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Vaccines Don’t Mean We’ll See the Last of Covid, Experts Warn

Past immunization campaigns suggest the disease may never be fully eradicated

Why this prediction that the Covid virus will never be eradicated? Because there will always be a large proportion of susceptible population in the community who are Not vaccinated..

By John Lauerman and James Paton. December 20, 2020

In record speed, vaccines are here, and more are on their way. 

Less than a year since the coronavirus began ravaging the world, the first shots are raising hopes for wiping the Covid-19 pandemic from the face of the earth.

Today’s programs in the U.S. and the U.K. are precursors to immunization campaigns intended to reach the planet’s entire population — all 8 billion people in every corner of the globe.

Is there reason for optimism? 

Vaccines are the best way to eliminate infectious disease: Smallpox has been eradicated and polio is on the brink, with just two countries where transmission persists. (How about the countries succumbing to sanctions from receiving vaccines, basic medication and basic food? Like Yemen, Libya, Syria, Palestinians in Gaza and West Bank…?)

But global vaccine campaigns take time — usually decades — suggesting that even with the latest technologies, money and power behind the unprecedented global drive to knock out Covid-19, the disease is unlikely to be eliminated any time soon.

“I would be surprised to see an actual eradication of this virus now that it’s all over the world, I’d be shocked, given how contagious it is.” said Walter Orenstein, associate director of the Emory Vaccine Center in Atlanta and former head of the U.S. Centers for Disease Control and Prevention’s immunization program. “I’d be shocked, given how contagious it is.”

Snags in supply and distribution have already arisen in the opening days of the U.S. campaign, and the U.K., the first Western country to begin immunizing, vaccinated just 138,000 people in its first week. Meanwhile, Europe has yet to start inoculations, and probably won’t do so until after Christmas.

Concerns are growing over how long it will take to immunize vast swaths of the world beyond a group of wealthy countries that have snapped up early supplies.

A global program called Covax, which aims to deploy Covid vaccines around the globe, has secured deals with developers including Johnson & Johnson and AstraZeneca Plc.

But some of those supplies are expected to come from an experimental inoculation from Sanofi and GlaxoSmithKline Plc that’s been delayed and may not be ready until late next year.

“It’s really, really complicated to make sure we get those vaccines produced and distributed in an equitable way globally, for both moral and economic reasons,” Mark Suzman, chief executive officer of the Bill & Melinda Gates Foundation, told reporters on a Dec. 9 call.

Suzman pointed to research showing that broad access to vaccines could deliver significant economic benefits to all countries and save many lives.

Since wealthy nations will likely have more than enough doses to vaccinate their entire populations, they should consider the reallocation of some supplies to those most in need, he said.

Smallpox Vaccination - NYC outbreak 1947
People line up for smallpox vaccinations outside a hospital in the Bronx after an outbreak in New York City in 1947.Photographer: Bettmann/Getty Images

Mass vaccination has been one of the most successful public health interventions in the world and has played an important part raising U.S. life expectancy by more than 50% over the last century.

About a third of U.S. deaths in 1900 occurred in children under age 5, many of them from diseases like smallpox, measles and whooping cough that are now preventable by immunization.

Some new vaccines have also gained quick and widespread use, like shots that prevent pneumococcal infections that can cause severe illness in children and adults. Introduction of the shingles vaccination has offered prevention of the painful disease to millions of people over the past two decades.

A veteran of the World Health Organization effort to eradicate smallpox, Orenstein would often immunize himself in front of entire villages to assuage safety fears.

The agency resolved to try to eradicate the disease in 1959 when it still afflicted many developing countries, but the effort didn’t kick into high gear until 1967 when more funds and personnel were committed by the WHO and its members.

The smallpox effort initially targeted entire populations, but that turned out to be impractical, recalled William Schaffner, a Vanderbilt University infectious-disease specialist who has advised the government on vaccination. The turnaround came when the strategy switched to identifying cases and then vaccinating everyone in proximity, sometimes hundreds of households.

This approach of creating a vaccination ring around cases was only possible, however, because smallpox can be a disfiguring disease, making it easy to identify, and spreads relatively slowly.

