Covid-19 and Britain's strategy: Full national lockdown and fast vaccination

Didem MERCAN

While many European countries are tightening their restriction rules to prevent a possible new Covid wave, the opposite is happening in the UK, which has suffered great losses in recent months. The lockdown restrictions have begun to be eased In the UK, where vaccination continues rapidly. Has the UK been successful in fighting Covid-19? How often will we have to be vaccinated? Could the imprudence in the summer undo all efforts?

Professor Gavin Wilkinson from Cardiff University Infection and Immunity Department and Professor Andrew Preston from Bath University Biochemistry Department gave a wide range of interview and assessed Britain’s Covid strategy to Birgun.

VACCINE TASKFORCE ASSEMBLED

► As many European countries are strengthening health restrictions to curb another possible Covid-19 wave, how did Britain achieve the successful result in fighting Covid-19?

G.W: It is difficult to see the UK fight against SARS-CoV-2 as a success when there have been more 127.000COVID-19 associated deaths. Although numbers are relatively low at the moment, that is because an extremely protracted lockdown.

A.P: I think many people would not consider Britain’s fight against COVID-19 to be successful. The UK has one of the highest death rates from COVID in the world, have suffered 2 major lockdowns, plus a 3rd slightly less restrictive lockdown.

However, the one area that has gone well is the vaccination programme. The government assembled a Vaccine Taskforce that interestingly, was primarily figures from outside of government. This Taskforce moved early, quickly and decisively to sign deals with a number of the vaccine companies to secure hundreds of millions of doses of vaccines from across the different vaccine platforms, and did so long before it was clear whether these vaccines would prove to be effective.

This enabled the UK to have an early access to vaccines as their trial data became available. The UK regulators moved quickly to assess the data and issue authorisation.

This meant vaccines were being used a very short time after they were authorised for use in the UK.

The vaccination roll out has been an astonishing exercise, that has worked remarkably well. Hundreds of vaccine centres were established very quickly providing access to vaccines across the 4 nations of Britain. Thousands of volunteers were trained to deliver the vaccinations along with thousands of others helping direct people at the vaccine centres. This has been a huge effort that has worked very well, enabling hundreds of thousands of vaccinations to be administered each day.

In the UK, those most at risk from hospitalisation and death from COVID were prioritised for vaccination. This meant that from day 1, vaccination was used to alleviate the burden from COVID on our health service. At the time the vaccination programme was rolled out, we were experiencing a savage wave of COVID, with over a thousand deaths a day, and tens of thousands of cases each day. Probably, this helped to encourage very high levels of vaccine uptake, meaning that for those most at risk from COVID, over 90% of them received vaccination.

The vaccination programme coincided with a full national lockdown that is only now starting to ease. The combined effects of lockdown and vaccination have led to the decrease in cases, hospitalisations and deaths that we have experienced.

Importantly, vaccination has broken the link between a rise in cases and the otherwise certain increase in hospitalisation and deaths. This allows greater confidence in being able to ease restrictions without risking the most severe consequences of the disease.

LARGE SCALE MOVEMENT IS RISKY

► Lockdown rules are being lifted in Britain with the promise of summer travelling ahead. Can easing the rules while other nations are still fighting with pandemic undo all the achievements in the UK?

G.W: The UK is still fighting COVID. The easing of rules in the UK could result in increased spread of endogenous variants within the UK, even without international travel. This will be monitored. The UK responded very sharply to the emerging B.1.1.7 variant last Christmas, that variant was first detected in the UK and recognised to be spreading faster than other variants. The long lockdown was both necessary and effective within the UK. While the UK has been trying hard to vaccinate its population, that is still in process. Global air travel was responsible for the pandemic spreading rapidly last year. Reintroducing conventional variants from continental Europe last summer help fuel a second wave in the UK last Autumn. Clearly the problem is not just conventional variants now, but also variants of concern that may transmit more efficiently and are resistant to neutralising antibodies induced by vaccines.

A.P: This is a contentious issue. My view as an infectious disease expert is that allowing large scale movement between Britain and other regions with very high incidence is a huge risk to the current progress being made in reducing the level of infection in Britain. Crucially, while the UK variant is currently dominant in Britain, the current vaccines appear to be effective against it. Other variants, such as the ’South African, ‘Brazilian’ and perhaps now the ‘Indian’ variant appear to be less well controlled by current vaccines. Mass importation of these variants in to the UK by international travel is perhaps the greatest risk to the further easing of current restrictions here, so there needs to be a solid decision made in government about whether we are prepared to risk the progress made internally, by reopening externally. Its certain that different sectors will have very different perspectives on this. UK based hospitality will be very reluctant to risk their reopening by importation of cases whereas of course the airlines, ferry operators and travel companies will take a very different view.

► Can people get Covid after being fully vaccinated?

G.W: Vaccinated people remain vulnerable until an effective immune response is induced. That immune response is not to provide complete protection to infection with the virus (SARS-CoV-2) but is reported to provide good protection to the severe forms of the disease (COVID-19).

A.P: The vaccine trials measured the ability of the vaccines to prevent COVID disease. Data suggests that they are very effective at protecting against death and severe disease, less effective against mild disease. So, some people could still get COVID even after vaccination. As mentioned above, the level of protection from vaccines against some variants is probably lower, although it is thought protection against severe disease and deaths is still high. We do not have clear data on whether the vaccines block transmission, i.e. people still becoming infected once vaccinated, even if they don’t show any symptoms, and transmitting the virus to others. Currently, it is thought the vaccines do reduce transmission, but not completely. This affects the ability of vaccines to create herd immunity.

► How often will we need to be vaccinated against COVID-19? Will we need a coronavirus shot every year?

G.W: The answer to that is not yet known. There is first the question of the longevity of vaccine protection, which is being assessed. It looks like there will also be a need to modify the vaccine to account for genetic changes in the virus selected to evade existing immunity. The vaccine to Influenza is re-assessed each year, and when necessary modified to combat what is perceived to be the greatest threat. The need to track sequence variation in SARS-CoV-2 as it circulates globally is extremely important in order to identify “variants of concern". Certain variants with increased fitness may spread more rapidly. Other variants may have changed sufficiently to evade the immune response in individuals who have been vaccinated to infected with SARS-CoV-1 previously. The variant B.1.1.7 is thought to spread more efficiently, but existing vaccines are effective against it.

A.P: We dont yet know how long immunity might last, either from being infected or from vaccination. So its not clear whether booster vaccinations will be needed, or how often. The other factor in this aspect is of course variants, it is possible that over time the virus will evolve sufficiently that new formulations of the vaccines are required. We’ll have to wait and see. It is prudent to plan for the need for boosters, and new formulations of the vaccines, so that they are in place if it turns out they are required.