As the UAE records one million infections to date, what's next in fight against Covid-19?

'Hybrid immunity', from vaccination and prior infection, is reducing rates of serious illness

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  A woman receives a dose of the Pfizer-BioNTech Covid-19 vaccine at Zabeel Health Centre in Dubai.

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  A teenage receives the Pfizer-BioNTech vaccine in Dubai.

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  A woman receives a dose of the Pfizer-BioNTech Covid-19 vaccine at Zabeel Health Centre.

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  Asha Susan Philip, a nurse with Dubai Health Authority, receives the Pfizer vaccine. Dubai Media Office

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  A girl receives a vaccine dose in Dubai.

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  A boy receives the Covid-19 Pfizer-BioNTech shot in Dubai.

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  A health worker prepares to administer the Pfizer-BioNTech vaccine in Dubai.

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  A nurse displays a dose of the Pfizer-BioNTech Covid-19 vaccine at Al Barsha Health Centre.

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  A boy receives a vaccine dose in Dubai.

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  A boy is given the Pfizer-BioNTech vaccine.

As one million cases of Covid-19 are confirmed in the UAE to date, many will wonder how the pandemic will probably play out in the country.

While the authorities were among the fastest in the world to introduce vaccinations, the coronavirus has not gone away, with thousands of positive test results each week.

But the number of deaths has fallen in recent months, with the last time there were more than 10 recorded in a single week being back in February.

Immunity within the population, from vaccination and prior infection, is expected to be part of the reason why infections are less severe.

In June, the UAE said “100 per cent of the target groups in the country” were now vaccinated.

Prior infection and vaccination offer protection

“All the conclusions we have reached about immunity which apply to the other countries will apply to the UAE,” said Prof John Oxford, a virologist and emeritus professor of virology at Queen Mary University of London.

So, prior infection will continue to provide at least some protection, even against new variants, strengthened by vaccination, he said.

Prof Paul Digard, a virologist at the University of Edinburgh, said a distinction should be made between sterilising immunity, which completely prevents infection, and partial immunity, which stops a person from falling seriously ill.

Vaccination and prior infection may often fail to provide the former, meaning that they may not be able to prevent a person from catching the coronavirus again, as repeated infections that some individuals have experienced have shown.

Limiting effects of virus

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  People waiting for their turn to get the Covid-19 vaccine at the Ajman Society of Social and Cultural Development. All photos: Pawan Singh / The National

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  People arrive at the vaccination centre to receive shots of either Sinopharm or Pfizer-BioNTech.

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  Rashid Al Shamsi after getting his Covid-19 vaccine shot at the centre.

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  People in Ajman have responded to government calls to support the nationwide vaccination drive.

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  A man receives the Covid-19 vaccine at the Ajman Society of Social & Cultural Development centre.

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  Numbers of Emiratis getting vaccinated at the Ajman centre have increased significantly in recent months.

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  Muna Saqr Al Matrooshi, general director of Ajman Society of Social and Cultural Development, has welcomed the rise in Emiratis being vaccinated at the centre.

However, protection from vaccination and prior infection does provide partial immunity, meaning that it substantially reduces the likelihood of severe illness, even if it does not prevent infection entirely.

Some studies have credited this combination of vaccination and prior infection — also referred to as hybrid immunity — with reducing the rate of hospital admissions in later waves of coronavirus infections.

For example, a study from South Africa earlier this year found that during that country’s fourth wave of Covid-19 infections, about one in 100 cases resulted in a person needing to go to hospital, while during earlier waves the figure had been as high as one in 24. Reduced pathogenicity of the virus over time may also have played a role in lower hospitalisation rates.

More recent research from Qatar found that a previous infection with one of the older Covid-19 variants, such as Alpha, Beta or Delta, provided some protection from reinfection against even two recent iterations of the coronavirus, BA.4 and BA.5, both sub-variants of Omicron.

However, the researchers found that an infection with Omicron provided stronger protection against reinfection with BA.4 and BA.5, although part of the reason may have been that Omicron has been circulating more recently than the earlier variants, protection conferred by which may have faded.

Reason for cautious optimism

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  1. The UAE is the travel industry's most recovered country. Photo: DTCM

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  2. The Dominican Republic is the second-most recovered country, while Punta Cana is the world's most recovered city. Photo: Unsplash / Joshua Wilkinson

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  3. Cancun, Mexico is the third-most recovered travel destination. EPA / Alonso Cupul

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  4. Bangladesh has bounced back from Covid-19. People take pictures among Kans grass at Sarighat area in South Keraniganj. EPA

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  5. Pakistan is the fifth-most recovered destination based on bookings made up until March 2022, according to Travelport.

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  6. A tourist surfs along a beach in Mirissa, Sri Lanka. AFP

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  7. Hot air balloons glide over the historical Cappadocia region, located in Nevsehir province of Turkey. Getty Images

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  8. The Maldives has an abundance of beaches boasting golden sands and crystal-clear waters, which has aided its quick tourism recovery.

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  9. Tourists take a picture with a camel on a beach facing the Gulf of Aqaba, in the Red Sea resort of Sharm El-Sheikh, Egypt. Reuters

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  10. A view of the Old Jaffa Port in Tel Aviv. A strong vaccine drive has helped Israel's travel recovery. EPA

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  11. Visitors at Las Delicias waterfall in San Jose del Guaviare, Colombia. The country reopened to travellers early in the pandemic. EPA

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  12. Tangier's street-side stalls are popular with tourists visiting Morocco. Getty Images

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  13. A tourist visits the Abu Lawha Nabataean tomb at the desert archaeological site of Hegra, north-west of Riyadh, Saudi Arabia. AP Photo

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  14. People walk along the Dom Luis I Bridge in Porto, Portugal. Reuters

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  15. A skier at the Revelstoke Mountain Resort in Canada, the 15th most recovered destination. Photo: Garrett Grove

Looking ahead, Prof Digard said it was likely that Covid-19 would increasingly “fade into the background of seasonal respiratory diseases” familiar before the pandemic, although it remained to be seen how long this would take.

“I think the level of cross protection you get from having seen the virus repeatedly, that builds up, and then over years that infection will get milder and milder,” he said.

“If you look at the epidemiological curve for winter flu in the 20th century, there was a massive spike in the 1918 pandemic. Over the next 70 years or so, even with the odd spike, it was a generally declining curve.

“I think SARS-CoV-2 will behave like that, hopefully rather quicker than that general decline with flu.”

While he said a country such as the UAE - with a population of about 10 million - may experience spikes in cases again, these would probably be more modest than previously.

“Not one million cases of 10 million. It’s 100,000 of 10 million,” he said. “At that point you’re maybe talking of the background winter cold that everybody gets when schools reopen or go on holiday.

“We’ll pay less attention to it. The people who grew up with it will look at it like they’ve got a cold.”

While for most it will be a mild infection, Prof Digard said that some groups, notably the elderly, would remain more at risk.

Reformulations of the vaccines may be needed to cope with the continued changes in SARS-CoV-2, Prof Oxford said, with the virus having evolved faster than many researchers expected. It will be a case, he said, of “updating the vaccines and seeing how it goes”.

A concern on the horizon, he said, is the risk of another such pandemic. Bats act as a reservoir for many coronaviruses, one of which could jump the species barrier again and start to infect people.

“The question is really, with so many bats, when is the next one going to arrive?”, Prof Oxford said.