“It has this reputation of spreading rapidly but it actually spreads rather slowly,” Schaffner said. “You also need rather close contact for transmission to occur.”

Those features allowed vaccination teams to identify patients just as they were becoming infectious and close off all opportunities for transmission. Even so, it took two decades for the worldwide effort to contain the last outbreak in 1977.

A better comparison to Covid might be polio, an intestinal virus that sometimes causes permanent, severe disease. Polio is similar to Covid in that only a minority of infected people — about one in 100 — become extremely ill.

Sabin Sunday
Children and parents line up outside the Children’s Hospital to receive polio vaccines in Cincinnati, Ohio, on April 24, 1960.Photographer: Cincinnati Museum Center/Getty Images

That’s created one of the problems anticipated in widespread Covid vaccination: People who don’t believe they’re vulnerable to the disease may not want to be vaccinated, even though it may benefit others by keeping hospital intensive-care units free and possibly preventing transmission of the disease.

An important difference with polio, however, is that it can cause severe disease in young children, leaving them with lifelong paralysis, Orenstein said. That’s unlike Covid, which mainly strikes the elderly and chronically ill. That’s left some portions of the public indifferent.

“We’re getting more than a death a minute — on some days two deaths a minute,” he said. “It’s very disturbing to see the lack of concern in other people.”

Yet even with the specter of children paralyzed from polio and a vaccine available for some 65 years, global elimination of that disease still hasn’t been reached.

Two countries, Afghanistan and Pakistan, continue to have spread because of insufficient vaccination rates,  according to the Global Polio Eradication Initiative.

The latest Covid updates Make sense of the headlines and the outbreak’s global response with the Coronavirus Daily.EmailBloomberg may send me offers and promotions.

To defeat Covid, “we’ve got to convince people to take the vaccine,” said Anthony Fauci, the top U.S. government infectious-disease specialist, in an interview.

If you have a highly effective vaccine and only 50% of the people take it, you’re not going to have the impact that you’d need to essentially bring a pandemic down to such a low level that it’s no longer threatening society. And that’s the goal of a vaccine, the same way we did with measles, the same way we did with polio, the same way the world did with smallpox.”

Most standard immunizations provide protection for years to decades.  We still don’t know how long Covid vaccines will last, Fauci pointed out.

And it isn’t clear whether they prevent transmission along with protection against symptoms, although studies may soon shed light on that.

The logistics and supply-chain challenge the world faces today is “more complicated than usual because for the first time in history we’ll be introducing multiple vaccines against the same target at the same time,Rajeev Venkayya, president of Takeda Pharmaceutical Co.’s vaccines business, said in an interview.

That means countries will need databases to track the rollout and ensure people are getting the doses at the right times, as well as systems to monitor potential side effects and share the information with the public, he said.

Early on, countries plan to prioritize the most vulnerable people as well as health-care workers and other critical staff, which will reduce deaths and suffering considerably, said Venkayya, former special assistant for biodefense to U.S. President George W. Bush.

“But transmission won’t go down dramatically in the beginning. It’s going to take time to get to a sufficient level of vaccine-driven population immunity before we begin to dampen transmission.”

Potentially by the middle of next year countries such as the U.K. and U.S. will be able to see a “real dampening of transmission,” he said. “That timeline is going to be delayed in many other parts of the world that don’t have this kind of early access to vaccines.”

Unvaccinated populations always threaten to reintroduce disease into areas where herd immunity appears to have taken over.

Just last year, the annual number of worldwide, reported measles case rose more than six-fold to about 870,000, the most since 1996, as immunization rates flagged. 

The world is likely to see the same level of viral persistence from the coronavirus, said Klaus Stohr, a former Novartis AG vaccine executive and WHO official who championed efforts to prepare for pandemics.

“The prediction is pretty clear: The virus will never be eradicated. Why? Because there will always be a large proportion of susceptible population in the community.” said Klaus Stohr

— With assistance by Jason Gale

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Is polio next to be eradicated? What disease was wipe-out anyway?

