, , , , , , , , , , , , , ,

Over the last week or so, I have had many discussions with several ex-colleagues and now friends about the true purpose of Covid-19 vaccines, the demonisation of anti-vaxxers, whether herd immunity can ever be achieved, and Novak Djokovic’s 4-day detention in Melbourne. The discussions have forced me to rethink my opinions about the world’s reaction to the SARS-CoV-2 virus and to attempt answers to a few fundamental questions such as these:

1. What is the purpose of the anti-Covid vaccines?
2. What is the purpose of all the rules and regulations that now govern entry into another country?
3. Should anti-vaxxers be considered anti-social?
4. Is herd immunity against Covid a realisable goal?
5. What defines the end of the Covid pandemic and are we there yet?

Let’s take these questions one at a time.

The Purpose of Anti-Covid Vaccines

The primary aim of a vaccine is to reduce the severity of symptoms associated with the infectivity (ability to harm) of a virus on the body. The vaccine produces antibodies and T-cells that fight the virus and even if they don’t win the fight outright, will cause the virus to weaken thus reducing its impact on the body. This is the symptom suppression effect of the vaccine.

A side effect of symptom suppression is a reduction of the number and hence transmissibility of active viruses in the body (called the viral load). This, in turn, reduces the risk of an infected person transmitting the virus to an uninfected person but the reduction is not down to zero risk and transmission can and does occur. A recent study, Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants, published in The New England Journal of Medicine and authored by eight people (six of whom have PhDs!), concluded that ‘The reductions in the transmission of the delta variant declined over time after the second vaccination, reaching levels that were similar to those in unvaccinated persons by 12 weeks in index patients who had received (vaccine) ChAdOx1 nCoV-19 and attenuating substantially in those who had received (vaccine) BNT162b2. Protection in contacts also declined in the 3-month period after the second vaccination.’ followed by a general conclusion, ‘Although vaccination still lowers the risk of infection, similar viral loads in vaccinated and unvaccinated persons who are infected with the delta variant call into question the degree to which vaccination prevents transmission.’ In other words, those who are vaccinated are less likely to pass the virus on to others but transmission suppression reduces over time and, eventually, becomes the same as those who are unvaccinated.

2. International travel rules and regulations

Before international travel was limited by country lockdowns, my wife and I regularly visited our daughter and her family in France in a town just over the Swiss-French border, 20 km east of Geneva airport. Our journey from the UK was by air to Geneva and then on by car or train to our French destination. Visits stopped throughout 2020 but we resumed our trips in the second half of 2021 and have more planned for 2022. For those who have not yet endured the thrills and spills of international travel during the pandemic, here’s a summary of what’s now involved in what used to be a mundane trip from one country to another.

Because our route takes us across two borders, we have to satisfy UK (non-EU) to Switzerland (non-EU) entry requirements and then Switzerland to France (EU) entry requirements, and then in reverse when we return. We also complete the direct UK to France entry requirements as we only transit through Switzerland and French Immigration may check our country of origin. To make matters worse, the border entry requirements of all three countries are constantly changing, sometimes with very little notice, and we go and come back with three or four documents each per border. Each time we travel, I sit down and study the entry requirements and make a plan for when and how we can obtain the requisite pre-flight Fit-to-Fly certificates (usually based on a PCR test and which must be taken within 48 hours of departure) and post-flight Day 2 negative test certificates (based on either a PCR test or a Lateral Flow Test, LFT, depending on the government’s mood of the day, and which must be completed online within 48 hours of departure). It’s a minefield full of vague statements. I also fill out Passenger Locator Forms (PLFs); sworn declarations that we don’t have Covid (for France); and make sure our NHS Covid Passes that detail our vaccination histories are up to date (they expire after 30 days ‘to protect data privacy’—a reason I have never understood), and so on. And that’s all for the simpler case of those who are fully vaccinated, as we are. We have seen people turned away by airline staff at the gate because they don’t have the right documents—angry exchanges, tearful faces, confused airline officials holding and consulting a summary of the latest requirements for entry into wherever the next flight is going.

The outrageous costs of some of the pre-flight Fit-to-Fly and post-flight Day 2/5/8 tests is a scandal waiting to be exposed. I have received post-flight at-home Day 2 tests with no swabs in the kits, and, on another occasion, with no Unique Reference Numbers meaning I was unable to return my results to the lab. Similarly, I complete PLFs saying where I will isolate on my return until I receive a negative Day 2 result but when I was unable to return my Day 2 result, nobody checked that I was where I said I would be and that I was negative. In other words, there is no connection between the government’s requirement for me to take the test and its result and record of where I am. Nobody has joined up the dots! That being so, what is the point of all these tests and location forms?

3. Are anti-vaxxers antisocial?

Ah now, this is the question guaranteed to split families, cause a ruckus in a pub or bar, and, potentially, start a war. I used to think anti-vaxxers were unacceptably antisocial but not anymore. You can read more in my article here but, in summary, I accept that some anti-vaxxers will have a bona fide medical reason not to be vaccinated whereas others may have other reasons which they do not want to disclose. But that is their right and as long as they understand that, as a result, they can become very ill and possibly die, we should not castigate them for their decision. The only antisocial label we can put on them is that if unvaccinated people contract Covid-19, they are more likely to end up in hospital than those who are vaccinated, thus depriving the bed from others who require hospitalisation for a different reason. But how likely is more likely? A recent publication in the British Medical Journal reports thus:

‘The Intensive Care National Audit and Research Centre (ICNARC), which has been monitoring activity throughout the pandemic, provides information on admissions to intensive care. Its latest report, published on 31 December, showed that the proportion of patients admitted to critical care in December 2021 with confirmed covid-19 who were unvaccinated was 61%. This proportion had previously fallen from 75% in May 2021 to 47% in October 2021—consistent with the decreasing proportion of the general population who were unvaccinated—before rising again in December 2021.’

