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In 2019 Greta Thunberg caught the attention of the world when she thundered about “fairytales of eternal economic growth”.

Now in 2020 we have a new fairytale: coronavirus is the dragon, spreading its fearsome wings and breathing fire while the world cowers in its tower.

Our response? Hunker down and wait for the vaccine in shining armour to rescue us. Or an effective treatment of some kind, something a little better than hydroxychloroquine or dexamethasone (or a glug of Drano). Which maybe doesn’t count as a knight. More a squire, perhaps, armour somewhat tarnished.

But the knight is a long way off. Despite positive noises about 90 vaccines in development, some starting clinical trials — with the reassuring name “Oxford” in at least one of these stories — they remain for the moment just that: stories. 

It’s one thing to show that you’ve produced antibodies in a gerbil or a bilby or whatever animal was unfortunate enough to meander into the lab but another to get to the point of proving it is both safe and effective in humans. Quite another again to manufacture and distribute the billions of doses needed.

Helen Clark, former New Zealand prime minister and recently appointed leader of the independent global inquiry into the pandemic, says: “I’m told from Geneva that the most optimistic scenario for a widely available vaccine would be at least two and a half years.”

The knight isn’t even on the horizon.

It’s possible a treatment may come sooner. Recently we have the positive news that the anti-viral Remdesivir, originally developed to treat ebola, has been approved for COVID-19 patients. The benefits for the severely ill can be significant, as can be the side effects. It’s also several hundred dollars an ampoule. There’s someone here on horseback, but it’s only a squire — and his armour definitely needs a good polish.

So for now and the foreseeable future we are left with the same choices as when this all began: lockdown, close businesses, restrict movements, socially distance and so on. Sure this will continue to be effective at stopping the virus spreading, but how long can we do it? It may be the right theoretical response from a health perspective, but at what cost to society and the economy (not to mention mental health)?

It’s time to seriously consider other options. Stephen Duckett, health economist at the Grattan Institute, recently argued we should switch to an elimination strategy

While the idea has appeal, I fear the COVID genie is not only out of the bottle (or was it a dragon?) but has no intention of slipping meekly back inside. It spreads too effectively, too covertly, to be able to stamp it out in a population of 25 million, let alone stop it from sneaking in from overseas.

Should we protect our vulnerable while allowing others to get on with life, taking appropriate precautions? I’m beginning to think we need to consider this in whatever form it might take. More would get sick, and more would die. But influenza kills hundreds of thousands each year (despite an annual vaccine) and we manage.

More than 1000 people die on our roads every year and countless more are injured, but we continue to drive. We protect our vulnerable as best possible (driving tests, licensing, safety features) and legislate where needed (speed, alcohol, drugs) and get on with life. 

Success with COVID-19 is predicated on the vaccine/treatment fairytale coming true at some point. We can all hope this is the case, but as my wife was taught about contraception at school in the 1970s: “Hope is not a method.”

It’s certainly not a method for framing our long-term strategy. It’s time to look at what options to consider if the knight fails to turn up.

Peter Fray

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