Melinda Gates spoke on TED (Technology, Education, and Design) and claimed that polio is 90% eradicated (kind of less than 2,000 cases last year).  She was apprehensive that the generous donors might be witnessing “polio fatigue”, and might be reluctant perusing donations after two decades of containing polio.

In India, a single case of polio generated the vaccination of 2 million kids in the region.  Ethiopia is witnessing a significant drop in infantile mortality rate because remote communities are training specialized nurses for vaccinating and delivering pregnant women.

Diseases like malaria, diarrhea, measles, tuberculosis, cholera, polio, and countless others banal diseases that have vaccines, or can be treated with antibiotics, are still rampant and killing everyday thousands of babies and adults in under-developed States, particularly, kids under 5 years of age.

For example, Cholera is back in force and threatening to spread in many neighboring States to Zimbabwe.  Mugabe of Zimbabwe refuses to step down as President and his State is suffering great famine, miseries, and the plague.  Thousands of people have contracted cholera and over 7,000 have already succumbed.   Cholera cannot be controlled; it could not be through the ages and current progress is not at a par with that plague.  Why?  Cholera has the capacity to mutate: an element of AND code new functions for the benefit of the bacteria, modifying its genome and increasing its adaptation to treatments or new antibiotics.

So far, medical research has not mapped out all the means of transmissions of Cholera.  It is possible that home pets, cats and dogs, carrying flea might be transmitters of the epidemic.  What is known is that older generations of antibiotics such as streptomycin, chloramohenicol, and tetracycline are increasingly inefficient against the bacteria of cholera.  The antibiotic based on fluoroquinolone might be of more effectiveness.

The best angle to analyze the topic of transmissible diseases to divide the diseases in three categories.  The first category represents the diseases that have effective and cheap vaccines and antibioticsThe second category represents disease that require costly vaccines, expensive treatments, and common surgeries but can effectively cure.  The third category is reserved for diseases that have no cures but can be contained for several years until progress is achieved like AIDS and a few other cancerous cases.

For the third category, funds are allocated to the under-developed States, simply because the rich States need guinea pigs to experiment with treatments that are traumatic in their own communities.

The first category is the most promising for decreasing drastically the casualties at an affordable cost.  Basically, the vaccines and the prior generations of antibiotics have already covered the expense of experimentation, and have been a cash cow for many decades.  The main expense would be to train local nurses in remote communities, and university students in medicine, to administer vaccines and inexpensive antibiotics that are still effective.

The second category is not as urgent for the under-developed States as the funding and the structural organizations for eradicating the diseases in the first category.  There has been a mobilization in 1994 for creating a world bank for medicament and vaccines and a few States invested funds in that bank but there was lack of active pursuit for the long term.  All the health related branches in the UN such as UNICEF, OMS, PAM, FUND, Red Cross, and Red Crescent have been working on the field for many decades, but diseases are gaining the upper hand.

The scarcity of resources allocated to fighting disease in the under-developed States need to be restructured.  Priority should be given to diseases in category #1, before attacking effectively diseases in category number two.  At least, trained nurses and medical students would be ready to tackle more complex treatments.

You may read my article https://adonis49.wordpress.com/2009/02/17/the-under-developed-countries-are-plagued-with-common-diseases-any-resolutions/

Note 1:  A short history on Cholera or plague.

Bubonic plague has a long history, through the ages, to devastating more than a third of a population as it hits.  Cholera lands suddenly, kills for a short period and then disappear for no known reasons.  The best remedy was to flee as quickly, as far away as is possible and not to return any time soon.

The Jews in Judea were decimated during David.  The troops of the Assyrian Monarch Sanhareeb, putting siege to Jerusalem in 701 BC, suffered the plague. Greece and Athens in 430 BC was devastated by cholera as Sparta was laying siege to Athens. Ancient Rome was plagued.  Cholera hit Byzantium during Justinian for one century and traveled around the Mediterranean basin; Pope Pelage II succumbed to cholera in 590.

In 1346, the Mogul troops, laying siege to Caffa in Crimea, were plagued and they catapulted infested bodies over the rampart of Caffa.  The Genoa defenders fled Caffa and transmitted the plague to all Europe; Spain, Marseille, Paris, England are contaminated and then Russia ten years later. France lost over a third of its population and Spain as many if not worse.

