As Melbourne emerges from months of lockdown, two infectious disease experts joined forces to discuss vaccine roadblocks, behavioural barriers and what a post-pandemic future looks like around the world.
US National Institute of Allergy and Infectious Diseases director Dr Anthony Fauci and Doherty Institute director Professor Sharon Lewin spoke this morning with University of Melbourne assistant vice-chancellor Shitij Kapur.
What will normal look like (and when will we get there)?
The new normal will not be very normal at all, Fauci says.
“Our sensitivity to the potentially devastating effects of a pandemic will be extraordinarily heightened,” he says, with precautions like masks and limiting travel likely to continue for some time.
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To return to normality a vaccine would be crucial, he says. He’s optimistic there will be one widely available before the end of 2021: “[It] would really be the showstopper for COVID.”
Unlike HIV, the body produces an effective immune response to coronaviruses, making a vaccine more plausible.
But it’s not our only hope. The development of direct antivirals, combined with the quick diagnosis of asymptomatic people, could mean COVID-19 would be easily treated in a matter of days instead of weeks.
“We could really take away the fear and the dread of this particular disease,” Fauci says.
How effective will the vaccine be?
A key factor in vaccine efficacy is uptake, Lewin says, both domestically and globally.
“If we just vaccinate our own countries we’re not going to get out of this position,” she says.
International organisations and alliances have been working on making an affordable, equally distributed vaccine since the pandemic hit.
Uptake doesn’t just depend on availability, but also on people’s willingness to be vaccinated.
“Vaccine hesitancy is everywhere,” she says. “About 20 to 30% of people [in Australia] are hesitant to have a COVID vaccine.” Luckily not everyone has to be vaccinated — having 60-70% of the population vaccinated is effective in controlling the spread.
The first generation of the vaccine will protect against the disease but not the infection, Lewin says. While you might still develop an infection in your nose, the vaccination will stop it spreading to your lungs.
Importantly, Fauci adds, we still don’t know everything about COVID-19, which may impact the vaccine’s effectiveness.
“What I’d like to know is what the durability of immunity is following infection,” he says. “If someone’s response diminishes rapidly, so that after a year or so they’re still susceptible to the same virus that they had a year ago, that’s going to be a real problem.”
Fauci is also concerned that those who recover may be at a heightened risk of heart conditions including cardiomyopathy and arrhythmia.
Why have the US and Australia fared so differently?
More than 225,000 people have died from COVID in the United States. Fauci anticipates that number will climb much higher during its winter.
Yet Australia has gone through winter, a second wave and a footy season with just 905 deaths. What’s the difference?
“[In] Australia which is a gigantic island, it’s probably easier to contain,” Fauci says.
But it’s down to more than just geographical luck. Lewin says Australia’s political and scientific response was commendable.
“We had good national leadership,” she says, stressing that closing the borders, establishing the national cabinet and promoting open dialogue between scientists and premiers meant action could be taken quickly.
“We have universal health coverage, we have a very, very robust public health system … and we had testing set up pretty early on.”
Finally, Australians are sticklers for the rules.
“We have universal mask-wearing in Melbourne because you’re fined $1000 if you’re outside not wearing them,” she says.
This, Fauci says, would not work in the US.
“I really wish that we could transplant that kind of mentality here because masks in the United States has become a political statement,” he says.
“[It’s] painful to me as a physician, scientist and public health person to see such divisiveness centred around a public health issue.”