The first vaccines against the coronavirus began to be applied just when the number of infections and deaths from COVID-19 soared again in many countries.
And that, together with the slowness of a process that for the moment has started especially in some of the richest countries in the world, has ended up making people aware that the end of the pandemic is clearly not around the corner.
Anna Mouser, Vaccine Advocacy and Policy Officerl Wellcome Trust -one of the most important health research NGOs in the world- nevertheless considers that, in the midst of it all, the news is good.
But in an interview with BBC Mundo, he also warns that if the vaccination effort is not truly global, even the vaccinated populations of the richest countries will be threatened by new mutations of the coronavirus.
Are you surprised by how slowly the vaccination process appears to be progressing?
I think you have to step back and look at the context to begin with: this is and will be the largest vaccine launch ever. It really is a huge task. And while I understand that with the pandemic as it is, people everywhere are feeling impatient and frustrated – for many the vaccine might not come soon enough – it seems to me that things are moving relatively fast, even if it doesn’t seem like it.
Part of the problem is that many of the vaccines still have some hurdles to overcome. At the moment only the Pfizer and Moderna vaccines have been fully approved. The United Kingdom, India and Mexico have also approved the Oxford AstraZeneca vaccine, but it has not been approved by the FDA or the EMA, which are the US and European regulators, which is what would allow its approval by the WHO.
That’s one of the reasons things are taking time: because there are regulatory processes that have to be completed. Regulators are moving as fast as they can – I have heard reports from regulators that they are working 24 hours a day – but that is an essential step in making sure vaccines are safe and effective.
Now, in addition to regulatory processes, I think one of the biggest challenges will be that many countries in the world probably don’t have platforms to immunize adult populations. Most vaccines are usually given to children, and that too is done in a staggered fashion – shots are given throughout the year, when children are born, or when they reach different ages.
But this is really different. I know that some countries have vaccination programs against influenza, which reach the elderly and health workers, which is more similar to what we are seeing, but in many countries where there are no vaccination programs against influenza will have to create mechanisms from scratch to immunize the entire population, which is really difficult.
As I said, I think the impatience and frustration are understandable, the situation is really difficult for everyone at the moment, but it is extremely important that we remain calm, that we make steady progress in launching vaccines, and that we focus on doing make vaccination as simple as possible for all people, wherever they live.
But in the latter there are also obvious delays …
Certainly. Equitable access is a major issue. The world needs to work together to ensure that all healthcare workers, wherever they live, are immunized. And not just healthcare workers: we have to make sure that priority groups around the world are immunized. It really takes a global effort, and only a global effort can guarantee that we can end the pandemic.
Now, at the moment what is happening is that the first vaccines are only being administered in high-income countries. And people are understandably wondering why, and the answer has to do with COVAX, the primary mechanism for ensuring that doses reach everyone.
As of today, COVAX does not have an agreement signed with Pfizer and I think they have not signed it with Moderna either. So we are really waiting for the approval of the AstraZeneca vaccine so that vaccination really starts globally. But I think it is very important that all pharmaceutical companies seek to provide dosages and reach agreements with COVAX.
And it’s also vitally important that governments, particularly those in high-income countries that are already administering vaccines, invest in this global effort, that they make sure that not only are their national populations being vaccinated, because we are a crucial moment for multilateral efforts and global unity.
And why should they? That is, what is the consequence of immunizing the population itself and ignoring the rest of the world?
Because that would allow the virus to continue to spread uncontrollably in other parts of the world. On the one hand, this has obvious human and economic costs, especially in the affected areas. But also, the longer we allow the virus to move freely among the population, anywhere in the world, the greater the risk of mutations.
And we have already seen how the situation of the pandemic changed radically in the last month with the appearance of new strains. We know that the UK strain is spreading quite quickly here and in many other countries, because it is much more transmissible, and there is also the South African strain, which appears to be a different mutation that may render some potential treatments ineffective.