Cholera crashed London in 1665.   The English monarch and his family had to pay a long visit to the French Monarch.  The plague subsided when fire engulfed the better parts of the poorer quarters of London in 1666.

The last time, before Zimbabwe, that cholera expressed its virulence was in 1894 in south east China.

History accounts shows that cholera was carried by the Mogul troops arriving from Mongolia and Central Asia. As they sweep into relatively humid regions then plague settles in during summertime. India, Iran, Iraq, and Syria suffered plague during the Mogul successive invasions. I cannot but figure out a few hypotheses.

Note 2:  Alexandre Yersin, a French physician and bacteriologist, discovered in 1894 that Cholera is a bacteria but he failed to come up with a curative serum. Yersin still believed that rodents (rats) are the main culprit for transmitting this disease.  Only in 1898 did Paul-Louis Simond confirmed that cholera is transmitted by flea that quit dead rats to other greener pastures by sucking blood elsewhere.  Rats are infected with cholera but they are not affected or transmit it because they rarely bite humans.  Once a man is afflicted with cholera then the main transmitter of the epidemics are men.

Cholera infects people but does not bloom in dry arid regions.  Cholera is virulent in humid regions and during the hot seasons. Could it be because people sweat profusely? Especially because people failed to wash or take bathes in older days?  Or is it that since sweat excretes most of the salt in the body then cholera has an ideal medium of less salty body fluids to flourish and concentrate during the ripe seasons?

The under-developed countries are plagued with common diseases: any Resolutions? (February 15, 2009)

Fundamentally, most governance in “non-developed” countries is performed on a caste-structure basis, regardless of religion, race, language, or colonial mandates. 

I have written many articles on caste structures but this is not the topic of this articles.

The facts are that many diseases that have been conquered and eliminated in the developed States, are still raging in the poorer States, and millions die uselessly, especially kids under 5 year-old.

 Why the funds and medical aides from the developed States and the UN are not making a dent in saving millions from common diseases that already had remedies for decades? 

Since 1941, penicillin has vanquished countless microbes and new antibiotics are being produced to counter the resilience of microbes that have developed resistance strategies, such as the Staphylococcus and other Streptococcus.

Diseases like malaria, diarrhea, measles, tuberculosis, cholera, polio, and countless others banal diseases that have vaccines, or can be treated with antibiotics, are still rampant and killing everyday thousands of babies and adult under-developed States.

The best angle to analyze the topic is to divide the diseases in three categories: 

The first category represents the diseases that have effective and cheap vaccines and antibiotics;

The second category represents disease that require costly vaccines, expensive treatments, and common surgeries, but can effectively cure;

And the third category is reserved for diseases that have no cures, but can be contained for several years until progress is achieved like AIDS and a few other cancerous cases.

For the third category, funds are allocated to the under-developed States, simply because the rich States need guinea pigs to experiment with treatments that are traumatic in their own communities.

The first category is the most promising for decreasing drastically the casualties at an affordable cost.  Basically, the vaccines and the prior generations of antibiotics have already covered the expense of experimentation, and have been a cash cow for many decades. 

The main expense would be to train local nurses in remote communities, and university students in medicine, to administer vaccines and inexpensive antibiotics that are still effective.

The second category is not as urgent for the under-developed States as the funding and the structural organizations for eradicating the diseases in the first category. 

There has been a mobilization in 1994 for creating a world bank for medicaments and vaccines, and a few States invested funds in that bank, but there was lack of active pursuit for the long-term. 

All the health related branches in the UN such as UNICEF, OMS, PAM, FUND, Red Cross, and Red Crescent have been working on the field for many decades, but diseases are gaining the upper hand.

The scarcity of resources allocated to fighting disease in the under-developed States need to be restructured.  Priority should be given to diseases in category #1, before attacking effectively diseases in category 2. 

At least, trained nurses and medical students would be ready to tackle more complex treatments.

Note: Constitutions in the under-developed States are shells. Constitutions were created to satisfy the basic requirements for adhering to the UN as a member State. Saudi Arabia failed to satisfy even a single clause of the UN Charters.


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