Putting all our eggs in the vaccination basket is delusional

21/01/2021

Governments worldwide have placed their hopes for fighting the pandemic in the roll-out of vaccines. But the jab will not be a panacea for society. Behavioural modifications will still be required.

It is not often that I agree with Prime Minister Scott Morrison. But I have to thank him for his sensible observation about a Covid vaccine. He warned that it is not the ‘silver bullet’ that will end the pandemic immediately.

The pandemic is reasonably well controlled in Australia and New Zealand. This suggests that isolation is effective prevention. The reluctance of governments in countries such as the UK and the US to adopt strict lockdown policies has allowed the virus to flourish.

This reluctance is attributable to political timidity. Governments have been afraid to cause even short-term pain to the economy. Control is incompatible with neo-con ideas. And part of the readiness to muddle through relates to hopes that a vaccine will soon control, and possibly eliminate, the disease.

Such hopes are delusional. We will still require public awareness and action to minimise the impact of the virus. Influenza vaccines have been available for decades now. Flu remains a huge health problem. There is a constant need to develop new vaccines.

Health authorities have learnt important lessons from the use of fluvax and other vaccines. The virus will not be eliminated. It mutates to survive. In the meantime, we must be educated about the aim of vaccination programs. A vaccine should prevent people contracting the virus, prevent death and ameliorate symptoms. On the other hand, while a vaccine can reduce contagion, it will not eliminate it. Vaccinated people can still transport the virus. So vaccinating aged care workers does not guarantee protection for nursing home residents.

There are questions about a vaccine’s degree of effectiveness. Even where a vaccine promises a 95% effectiveness rate, this is apparently based on the percentage of the trial population for whom the vaccine works and who gain some protection. It is not clear whether this means that an individual has a 95% chance of gaining total or some immunity. The public health setting into which the vaccine is introduced must take such measures into account. It might well be best to assume nothing until the vaccine has been used for several years.

Society faces some serious choices concerning distribution priorities. There have been calls for the most vulnerable people to receive the vaccine first. There are two distinct types of vulnerability. Many people are likely to contract the virus because they cannot isolate themselves. So health workers and teachers should have priority because they risk infection in their daily roles.

Alternatively, perhaps priority could be given to those most likely to die if infected, such as the elderly and the chronically ill. But when these people receive a vaccine it might not elicit a strong immune response. Their immune systems may be compromised, either by their illness or their medications. Have trials included people from such groups or will the first applications be, in effect, experimental? There is also a danger that side effects could result when a vaccine is given to such people, which would cause unnecessary alarm in the general population.

Suggestions have been made about vaccinating the young and healthy first. Some leaders still hope that things will return to ‘normal’ if we give priority to economic activity.

How long should we wait to see whether the vaccine has worked? Indeed, how will we know whether the vaccine or other preventative measures are responsible for a fall in infections?

We need a vaccine as soon as possible. We also need realistic expectations about what a vaccine can achieve in the face of an adaptable virus. For a vaccine to be really effective, Australia needs to have a very high participation rate and to maintain its national quarantine.

What we do not need is for popular enthusiasm for protection to allow decision-makers to sit back and wait for a vaccine to suddenly, magically, lift responsibility from their shoulders. The current generation of politicians spend money, time and energy avoiding accountability on numerous issues. There is no vaccine against dishonesty in politicians or against complacency or stupidity in the general population. Let us hope that the Prime Minister maintains his realistic approach to vaccination as just one part of anti-pandemic measures.

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