right time that the World Health Organization is talking about the possibility of a treaty, which will bind countries through national legislation to react in a certain way when there’s a pandemic: sharing of information, and working together to make sure that there is in fact equitable distribution of information and goods.
We saw that there was a very bizarre reaction of countries locking down against South Africa when South Africa actually reported a viral variant that was very important for the rest of the world to know. Yet they were ostracised for having done that, rather than complimented for having provided this information, which helped other countries to react rapidly. Early on, countries were locking down. That was maybe justified in the first few months of the pandemic because it gave them time to prepare before the pandemic arrived and it gave them maybe one or two weeks to get prepared, but today, that is no longer necessary. Countries are prepared, they’re dealing with this, and to ostracise a country that’s sharing its data is just not acceptable, and this happened in many countries around the world, where they just banned travel from South Africa.
Emma Ross
Compared to historically other crises, global health crises, I guess what – to dig in more on this is, has the system got weaker, so has co-operation got weaker compared to what we’ve done in the past with other crises? So, whether it’s SARS or the Ebola, yes, there’s never been anything that’s affected everybody, so I’m just wondering, are we – is the international co-operation more remote than ever? Has this been good, maybe giving us a kick up the bum to wake us up, that we have to get on this, or has it entrenched the, “it’s just not going to work”?
Professor David Heymann CBE
Well, you know, global co-operation works in some instances. It’s working, continuing polio eradication, it worked during the SARS outbreak in 2003 when countries worked together with the World Health Organization, so it’s not right to say that it’s not working. It’s not working, however, in the current situation of this pandemic. Countries have taken the initiative to do it on their own and to collect information from the many, many sources that are available.
It’s quite unusual to have all these peer-reviewed articles available in front of the paywall of medical journals, so that any country can grab them, use the evidence they provide, and make their own risk assessments and their own decisions. So, hopefully the world will begin to work more closely together through mechanisms like the ACT Accelerator, through the World Health Organization and others, but it may take a treaty, and I know Ilona, who asked the question, has been very involved in working to help understand what a treaty might look like.
Emma Ross
Okay, I’m going to go to another – thank you for that, and for letting me press you on some of those to get to that, ‘cause I think it’s an important issue and a lot of people are watching and waiting to see, you know, what does this mean for multilateralism and co-operation and obviously, at Chatham House, we’re very much about that. So, it was good we delved a little deeper into that.
I’m going to take a press question now from Naomi Kresge at Bloomberg and this is taking us back to whether you expect COVID-19 to become endemic in 2022, or will it take more time? And you’ve already said that, you know – hinted that maybe we’re already endemic in the UK and I asked you, does it have to be global to be endemic? So, maybe add a little bit more on the question of, when are we transitioning out of pandemic into endemic and will it happen this year, first of all, timing and second of all, what do we mean by endemic, where?
Professor David Heymann CBE
You know, what would be really helpful if Journalists were not making just statements about 2022, it might become endemic, but giving the readers the understanding of what it will look like when it becomes endemic and understanding that the population immunity is one of the major factors in having the virus become endemic. It may be endemic in many places. It may already in Sub-Saharan Africa where there’s this high level of antibody in certain urban areas, the virus may be circulating there happily, causing the common cold like other coronaviruses, and it’s endemic. You can’t generalise in the current pandemic, and Journalists many times want to do that, rather than giving people the understanding of how they can judge for themselves when something is becoming endemic. So, in the UK, some Journalists will say it’s endemic, some will say it’s not endemic, some Scientists will say it’s endemic, some will say it’s not endemic and it just depends on where you – what information you’re using to make that decision, and it really doesn’t matter in the end if it’s endemic or not. What we need to see is that this virus is circulating at a level where it’s not causing serious illness and death.
