International flights should be immediately halted in regions where a respiratory virus such as COVID-19 is detected, Nobel laureate Peter Doherty has told an infectious diseases conference considering lessons from the pandemic.
Several speakers warned that the pandemic would not end until the whole world is vaccinated, with the Doherty Institute’s director of modelling Jodie McVernon declaring Australia needs to reset its thinking to a country where COVID-19 is prevalent.
“We have moved in a heartbeat from a low prevalence to a high prevalence country, and that means we have to reset all our thinking and expectations,” Professor McVernon said.
The Melbourne conference, held in person on Tuesday, heard of the intense pressure public health officials came under, including some receiving death threats.
The director of the Doherty Institute, Sharon Lewin, said it would have been better if the world had committed to purchase enough vaccines for everyone.
She said the chief operating officer of the philanthropic Wellcome Trust had advocated buying “7 billion vaccines upfront and have them for the world”.
“It was not an issue for manufacturing,” Professor Lewin said. “Instead, what we did, we quibbled over these tiny numbers of vaccines. Every country was fighting for itself.
“We hadn’t really ever thought that it would be possible to produce 7 billion mRNA vaccines. But he was saying that the logistics were there; it was just that no one’s thought of it. Maybe that’s what we’ll do next time.”
Professor Lewin also warned that each variant to date has been resistant to previous variants, meaning infection with the original Wuhan variant, for example, did not give you protection against delta or omicron.
She also supported the observation by former New Zealand prime minister Helen Clark that a lack of early decisive action meant February 2020 was “a lost month”.
The Tuesday conference was hosted by the newly formed Australian Institute for Infectious Disease, which is establishing a $650 million purpose-built research facility in Melbourne’s Parkville precinct to drive better and more unified preparation and response to global pathogens.
The Victorian government is contributing $400 million to the project, along with contributions from Melbourne University, the Doherty and Burnett institutes and philanthropists.
Close international borders
Professor Doherty told the conference the need to immediately close down borders was an important lesson.
“China didn’t make the virus, they didn’t distribute it, they didn’t cause the pandemic,” Professor Doherty said, dismissing calls for an inquiry as attempts to politicise the pandemic.
“The Chinese should have stopped the planes. And they and the rest of the world should have done what we did: stop the planes coming in. China stopped its internal flights, but it didn’t stop its international flights.
“We have to have agreement that as soon as something comes on the radar ... as soon as that happens, the planes have to stop in those regions if it’s a respiratory pathogen.
“If it’s mosquito-borne or something, it’s not the same thing [but] a respiratory pathogen, you have to stop the planes right away.”
The important thing about COVID is for us ... to learn from it and put those lessons out there and try to get people to continue to engage with the realities.
— Nobel laureate Peter Doherty
Professor Doherty also stressed the importance for research to be openly available.
“We must have open exchange between scientists,” he said. “We have to have scientists out there looking, particularly in south-east Asia, where a lot of these things are going to come from, where you’ve got bats.
“Because a lot of them [respiratory diseases] are going to come from bats.”
Managing the politics
Professor Doherty said Australia’s successful response to HIV in the 1980s was because of the strong linkages between the scientific community and political leaders, in particular then health minister Neal Blewett and his opposite number in the opposition, Jim Carlton.
“We built that interaction between the medical community and the political community. It’s not just about medicine; it’s about the political realities.”
His comments were supported by French Nobel laureate Françoise Barré-Sinoussi, who said the demonisation of HIV in the 1980s had stymied vaccine and anti-viral research for decades.
Several speakers cautioned about the need to maintain institutional readiness against future vaccine resistant variants amid warnings the pandemic is far from over.
“Globally, the emergence of omicron has washed through the world is leaving SAGE (the Strategic Advisory Group of Experts on Immunisation) to rethink what is the role of vaccine on top of this wave of natural immunity,” Professor McVernon said.
“The concept of hybrid immunity is the hot topic right now.”
It has been suggested hybrid immunity could offer enhanced protection against both re-infections and severe forms of COVID-19, which neither infection nor vaccination can individually provide.
Acting Victorian Chief Health Officer Ben Cowie called out the role of modelling.
“Honestly, I can’t think of a single example of something that was of a greater utility as some of those really difficult decisions were being made,” Professor Cowie said.
“Whether it was the Burnett Institute, the Doherty Institute, University of Melbourne, Monash University, all of the different modelling groups.
“Those are amazing skills that really continued to fundamentally guide.”
He also said strategic surveillance would continue to be essential.
“Important strategic intelligence ... to surveil what variants of concern are dominant, to be able to get that guidance from public health reference laboratories in real time and see delta being replaced by omicron, being able to monitor the emergence – this is all essential for public health responses.”
Dealing with uncertainty and anger
Professor Doherty and Burnett director Brendan Crabb both called for more nuance in trying to understand and learn from the pandemic.
“I think the important thing about COVID is for us – not just us – for us as academics, everybody from the social scientists, economic sciences to medical doctors to chemists to learn from it and put those lessons out there and try to get people to continue to engage with the realities of what these things are like,” Professor Doherty said.
“There are no easy solutions. Nuance and uncertainty is our world.”
Professor Lewin said she was hopeful that greater scientific literacy in the community would help people better understand the uncertainties associated with pathogens.
A member of the Australian Technical Advisory Group on Immunisation and obstetrician, Michelle Giles, spoke of the complexity of ensuring vaccine safety when there was rapidly emerging evidence. ATAGI advised in June that it was preferable for people under 50 years old to receive the Pfizer vaccine because of concerns about blood clotting, especially in younger women.
“One of the things to deal with is really some of the anger and anti-vaccination sentiment that exists in society,” Professor Giles said.
“Many of us were subject to trolls. There are also members of ATAGI and other committees that I’m aware of that have been subjected to death threats, just really for doing our job.
“We had to think about the impact of the recommendations on the whole of the program, and that was certainly foremost in our mind when we were considering the safety signal in relation to AstraZeneca.”
Departing AstraZeneca Australian president Liz Chatwin separately told ABC Radio National that the decision contributed to vaccine hesitancy.
“We were definitely disappointed by the rhetoric, as I said, around our vaccine because we saw that it did cause some vaccine hesitancy,” Ms Chatwin said.
Professor Lewin said the early experience Australia had with a coronavirus about 2003 (SARS-CoV-1) had prepared public health officials to move decisively to limit the contagion.
“Australia was just focused on the information from China and what Singapore, South Korea, Hong Kong were doing, and we just went down this totally different road that was very different in Europe,” she said.
Professor Crabb said vaccine inequity had been an “own goal”.
“If we are talking about $20 trillion, which is what the IMF (International Monetary Fund) predicts will be the cost of SARS-2 (COVID-19) ... it is inequity that’s driving that,” he said. “The IMF says the number one problem is vaccine inequity. If we want to cut potentially trillions of dollars down ... we will have to have vaccine equity.
“And yet it’s an afterthought. A third of the world had not had a single dose of vaccine. And that’s just an own goal that we can’t afford to do next time.”