So it is about containing the spread of the virus as much as possible, because that will increase the chances of reducing possible mutations.
At the same time, we live in a very globalized world and we have already seen how quickly the virus spreads. Countries cannot be completely isolated. And if our answer is country by country, we will see how the new strains spread. For all of us to be protected, vaccination really has to be global.
So it is not just a matter of equity …
No. For me, equity is the most important thing, I think it is the right thing to do, that we must make sure that we are not prioritizing only vulnerable people in our own country, whatever it is, but all over the world. That’s right.
But there are also very, very real risks of taking that kind of country-by-country approach. And the pandemic will last longer if we do not focus on vulnerable and priority groups globally. If some countries are dedicated to vaccinating their entire population before other countries have vaccinated their priority groups, that would undoubtedly extend the duration of the pandemic.
And is there not also a risk of mutation if it takes too long to immunize the entire population of a certain territory?
I think there is always the risk of mutations. But these occur mostly in places where the virus is uncontrolled and spreading rapidly. A possible quite British analogy is that of the Great Fire of London, which was a fairly large and significant event here. What had to be done was to create a gap between the houses, so that the fire no longer had fuel to spread. And it is a bit like this with the virus: you need to create a kind of gap between people, big enough so that this virus can no longer infect and that slows it down.
So it pays to have priority groups within populations rather than entire populations, because even that has a really big impact. So countries can target health workers, the elderly, the most vulnerable groups in each country. That will significantly slow down the spread of the virus, even if it doesn’t reach the entire population.
How concerned should people be about the impact of mutations on the effectiveness of vaccines?
I am not a scientist, but from what I understand there is not much concern when it comes to the new UK strain. Everything indicates that vaccines are still just as effective. And that seems to be the case for the South African variant as well. Therefore, it is very likely that the vaccines will continue to work.
Now, there is always a risk that there is a mutation that changes that for some of the vaccines, but the good thing about the ones that have been developed for Covid is that they adapt quite easily to new strains. Therefore, it would not be necessary to start from scratch.
But for the moment, that is not an imminent threat. So I think people can rest easy, because right now vaccines are proving to be effective and because they could adapt quickly in case there is a new strain that somehow evades the action of vaccines.
Are there countries that are doing better than others regarding vaccination?
I think people are always going to compare and this is going to be a debate and a question that will be asked over and over again over the next few months and years. I would not dare to go into the details of the launch of vaccines country by country, because it is something very complex and it is not something in which we are involved.
But whatand Do you think, for example, the decision of the United Kingdom to space the two doses more space to be able to give the first to a greater percentage?
We as Wellcome believe that it is best to stick to the vaccination schedules recommended by the trials. But this is an extraordinary pandemic. And the extremely virulent strain we have in the UK is an acceptable reason to widen the dose gap.
People shouldn’t worry too much about this because it is kind of the standard in immunology to have delays between the first and second doses. And there is evidence to suggest that extending the time between doses can actually improve the immune response.
That said, I think this decision was very specific to the UK context. Some data from the trials were used, but it was not something that was formally tested in the trial. And therefore, it must be done with great caution, it is not a recommended strategy everywhere. The rationale was simply to reach more people with the first dose faster, but the second dose of all vaccines is absolutely vital for immune protection and should not be delayed too long.
I know there have been suggestions to give just one dose, and that’s definitely something that would not be a good idea, because booster doses are really important for long-term protection against viruses.
Another thing we are saying is that in those countries that are doing things differently, that are modifying procedures, monitoring studies should be carried out. How does that affect the launch of the vaccine? It is best to act on the evidence and evaluate it, especially when there are many other things uncertain at the moment.
And how much of a problem does rejection or mistrust of vaccines create? What impact has the pandemic had on anti-vaccine sentiment? So that dIn some polls, sometimes it seems that he has stoked it …
That’s a pretty hot topic, as you already know. And many different surveys have been conducted in different countries to ask people whether they would apply them or not. But the evidence we have at Wellcome suggests that the vast majority of people will most likely want this vaccine.
