Hold up a mirror to a “strategy” based solely on vaccines and what emerges? Variants that risk undermining them.
The UK is confronted with variants that threaten the potency of vaccines and public health, but their emergence was politically-assisted.
Mutations of viruses occur randomly and are part of the natural Darwinian process of evolution. Occasionally, a series of mutations may render the behaviour of a virus more favourable for its survival. This is facilitated in an environment that allows a virus to frequently jump between hosts, and continually replicate. Policies that tolerated high circulation of the virus fostered this probability.
Political passivity enabled these mutations to occur in the UK and for more challenging variants to become dominant.
But local challenges quickly become global challenges. “A problem anywhere, is a problem everywhere,” Professor Chris Whitty affirmed. Without a comprehensive, long-term strategy, further variants that threaten global health security are likely to arise on home soil.
Ironically, the UK committed to improving global health security through its (genuinely) “world-beating” genomics expertise for new mutations.
However, surveillance alone will not prevent the origins of future problems. High levels of replication must be thwarted and the evolutionary process slowed. This is achieved by keeping infection rates low, through a strengthened, locally-delivered test-trace-isolate-support system.
The Biden-Harris administration published their plan for responding to Covid-19 in the United States on their first full day in office, yet the UK government still do not have a strategy.
The current mitigation approach involves an unsustainable blend of periodic lockdowns and mass vaccination. A clearly sub-optimal approach compared with elimination responses adopted across the Western Pacific, East Asia and some Nordic countries.
On Friday, The New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) reported the possibility of a higher risk of mortality associated with the B117 variant, originating in the UK. It should be emphasised that the data presented had several limitations, and a conclusion can not yet be determined with confidence.
Although this is an alarming statement, the 56% increase in transmissibility, established in mid-December, remains a far more serious cause for concern. More lethal variants will marginally increase deaths, presuming infection rates are unaffected. More transmissible variants escalate infection rates, raising the relative proportion of deaths, even when the same case fatality rate is assumed.
The potential collision of both characteristics should highlight the danger of current methods and reinforces the urgency of working towards the goal of eliminating community transmission.
Professor Devi Sridhar prognosticates the defining feature of this year: “2021 is going to be a cat-and-mouse game to see if we can vaccinate people quickly enough to stay ahead of the variants.”
Although scientists remain confident that vaccines can be quickly modified to respond to the issue of new variants evading the host immune response, national rollout is a huge logistical effort.
Health Secretary Matt Hancock outlined the extra measures required to contain the spread of new variants, describing stringent border controls and intense contact tracing. These two measures should not only be considered unique for new threats; the previously dominant variant required similar interventions since last spring.
Perhaps these signify a slow realisation that there is no better alternative than to pursue maximum suppression in the short-term and follow with a forensic effort to eliminate community transmission. Variants may be the political scapegoat to disguise this shift.
There is some assuring indication that the current lockdown is working. Once an acceptable degree of suppression is achieved, an elimination effort must follow, through a robust endeavour to test, trace, isolate, and support.
To briefly evaluate each component, mass testing has significantly improved. Weekly reporting from NHS Test and Trace consistently demonstrates that contact tracing coordinated by local public health protection teams are substantially more effective than using wider online and call centre capacity.
Crucially, suspected and confirmed cases alongside their close contacts must be adequately supported to self-isolate. This should cover the provision of alternative accommodation if home isolation is not feasible. Isolation is foundational to the entire NHS Test and Trace infrastructure – no corners can be cut. Chains of transmission will not be broken otherwise.
New challenges have already and will continue to confront the pandemic response this year. Vaccination is an essential tool for building population immunity, but their value can only be realised when integrated as part of a comprehensive zero-Covid strategy.
It is not too late to move towards zero-Covid. In light of the current and forecasted challenges, support for this strategy is only strengthened.
Jay Patel is a Researcher at the Global Health Governance Programme, Usher Institute, University of Edinburgh.