THE WORLD HEALTH Organisation’s special envoy on Covid-19 has said surplus vaccines should be used to inoculate people at risk of serious illness globally, rather than vaccinating younger age groups domestically.
Dr David Nabarro was speaking to TheJournal following the National Immunisation Advisory Committee’s (NIAC) decision to greenlight the use of both the AstraZeneca and Janssen vaccines for younger age groups here – the two jabs were previously made available for those over 50.
Ireland is due to have “hundreds and thousands” of surplus AstraZeneca vaccines available after older age groups have received two doses. Taoiseach Micheál Martin backed the moved to speed up the vaccine rollout in an effort to help fight the spread of the more transmissible Delta variant.
Dr Nabarro said that the utility of the vaccines for reducing community transmission is still being assessed internationally and that there is currently an “enormous unevenness in [vaccine] distribution”.
“It’s not appropriate for me to express a view on what Ireland should do. This has to be a decision that’s made in the country,” he said when asked about the government’s plan to speed up the vaccine rollout for younger age groups.
“Our position is, these vaccines have been listed for emergency use to prevent severe illness and death among people at risk. That’s what these vaccines should be used for.”
He believes that once those at risk are vaccinated, test and trace capacity needs to be built up throughout society to detect future spikes of Covid-19 cases, allowing action to be taken locally to interrupt transmission through case finding, isolation, and contact tracing.
“My main request to everybody is, by all means, vaccinate. And by all means, encourage opening up – I mean we have to get economies going – but building that extra protection of really being able to pick up spikes of the disease quickly and reacting to them is the vital ingredient.”
“I think Ireland’s got it, a very well organised public health service at the county level, but proof of that will be seeing how it reacts in the coming months.”
The WHO’s regional director for Europe, Hans Kluge, warned today today that “there will be a new wave” of disease in Europe “unless we remain disciplined”.
Noting that Covid-19 cases had declined for 10 weeks in the WHO’s European region, Kluge said that “last week, the number of cases rose by 10%, driven by increased mixing, travel, gatherings and easing of social restrictions”.
Vaccination freedoms
The WHO is of the view that vaccine access should not be on the basis of geographical location or nationality and that countries with spare vaccines should be giving spare doses to Covax – the WHO’s programme that seeks to ensure equitable access to vaccines.
The Covax facility has so far delivered 89 million doses to 133 participating territories but supply lines have all but dried up this month, according to the WHO director-general Tedros Adhanom Ghebreyesus.
With wealthier nations hogging vaccine batches rolling off production lines, some countries are waiting to administer their first doses.
Dr Nabarro said this inequality needs to be considered if vaccination status is going to become a key determinant of whether people can do things, such as indoor dining.
“We need to recognise that that’s going to be acting against the interests of the vast numbers of people in our world who’ve not been vaccinated.”
Nabarro said the WHO is conscious of the linkage of vaccination status and the potential for individuals to mingle, adding that there is no expectation that vaccinations will be mandatory.
“We know that for some choosing to be vaccinated is a very difficult thing, so they will then be in quite a challenging situation of also having to make choices, not only about whether to be vaccinated, but also in relation to all the extra opportunities that will come.”
He said the overall issue of a vaccine certificate is an important ethical issue that needs to be dealt with by individual nations.
“We have recently been clear that in our experience, attempting to incentivise vaccination can be difficult and vaccine hesitancy is a real thing.
“The only way to deal with this is to look at the world like its one constituency, one population, one community. And do everything possible to avoid micro-fragmentation [of restrictions and public health guidelines].”
Moving on from restrictions
Last week, the European Union’s disease control agency warned that any significant easing of public health measures this summer could lead to a new surge of Covid-19 this autumn. The European Centre for Disease Prevention and Control (ECDC) urged countries to keep their vaccination programmes moving quickly.
Nabarro said discussions around the speed of reopening have so far been based on the logic that “the future is about authorities telling people what to do in order to reduce their risk” but that this needs to change.
He said countries have to move to a point where the style is one of a partnership between authorities and people rather than restrictions, but “we’re not there yet”.
“Over time that’s what has to come because you can’t police everybody’s behaviour, you’ll always get something going wrong,” he said.
“Gradually, and I’m not sure how quickly it can be, we have to work out for ourselves, how we deal with this virus. It’s a huge collective learning experience and it’s coming.”
Nabarro added that he really likes the Irish government’s “whole country” response, which he personally favours.
“There seems to be a much greater willingness in different parts of government to listen to what people are thinking. I’m super hopeful that this will be a country which shows that levelling with people and bringing them along with you is the best way forward.”
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