How to avoid reverting to pandemic day one amid vaccination fatigue

EU health commissioner Stella Kyriakides at a news conference on 27 April 2022. [Twitter account of Stella Kyriakides]

This article is part of our special report A new phase of COVID-19 fight.

Living with the COVID-19 pandemic for over two years, Europeans are falling into “pandemic and vaccination fatigue”, but health organisations worldwide are concerned about how new variants could set the world back to day one, as low-income countries reached only 15% of vaccination coverage.

Even though the beginning of April was marked with the lowest number of COVID-19 cases worldwide since the early days of the pandemic, “some countries are still witnessing serious spikes in cases, which is putting pressure on hospitals,” said World Health Organisation (WHO) Tedros Adhanom Ghebreyesus.

Therefore in mid-April, the COVID-dedicated committee at the WHO unanimously agreed that the pandemic remains a public health emergency of international concern.

However, the EU released a communication on 27 April featuring a range of actions to manage “the pandemic in the coming months, moving from emergency to a more sustainable model.”

It also urges member states to prepare before autumn to prevent a new wave of COVID-19 from washing over us in the winter months.

“As we have said many times since the beginning of this pandemic — preparedness is key. [We are proposing] actions which are geared to manage the current phase, [and to ensure] that we can react very quickly if the situation so demands it,” said Health Commissioner Stella Kyriakides at a press briefing.

She warned of waning immunity against COVID-19, the next winter season, and the virus’s continued global presence making new mutations very likely.

The vaccination rate in the EU is over 70%, but European Centre for Disease Prevention and Control (ECDC)’s Chief Andrea Ammon warned that vaccination “figures have been plateauing over the past month.”

“We have seen, and we are seeing that after more than two years, there is pandemic fatigue, there’s also vaccination fatigue,” Ammon said on Tuesday (26 April).

For this reason, Ammon added that public health authorities need to look into how vaccination programs can be further strengthened, which includes assessing the factors behind why people do not get vaccinated and addressing them.

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Fear of ‘reset’

According to Lucia Pastore-Celentano, head of the vaccine-preventable diseases section at the EU’s infectious disease agency, vaccination rates are highly unequal among EU/EEA countries and across different age groups.

“Only 23% of people under 18 years old have completed their primary vaccination course, and over 60% of children aged 10 to 14 have not yet been vaccinated,” she said.

While vaccines are one of the pillars of fighting against COVID-19, therapeutics are also essential for tackling serious illnesses.

At the WHO press briefing on therapeutics on 21 April, Janet Victoria Diaz, WHO’s COVID-19 clinical care lead, highlighted that therapeutics does not replace vaccination, they just give us another treatment option for those patients that do get infected that are at higher risk.”

But despite having a well-established portfolio for both vaccines and therapeutics, the fear of a new variant emerging that would need adapted vaccines to tackle it remains.

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One of the fourth scenarios included in the WHO’s COVID-19 Strategic Preparedness and Response Plan (SPRP) is called “a reset”. In this eventuality, the virus would change so much that “essentially we have a susceptible population again, and it resets us,” explained Maria Van Kerkhove, infectious disease epidemiologist at the WHO.

She added that this “is not something that we consider as what might exactly happen, but we have to plan for it.”

Likewise, WHO chief scientist Soumya Swaminathan also warned that “we have to be prepared for the possibility that this virus might change so much that it’s able to evade existing immunity.”

Four areas of action

In the meantime, the newly set-up EU’s European Health Emergency preparedness and Response Authority (HERA) is working on the adaptability of the next vaccines with developers and researchers to ensure that the EU has immediate access to medical countermeasures.

However, according to the latest information from vaccine developers, the Commission is not expecting applications for approved or adapted vaccines to be submitted before the summer.

The Commission’s communication presented on 27 April suggests eight actions for member states to be summed up to four areas.

Firstly, EU countries are being asked to adapt their surveillance and testing systems, moving away from mass testing to focus on fewer representative cases.

The Commission also urges the member states to improve “the resilience of their health systems”, including hospital capacity and the ability to scale up testing quickly if it becomes necessary. A third area is the increase of vaccination and boosting to offer citizens protection against the virus.

The last area is the overall pandemic preparedness, the commissioner explained, saying that the Commission from the beginning has said it “is not Europe first” and that “we need to improve access to COVID-19 vaccines and therapeutics globally.”

“Now that supply issues have been addressed, we should really focus on our global vaccination and improving infrastructures to be able to cover other continents as quickly as possible,” Kyriakides said.

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The other side of the world

Indeed, the situation is different on the other side of the world. It is especially worrying for those that had to wait at the back of the queue to get their first COVID-19 vaccine doses.

To avoid repeating the same scenario, the Global Alliance for Vaccines (GAVI) launched the pandemic vaccine pool.

Marie-Ange Saraka-Yao, Gavi’s Managing Director for Resource Mobilisation, Private Sector Partnerships and Innovative Finance, told EURACTIV in mid-April that funding is needed to buy an adaptive vaccine if needed.

“Every three or four months, we have had a new variant. It’s essential that we are able, in case a new variant arrives, to support countries so that we don’t end up back where we were in 2020, where they were at the back of the queue,” she said

“Bridging the vaccine equity gap is the best way to boost population immunity and insulate against future waves,” WHO’s Tedros said, adding that this includes therapeutics.

Michael Ryan, Executive Director, WHO Health Emergencies Programme, added that this stage is crucial for preparing for the future while working on the issues that still exist today.

“If we do the things right now that allows us to track the virus, to treat patients early, to vaccinate everyone, if we keep doing those things, they’re the learnings that will lead us into a phase of profoundly better preparedness for the future,” he stressed.

“Our success now will determine our success and future,” he concluded.

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[Edited by Gerardo Fortuna/Alice Taylor]

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