Leading medics issue plea for global 'vaccines-plus' plan to beat pandemic

More vaccines and a focus on stopping infections could prevent more variants – BMJ letter

Vaccines and infection-aquired immunity alone will not end the Covid-19 pandemic, a BMJ letter signed by experts says. AFP

The world needs to urgently adopt a “vaccines plus” strategy to defeat the coronavirus pandemic that includes clear advice to take precautions against infection from airborne transmission, a global forum of experts have said.

Attempting to curtail the pandemic by immunity through either vaccines or infections was not working and was potentially harmful, the group said in a letter in the British Medical Journal, which instead set out new priorities around social restrictions, respirators and inoculations.

The strategy pursued by countries such as Britain, which was not named, was ineffective and could help the virus mutate, according to the paper signed by more than 100 doctors and scientists from around the world

The “high transmissibility and degree of immune escape” by the Delta and Omicron variants proved that sustained immunity was unlikely, especially with vaccines based on the original strain.

Widespread transmission brought “unpredictability to the pandemic response” and had resulted in “rapid adaptation” of the virus, making it more transmittable, virulent and capable of escaping antibodies.

“There are other drawbacks to a vaccines-only strategy,” the letter said. “Countries which tolerated high transmission have seen rises in both Covid-specific and all-cause mortality, healthcare worker shortages, and repeated lockdowns to control surges in case numbers.”

Currently Britain is experiencing extremely high infection rates, averaging 160,000 a day, leading to staff shortages across the workforce despite having one of the highest booster vaccine rates.

The paper argued that countries that suppressed transmission early on “saw reduced mortality and less economic damage”. China, which was not named, is the leading example of the so-called Zero Covid approach, with highly effective track-and-trace systems leading to lockdowns of cities suffering just a handful of infections.

“Some countries view infection as a net harm and pursue strategies ranging from suppression to elimination,” the letter said.

These countries aimed for low infection rates through a combination of vaccines, movement restrictions and financial support for businesses.

A failure to control high transmission rates created a “negative feedback loop” in which track and trace and public health “become overwhelmed, making them less effective, further fuelling transmission”.

The world needed to adopt a “vaccines-plus approach” to slow the emergence of new variants. This would also ensure that they could be more controlled allowing people to go about their daily lives.

Dr Ilan Kelman, an emergency planning expert at London University, welcomed the paper, saying it recognised that there was “no single solution”.

“The pandemic has to end at some point so it’s a question of how much hurt we want to cause in managing it,” he told The National. “If a balanced approach taking a variety of measures is not taken by all countries then this will only prolong the hurt.”

The paper also quoted WHO director general Tedros Adhanom Ghebreyesus who last month said that “vaccines alone will not get any country out of this crisis”.

The medics and scientists called on national governments and the World Health Organisation to rapidly undertake a series of measures as the vaccine-plus strategy.

They needed to “unequivocally declare” Covid as an airborne pathogen “to remove confusion that has been used to justify outdated policies”. The declaration would lead to the use of high-quality respirators for indoor gatherings as the benefits of face masks was now well established.

New measures were needed to filter air inside buildings beyond merely opening windows and they called for a “paradigm shift” to ensure all public buildings had clean air.

There should also be “set criteria for imposing or relaxing measures to reduce Covid-19 spread based on levels of transmission in the community”. Track and trace as well as isolation were essential to control the disease.

Finally, “urgent measures” were needed to achieve “global vaccine equity”, which includes sharing doses, suspension of patents and allowing technology transfer. Regional production centres were also needed to generate plentiful local supplies

“Failure to control the virus are likely to have a lasting impact on the well-being and prospects of the next generation,” the experts said.