The quoted two-out-of-three (61%) unvaccinated percentage figure can be all over the map depending on a variety of factors—percent vaccinated and vaccination level (single, double or triple-jabbed), population density, rules regarding bubble size and entry into public places, whether face masks are worn and social distancing practiced, those with natural immunity, and so on. It’s tough to defend an antisocial label based on a moving bed of statistics.

In other respects, unvaccinated people are just like vaccinated people in that both can be transmitters of the virus and both can catch and even recatch the virus. Sure, people who have been recently vaccinated or who have survived Covid-19 and are now naturally immune are not so likely to transmit the virus to others for a short space of time but, eventually, both the vaccinated and unvaccinated return to the same point in respect of virus transmission. What effect does this have on the holy grail of herd immunity?

4. Is herd immunity against Covid a realisable goal?

Google defines herd immunity as:

Herd immunity occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune.

In my anti-vaxxers blog, I wrote: 

Until herd immunity is achieved there will always be a risk of infection but Covid-19 herd immunity, either by vaccine or natural methods, is now regarded to be an impossible objective due, primarily, to the constant evolution of the virus producing mutations such as the recent delta and omicron variants; vaccine-induced immunity levels in the body decaying over time; the fact that vaccines are not effective transmission blockers; uneven global rollout of the vaccines; vaccine hesitancy/anti-vaxxers; and delayed vaccination of children.

I believe it will be impossible to reach the point where the SARS-CoV-2 virus dies naturally because it can no longer find a host i.e., herd immunity. Look at the history of influenza (flu). People have suffered from flu-like symptoms for 1,500 years according to https://abionline.com/history-of-influenza/ The same reference states that viruses were not discovered until 1892 (by the Russian botanist, Dimitri Ivanovsky) and the 1918 Spanish flu pandemic killed an estimated 50 million people worldwide. Compare this figure with the estimated 5.5 million deaths caused by Covid-19 so far. Anti-flu vaccines were developed in the 1930s with mass population rollouts in the 1940s, particularly in the USA, but still we don’t even have countrywide herd immunity against flu, let alone worldwide. Every year, new variants of flu appear and every year we have to modify the vaccines and launch a seasonal vaccination program. Flu has become an acceptable seasonal part of life, just like the common cold.

If 90 years of fighting to eradicate the flu virus (of which there are now four main strains) in order to achieve herd immunity hasn’t worked, what chance do we have of eradicating the SARS-CoV-2 virus and its alpha, beta, delta, and omicron mutations?

Answer: none!

5. What defines the end of the Covid pandemic and are we there yet?

The $64,000 questions. Can we vaccinate our way out of the Covid-19 pandemic? Can we set a deaths-by-Covid threshold below which we say we are no longer in a pandemic? Will people just get fed up with all the rules and restrictions and decide not to follow them anymore—a rebellious social ending?  I googled, ‘What defines the end of the covid pandemic?” Here’s what I found:

The management consulting organisation, McKinsey and Company, asserts that ‘endemicity remains the endpoint.’ (In this context, endemicity means reducing the pandemic into a series of localised epidemics wherein the virus becomes endemic.) This theme is echoed by a number of epidemiologists, virologists, infectious disease modellers, WHO officials, and historians in a survey article from Stat, a website devoted to the analysis of ‘biotech, pharma and life sciences,’ and by Avera Health Services who define pandemic and endemic thus:

Pandemic: An epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people. COVID-19 was declared a pandemic in March 2020 by the World Health Organization.

Epidemic: The occurrence of more cases of a disease than expected in a given area or among a specific group of people over a particular period of time.

We can walk a coach and horses through these definitions but, in non-scientific terms, a pandemic reduces to an epidemic when we learn to live with the virus and consider we have some degree of control over it in terms of vaccination efficacy, medical treatment, suppression of transmission, and the severity of its effects. We already live in this way with the common cold and with flu and we will do so in the future with Covid-19. As for when, I would argue we are ready now. Given the vagueness of when does a pandemic reduce to an epidemic, what is the point of delaying the movement back to normality? For those who say wait a while, I would counter with why? What are you waiting for? Is the threshold scientifically defined and accurately measurable? If so, by what parameters and how accurate and appropriate are those parameters?

The tennis player, Novak Djokovic’s recent 4-day detention in Melbourne has revealed confusion over the interpretation of entry rules and, for me, highlighted the future futility of quarantine for unvaccinated people entering the country. Even vaccinated people can be infectious. Is it the intention of the French government to deny Djokovic entry in May for the French Open tennis tournament? What will the UK government say when he flies into London for June’s Wimbledon tournament; and the USA government in August when he applies for a visa to participate in the US Open? Djokovic is a polarising Marmite person—love him or hate him—but if you ignore any personal feelings you may have for him and look at his situation objectively, he has become the catalyst for asking the question—do we still need all these rules, regulations and restrictions or is now the time to remove them and start the process of returning to normality? If you think the answer is, ‘No, not yet’, I would challenge you to say why and to also say what will change your no into a yes in terms that are objectively expressed and measurable.

My answer is yes; it’s time to return to normality. Convince me otherwise.