Emma Ross
Yeah, I guess it’s difficult for Journalists, in their defence, when there are experts and Scientists, some saying endemic not, or it will, or we don’t know, whether it will or not, or it might, you know, have they let go of the idea that this might go away and also, it’s always been presented as like, a threshold. But then we’ll be out of pandemic, which is the panic, emergency responsey bit, if it’s endemic it just becomes part of the norm and there seems to be a definite kind of threshold in attitude or response to that. So, I guess it’s natural to want to pinpoint, when are we going to get to that?
Professor David Heymann CBE
Yeah.
Emma Ross
But I…
Professor David Heymann CBE
If I would say one thing about this pandemic, it’s been confusion among many, many different people. It’s been confusion among the Scientists. Early on, modellers were calculating a level of herd immunity at 75%, not knowing really what that meant. Herd immunity can only occur, as I said earlier, if you prevent infection and if you can’t prevent infection, then you have to talk about population immunity and not herd immunity. Most modellers now are not talking about herd immunity. They’ve changed their talk to population immunity, but there was confusion at the start, rightfully so, because we didn’t understand this virus. Now we begin to understand much, much more. So, it’s not a criticism of Journalists. Journalists have done a tremendous job in putting out the information, but to put out general statements about the pandemic will be over in 2022, is not possible, because it will be over at different – in different countries, at different times, based on what their strategies have been.
Emma Ross
Okay. Okay, thanks for that. I’m going to go to the ne – the most up-voted question at the moment is from Dina Mufti and this is, “What is the most effective home treatment for COVID?”
Professor David Heymann CBE
A home treatment? Well, first of all, what’s most important is prevention, home prevention and making sure that there are the right measures in place to prevent people from getting infected if they’re vulnerable to serious illness after infection. Home treatment is no different than it is for a common cold. It’s making sure that if there’s a sore throat, you take the right – a paracetamol or some drug, which will help you decrease a fever, or decrease a sore throat, and it’s also understanding that if it becomes more severe, then there be a self-test or that there be contact with the health system to let the health system know signs and symptoms, so they can advise. But, you know, living at home with the virus now is like living at home with a common cold, in most instances.
Emma Ross
Okay, I’m going to move to pandemic preparedness now, there are two questions that are related. The most up-voted question at the moment is from Frank Newhofer. “How do we get better prepared for the next pandemic?” And there’s a related question from Paul Nuki at The Telegraph saying, “You mention that many countries were not prepared for COVID. What should have been done which wasn’t?” So, maybe take the first question first, of this time, they weren’t prepared, what should they have done that they didn’t? And then, how do we get better prepared for the next pandemic? I guess, informed by the experience we’ve had with COVID, you know, I don’t even know if that would change what you’ve been saying for decades, you know, after COVID, have you changed your mind about what should be done in the future? But let’s start with, what was not done that should have been done, to be prepared for this?
Professor David Heymann CBE
Well, after the SARS outbreak in 2003, there was a revision of an international governance mechanism called the International Health Regulations and that put a focus on countries developing core capacities in public health, so that they could detect and respond to an epidemic rapidly to prevent serious illness and death in the country and to prevent international spread. That was the focus of the International Health Regulations and countries agreed, in the – in signing these regulations off at the World Health Organization, that they would, by the middle of – by 2014 at the latest, develop those core capacities.
Did countries do it? Not many developed the capacities they needed to do it and it was surprising that the countries which did have those capacities early on in the pandemic, were just sitting around watching and not activating the systems that they had. Watching what was happening in Asia, not looking for the outbreaks in their own countries and responding to them rapidly, even though they were occurring. Was that a defective preparedness system or was it a defective willingness to activate those systems? It’s not clear, but certainly, some countries had much of the public health capacity in place to detect early and respond early. And some countries have done quite an amazing job with that, especially some countries in Asia where they’ve limited the spread of the virus and prevented serious mortality and morbidity.
