Why vaccines alone are not enough, how the UK government could mess things up again and which European country will eliminate COVID first?

 

Why has the UK government decided to apply serious travel restrictions to incomers because of COVID now, almost a year after the pandemic began? What took them so long, and what has changed? The obvious answer to the second question is vaccination and mutation.

We don’t know how much the vaccines so far approved will stop people passing on the infection to others, but what evidence we have suggests there will be at least some dampening effect. Israel is likely to provide the first firm evidence on this. That will reduce R, the number of people one infected person passes the illness on to. What vaccines will certainly do is substantially reduce the chance of people getting ill from COVID.

The danger is that, as vaccines are rolled out, the virus develops the ability to bypass them through mutation, so vaccines either don’t work at all against this new variant or work less well. This doesn’t seem to have happened to a large extent yet, and it isn’t inevitable, but it has happened to a small extent and it would be unwise to assume it will not happen. The chances are that variants are likely to emerge in other countries first, so it makes sense to try and stop that variant entering into the UK for at least as long as possible.

While this provides an excellent justification for creating travel restrictions today, it doesn’t explain why effective general restrictions were not imposed before. (There have been requirements to self-isolate, but these seem largely voluntary.) A cynic might say that the underlying UK strategy is and always has been herd immunity, but I think that only applied at the beginning of the pandemic. After then, with UK cases more often than not higher than elsewhere, the incentive for effective and generalised border controls was not enough to motivate this government.

While the chances are that any variants that can bypass vaccines will emerge abroad, it is possible they will emerge in the UK because we are vaccinated in an environment of widespread infection. The big danger left is that Johnson will once again relax lockdown restrictions too soon, before enough people have been vaccinated. The quicker we reduce case numbers in the UK, the less chance there is that a vaccine-resistant mutation develops in the UK. In addition the more cases there are, the easier it is for an overseas variant to multiply. No restrictions on people entering can be 100% safe, as New Zealand recently found, and a complete ban on people entering is not feasible because of returning nationals. Johnson should know this because his failure to get case numbers really low over the summer allowed the UK variant to develop and multiply.

It makes sense to reduce UK cases as quickly as possible to very low numbers, to reduce the chances of mutation and increase the chances of isolating any variant that comes in from abroad. Whether you call it zero-COVID or elimination or whatever, that strategy has always been the one that minimizes deaths and gets the UK back to normal as quickly as possible. Vaccines don’t change that reality, they just make it easier to implement. One argument put forward against an eradication strategy has been the costs of quarantine in hotels, but now the UK government is doing quarantine that argument falls away.

Just as the UK is now imposing quarantine for incoming travellers, or requiring recent tests, the same is likely to happen in other countries for similar reasons as their vaccine programmes are rolled out. For a period of time we will have many Western countries where there is much reduced inward human travel. This is an outcome that I imagined happening many months ago once the scale of the pandemic became clear, and should have happened if best practice had been followed.

Once such a situation comes about, it creates two sets of very positive incentives for countries imposing quarantine. First, each country has a strong incentive to eliminate the virus, so that they can free travel up with other countries that have done the same. We will get travel bubbles being formed. Those bubbles will be fragile, as they have been for Australia and New Zealand, but they represent the beginnings of international cooperation to eliminate the virus.

The second incentive for those countries that do eliminate COVID is to get other countries to do the same, so free travel between countries becomes possible again. But even with quarantine, risk can only be completely eliminated when all countries have eliminated the virus. So the second incentive is to get the vaccine to poorer parts of the world as quickly as possible, with the help of international cooperation.

That is the strategy that the UK should now follow. However the UK is a country that has more than a 100,000 dead from the virus, with currently one of the highest death rates in the world. This reflects in part the fact that we have a weak Prime Minister, who is very indecisive, puts off decisions, wants to please and is easily swayed by pressure from others. We already have a large number of Tory MPs and business people who are clamouring to end the lockdown whatever dangers that brings.

The problem is that Johnson does not only listen to scientific advice, which is to avoid any relaxation for some time. He also listens to his MPs, some of whom have very strange but strongly held views on lockdowns. He has already said that he hopes to reduce some restrictions at the end of February, despite also saying that closing schools will be the first restriction to end and it probably will not happen until Easter. Of all the restrictions in the current lockdown there is a strong case for getting schools back first, but any relaxation of other elements of lockdown before then makes that less likely or more dangerous. Time and time again Johnson has gone for short term popularity with terrible long term costs, using as an excuse a trade-off between health and the economy that does not exist beyond the very short term.

Another indicator that Johnson may mess things up is how he has oversold vaccines. They have been presented as the solution to the pandemic, rather than as a key tool among many in ending the pandemic. With new infectious variants already circulating, we cannot be sure that the vaccination of everyone who is willing to be vaccinated will be enough to achieve herd immunity (see also here). But the main reason why vaccination is not enough on its own is the generation of variants. As this excellent discussion from Anjana Ahuja suggests, Taiwan, China, Australia and New Zealand are the examples to follow, and vaccination will make it much easier to follow that strategy.

It would be nice to be optimistic that some other Western countries will follow this advice. Unfortunately, while most European governments are not as foolish as ours, very few have shown much wisdom either. Read this from Le Monde on how Macron is also putting off the inevitable as cases climb. To quote, Macron “does not want to let this measure be imposed as long as the figures do not show the urgent need for it. With around 20,000 new cases per day, France can still avoid it, he believes.” You only need to look at the data to see how unlikely he is to be right.

It is an interesting question why no Western government has learnt the lessons from the East. Why do none have a leader who is prepared to go with the science? Instead we have politicians who balance what the experts say with pressure from small businesses and others in various sectors to do the opposite. Everyone wants financial support and Ministers of Finance worry about the cost. Few with any power seem to realise that the strategy that minimises costs, disruption to business and saves the most lives is locking down hard and fast, and trying to minimise cases. The media reflects the myopia of actors rather than leading. (How many discussions on how Australia has handled the pandemic have you seen in the UK broadcast media, and has it been greater than discussions of Sweden?)

The common idea as to why Australia and New Zealand have followed an eradication strategy from the start is that it is easy because they are islands with less international travel than European countries. That is not quite right for Australia. COVID policy is determined at the state level, and the states have imposed land border restrictions between each other when outbreaks have occurred. We can only hope that once European countries start imposing international travel quarantines as their vaccine programmes are rolled out, and now they have a better understanding about how not to handle the virus, some at least will follow Australia and adopt eradication as a goal.

I think it is likely that once a few European countries do this, most will follow as the advantages of an eradication policy become clear. As Norway already has a variety of border controls including hotel quarantine in place, and a low number of cases, my guess is that Norway may be among the first European countries to adopt elimination of COVID as a strategy. Finland, which also has strict entry requirements and a relatively low number of cases, is another possibility. With a head start in terms of vaccine supply it could be the UK, but with a Prime Minister who says he wants to wait before learning from past mistakes I somehow think it won't be.