We must not forget that hundreds of millions of children are vaccinated each year. Getting vaccinated is really a normal activity, in a sense it is part of everyday life …
But there we are talking about vaccines that have been used for a long time, not vaccines developed in record time …
Certainly. But I think that surveys that were done when vaccines were still in development may not adequately reflect the sentiment of the people. While they have now been approved, they have been scrutinized by regulators …
Obviously people will follow legitimate questions and want to understand how they work. And we have to do a good job of communication in that regard. People wonder, how can they have done it in a year when it normally takes much longer? And the analogy that I have used is that it is a bit like crossing a city at rush hour. In a normal situation it can take years, because there are all kinds of queues, traffic lights, etc. But what they did with this vaccine is a bit like crossing the city with a police escort. This way it was possible to cross it much faster, although the path was the same as always. In other words, the same steps were followed, but it was given much higher priority and more resources were injected, more money than usual.
I think that is a very important message. People should feel reassured that no risks have been taken, that no steps have been skipped. It’s just that a really Herculean effort has gone into being able to pull it off. And as you already know, the effectiveness of these vaccines is much higher than anyone expected, so we have had some very good news. Even though it is a very difficult time around the world, what was achieved is truly incredible.
So what do you think the effect will be on future vaccination campaigns? It will help you to will people remember how important vaccines are, or will it fuel the skepticism seeded by the anti-vaccine movements?
My hope is that when surrounding countries start vaccinating against COVID, their immunization systems will be strengthened. Because there are many countries that have not done anything like this in a long time, since they have not had to face infectious diseases. Indeed, in many countries the threat of infectious diseases has been quite low for many years and we have forgotten what it feels like to live with that level of risk, that level of concern in our lives. And, in that sense, I think this is all a powerful reminder of what vaccines do for us every day.
Before, every summer parents were concerned about polio, swimming pools were closed, public places were locked. I hadn’t realized it before the pandemic started, but lockdowns were something that happened quite often because of polio. And now we have almost completely eliminated it from the planet. So I hope all of this underscores the amazing work vaccines do and reminds us and strengthens our systems.
At the same time, however, there is also a risk. If things are not done well, if communications are poor, there is a risk that misinformation will gain ground. I hope that is not the case. But for that, community participation is absolutely vital wherever the vaccine is implemented in the world.
There are community leaders who need to be involved in the process. You have to rely on them, religious groups, etc., to build trust. Try to understand what might prevent people from getting a vaccine.
It is also really important to make sure that the vaccination systems are well designed. We know from accumulating evidence that it is often primarily practical factors that stand between people and vaccines. And if for some reason the vaccines don’t get to the right place at the right time, and people travel to get vaccinated and there are no doses available, that bad experience may mean they won’t go the next time.
Those kinds of things may not be as visible as the threat of misinformation and conspiracy theories, but those details are what really make a big difference in how successful the vaccine launch can be.
Vaccines have been presented as a turning point, but also I know has warned that they are not a magic bullet. What must continue to be done so that vaccination really marks the beginning of the end of the pandemic?
The first thing is to continue applying public health measures. And we must also continue to support the development of more effective diagnostic tests and treatments. Vaccines, treatments, diagnostic tests and public health measures are the tools we have against this virus. And keep in mind that it will be a long time before everyone is vaccinated.
Therefore, it will be necessary to maintain some of the public health measures for longer than we would all ideally wish. And a very small, but very important point is that people who get vaccinated should maintain those measures for at least two weeks, because it can take a while for immunity to activate. Many may believe that the vaccine starts to work as soon as it enters the body, but it actually takes a little time.
Now, the global effort around vaccines, treatments and diagnostics is currently underfunded and still struggling to get the investments it needs. So it’s very important that governments invest in that global effort. There are huge economic costs every day for the pandemic. And that investment, when compared to the losses we are incurring, is quite small and can make a big difference.
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