So, you know, the tools were there, the framework was there for preparedness, countries just didn’t follow it. They didn’t follow what they had agreed to follow and they didn’t strengthen their core capacities to the extent that…
Emma Ross
So, does that kind of indicate that – how to be better prepared for the next pandemic? I don’t want to put words in your mouth, but it seems like you must say, follow what systems you had in place, ‘cause if it was less of a case that they didn’t have the right preparedness, but it was an activation problem, for the next one, actually activate it, or what – have we learned anything about how to be better prepared? The fact is that we didn’t realise…
Professor David Heymann CBE
We didn’t learn.
Emma Ross
…what’s important, but now are.
Professor David Heymann CBE
I think we have some lessons, Emma. Whether or not those lessons will be followed is not clear. But clearly, the focus on public health alone was wrong because what happened was, then there was a surge of patients who couldn’t be accommodated and at the same time, the health system couldn’t accommodate those people who didn’t have infection. So, in looking at preparedness moving forward, it’s not only strong public health disease detection and a response, it’s also a surge capacity, so that health facilities can deal with patients who are infected if there is a pandemic, but also deal with patients who don’t have the infection, so that they cannot have an increase in mortality or a failure to follow what regimes they need to maintain their health.
And the third component, moving forward, we’ve learned from this pandemic is that populations have to be more healthy to be able to face infectious diseases. This infection did not cause serious illness in the majority of people who have good health. It was people who have comorbidities, who are obese, who have other, and who are elderly who are at greatest risk of serious illness and infection. So, looking forward in preparedness, there are actually three components: strong public health, certain – access to health at all times, and healthcare, rather, at all times, and the third is, healthy populations that can better resist infections. If you can put those three together in a health security agenda, countries can be better prepared in the future.
Emma Ross
And that is a slightly more nuanced understanding of pandemic preparedness than we had before this pandemic, is it not?
Professor David Heymann CBE
We had this understanding…
Emma Ross
The healthy society is a bit.
Professor David Heymann CBE
We had this understanding, but we were working in silos and, you know, what has to happen is, those silos have to be broken down. You can’t invest overly in hospital and healthcare infrastructure at the expense of enabling healthy lifestyles or at the expense of public health. All three have to be worked together and that means that you have to work to – work across the board and make sure that budgets aren’t distorted into one part of the necessary preparedness. Enabling healthy lifestyles is very important. It takes government intervention, it takes rules and regulations. It takes understanding and education by the population. Healthcare access requires universal health coverage at a time when there isn’t an outbreak and then it requires a surge capacity to ensure that that continues during an outbreak or a pandemic and the third is, strong public health that is on the alert at all times to detect and respond.
Emma Ross
Yeah, so, do you think – I mean, that’s a very clear description of knitting all those aspects together, that they – we’ve understood them and maybe worked in silos, but do you think the international community or governments get it? That those three have to be knitted together and that is pandemic-preparedness, or are there only a few lone voices out there that are banging this drum, that it hasn’t really been taken up yet? How much appreciation of that do you think there is?
Professor David Heymann CBE
You know, Emma, it’s early to say whether there’s appreciation of that or not, but there’s a great opportunity at the World Health Organization now, as they develop their treaty moving forward, to put these understandings into some kind of a document, which helps the Heads of State who will be the ones who have to get the treaty endorsed in their parliaments or in their governing bodies, to make sure that they understand these three issues and get them involved in national legislation. So, to be prepared in the future, we have to count on more durable and more – and stronger mechanisms to have countries adhere to the global health security requirements in the future. It’s not going to be an easy task, and I’m sure there are lots of people thinking about how that can be best done.
Emma Ross
Okay, well, we’re coming close to the hour, I just want to squeeze in a few more, if you don’t have a hard stop. I know people will be dropping off, but there are still 40 outstanding questions and of course, we won’t be able to get to all of them, but let’s go to a popular question from Louise Hart, and that’s, “With the growing body of research and new emerging variants, is there any evidence to suggest that COVID poses any increased risk to children than we previously thought?”
