We all want this pandemic to be over. As a society we have endured over a year of being focused on sickness and death. Our lives have been turned upside down, and we continue to be deprived of many important social, cultural and religious experiences which give our lives meaning.
The arrival of the first vaccines – Pfizer-BioNTech, Oxford-AstraZeneca and Moderna – in late 2020 has been hailed as a monumental achievement of science. Vaccines for Covid-19 have been developed at unprecedented speed, and with extraordinary international collaboration. The end of this pandemic is now closer than scientists could ever have imagined this time last year.
Vaccines clearly save lives. A recent analysis carried out by Public Health England concluded that the UK’s Covid-19 vaccination programme prevented 6,100 deaths in England up to the end of February 2021. These results give us hope. As the vaccination programme in Ireland accelerates over the coming months, we will see a significant reduction in illness and death as a result.
Although vaccines ultimately offer a potential exit strategy from the pandemic, this must be done gradually to mitigate large-scale public health consequences
However, we must remain cautious. Dr Mike Ryan of the World Health Organisation has warned of the dangers of neglecting the mundane behavioural measures which will remain a cornerstone of the public health response to Covid-19 for some time to come. Vaccines are important. But in isolation they will not make this pandemic end.
In a recent paper published in the Lancet, one of the foremost medical journals, epidemiologists from the University of Warwick report on a mathematical modelling study in which they use data from the UK to predict the future course of the pandemic.
They ran “optimistic” and “pessimistic” models, entering data in different ways and making different assumptions about vaccine efficacy and uptake. They conclude that, even with the most optimistic assumptions, it will be challenging for the UK to reach the required herd immunity threshold through vaccination, and that there are significant risks associated with early or rapid relaxation of behavioural public health restrictions.
Exit strategy
Although vaccines ultimately offer a potential exit strategy from the pandemic, this must be done gradually to mitigate large-scale public health consequences. There are a number of reasons for this.
First, vaccines are not 100 per cent effective. Therefore, even though vaccines offer considerable protection against disease for the individual, at a population level the more vulnerable in society still remain at an elevated risk where there are high levels of virus circulating in the community.
Second, while the evidence that vaccination prevents death and severe illness as a result of Covid-19 is strong, scientists are still unsure about whether the vaccine stops people from getting infected and passing it on to others. Preliminary analyses suggest that at least some vaccines do have this transmission-blocking effect, but further research is needed.
Finally, the success of any vaccination programme depends on population uptake. A certain proportion of the population needs to be vaccinated to deliver herd immunity. Vaccination is ultimately a behaviour. It is crucial to understand the drivers of vaccine uptake behaviour and target vaccine-hesitancy to ensure enough of the population get vaccinated.
One of the benefits of our delayed vaccination programme rollout is that we can learn from the experiences of others. Consider the situation in Chile, which has the fourth highest vaccination rate per capita in the world. Despite the fact that at least half the population in Chile have received at least one dose of vaccine, they have been forced to announce strict new lockdown measures. Last week Chile recorded 7,626 new cases over a 24-hour period, the highest daily total since the outset of the pandemic, which has overwhelmed its health services.
Brighter days
Ireland is in a good place right now. While we are struggling to reduce our daily case numbers which are stubbornly stuck around an average of 620, with a cautious evidence-based approach to easing the restrictions and the promised speeding up of the vaccination programme, we will indeed see “brighter days ahead”.
Furthermore, we have high levels of public support for such a cautious approach. In the latest Amárach Public Opinion Tracker survey, 82 per cent of the population agree that the Government’s approach to the coronavirus overall is at least appropriate. Indeed, half of this group believe the Government’s approach is insufficient and say it could go further.
We cannot, unfortunately, hope to be free of the behavioural public health measures needed to control the spread of the virus for the foreseeable future
Also, since the outset of the pandemic the data have consistently shown that most of the people are adhering to most of the restrictions most of the time.
While recent research suggests that there is some slippage in relation to reported social contacts, it remains among a small minority of the population.
In addition, the Irish population reports high levels of positivity towards the vaccine. From recent survey data we know that 88 per cent of the population indicate that they will definitely (72 per cent) or probably (16 per cent) get the vaccine when it is offered to them, with only 4 per cent of the population claiming that they will definitely not get the vaccine. These statistics bode well for the success of the vaccination programme.
Vaccines are a game-changer in this pandemic. However, they are not a magic bullet. We cannot, unfortunately, hope to be free of the behavioural public health measures needed to control the spread of the virus for the foreseeable future.
While the high-tech solution of a vaccine is very seductive, a multi-strategy approach where behaviour remains centre-stage is vital.
We need to be smart and creative over the next few months. We need to continue to boost public health capacity to implement highly effective test, trace and isolate systems. This will be key to reducing daily Covid-19 cases numbers now and ensuring that, when we have the case numbers low, we can keep them there.
We also need to tightly manage international travel to reduce the risks of importing new variants.
Cautiously
Moving ahead cautiously for now is the right approach, identifying low-risk ways of easing the restrictions with maximum well-being gain for society.
Getting our children back to education, spending time outdoors, low-risk non-contact sports, meeting small numbers of people outside while maintaining social distancing should all be possible soon, and will ease some of the fatigue associated with the pandemic.
The pandemic will end. But we must be patient. For now our priority must remain reducing community transmission of the virus. We need to do this even with the vaccination programme coming down the tracks. We need to better understand and reduce high-risk transmission situations. We need to avoid crowds, wash our hands, keep our distance, work from home, open the windows and wear masks. It’s not rocket science.
Molly Byrne is professor of health psychology and director of the Health Behaviour Change Research Group at NUI Galway. She is a member of the Department of Health’s Covid-19 communications and behavioural advisory group who advise Nphet