Professor David Heymann CBE
Well, it’s clear that it appears that the Omicron variant is causing illness in children, and it’s causing illness in children possibly more than it did in the past. But remember, children are the only population now where the virus can find a welcome home because they haven’t had infection previously. Others in the population have either had infection or had vaccination and so, are we driving this virus transmission to a lower age group because there’s nowhere else that it can transmit? And in addition, this transmits much more easily, so maybe it is transmitting and it’s more – it’s higher in the respiratory system and it maybe that it’s transmitting in a way that’s more useful in its efforts to perpetuate itself among younger populations.
Emma Ross
Okay, I’m going to squeeze in more on this. Oh, it’s just moved, my screen has just moved. ”How optimistic are you?” – Oh this is from Paul Smithson. “How optimistic are you that exposure to one or more variants will build sufficient immune memory to protect against future variants or at least sufficient to protect against severe disease?”
Professor David Heymann CBE
Well, it certainly may, but when we have an option of a vaccine, it’s more important to get the vaccine than to count on popula – on your immunity, from natural infection because of the fact that there is long COVID and infections in general are a risk. So, in a world today, where there’s vaccine, people should be getting the vaccination to prevent themselves from getting serious illness, unless there is a level of population immunity that appears to be maintaining the virus at a lower level of virulence.
Emma Ross
Okay, and one related to that from Emmanuel Olowe and just to cut a long story short, “Given the very low deaths in Africa, and the need for continuous booster doses for COVID vaccine, is there still a need for mass vaccination in Africa?” I guess there’s an assumption there that there’s a need for continuous booster doses.
Professor David Heymann CBE
Well, you know, the World Health Organization says yes, the ACT Accelerator, the COVAX facility, which is providing vaccines, says that the most important people to vaccinate now are the health workers and the elderly and so, it may be that the countries choose differing strategies to vaccinate their populations, depending on the national immunity. I just remember myself early on, measles vaccination in Africa was recommended at 12 months, but as studies went on, it was shown that most children got measles between nine and 12 months and so, the level was lowered to a lower level. That’s based on the epidemiology of the disease there, which is different than it is in industrialised countries. So, the answer to the question is, African countries need to understand the epidemiology of this coronavirus, they need to understand the populations that they need to vaccinate and hopefully, that information will become available as public health capacity in these countries increases.
Emma Ross
Okay, I’m going to do one last one. It’s not a particularly up-voted one, but it seems to be important and something that might come up and that is from Richard Kock again. “Do you have any update on vaccine adverse reactions globally and any epidemiological data on risk that is specific to vaccines or a type of vaccine?”
Professor David Heymann CBE
You know, the database is being maintained, but at present, there have been no clusters of side effects, which have caused the World Health Organization to have concern. So, there is post-vaccination surveillance going on around the world and that’s bringing in information and at present, that information that’s coming in, is not – has not yet shown that there is one effect above others that is more concerning. But there are individual reports of many different types of reactions associated with the vaccine, not possibly caused by, but associated with the vaccine and those are each being examined. So, it’s too early, Richard, for me to tell you whether or not there are any side effects, which are coming out that we should be aware of.
Emma Ross
Okay, thanks for that. So, I think we’d better stop now. There’s 39 outstanding questions. I apologise to everyone that we couldn’t get to everyone, but we have answered 13 of them, which indicates to me if there are – if there is appetite for this, so we haven’t been doing this as regularly ‘cause we weren’t sure, you know, of the need and the appetite, but if there is appetite for us to do this again in another couple of weeks, please do write into Chatham House or send a comment in, because, you know, we’d like to gauge appetite. Don’t want to crowd out people’s diaries or make demands if there isn’t demand for it, but if there is, very happy to come back.
So, thank you all for joining us and thank you, David, I’ve put – pulled you through the ringer this time and you’ve been non-stop, and I guess that’s it. We’ll be playing it by ear, so, thanks all for joining us and have a great rest of the day.
Professor David Heymann CBE
Thank you, Emma.
