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Covid-19 Vaccine success does not eliminate virus risk, concludes UK



LONDON – By the middle of this year, all adults in the UK will be offered a Covid-19 vaccine in what is by far the fastest vaccination in a major western country. But disease models advising the UK government recently made a thought-provoking projection: 56,000 more Covid-19 deaths over the summer of next year, even as the country tumbles out of lockdown and vaccines work.

The study points to the uncomfortable view that the virus, even with an effective vaccine, continues to take a toll on society and that some restrictions may need to be periodically reintroduced to control the spread of coronavirus.

Conclusion: Businesses and governments around the world need to prepare to live with Covid-19 and accept that the virus will not go away, but also that lockdown cannot continue forever once admissions are brought down to manageable levels.

“We cannot avoid the fact that lifting the lockdown will result in more cases, more hospital admissions and unfortunately more deaths,”

; British Prime Minister Boris Johnson told parliament on Monday as he mapped out a slow and conditional route out of the lockdown. “Therefore, there is no credible path to a zero-covid world or indeed a zero-covid world.”

Future burden

Disease modeling from researchers advising the UK government suggests that Covid-19 is likely to still cause illness and death, even after widespread vaccination, when public health measures are relaxed.

Cumulative deaths (12 February 2021 – 30 June 2022)

Cumulative hospitalizations (12 February 2021 – 30 June 2022)

* All adults over the age of 50, healthcare professionals and other priority groups will receive at least one dose of vaccine by 21 April

† Anyone over 70 and clinically vulnerable will receive two doses by 21 May

Cumulative deaths (12 February 2021 – 30 June 2022)

Cumulative hospitalizations (12 February 2021 – 30 June 2022)

* All adults over the age of 50, healthcare professionals and other priority groups will receive at least one dose of vaccine by 21 April

† Anyone over 70 and clinically vulnerable will receive two doses by 21 May

Cumulative deaths (12 February 2021 – 30 June 2022)

Cumulative hospitalizations (12 February 2021 – 30 June 2022)

* All adults over the age of 50, healthcare professionals and other priority groups will receive at least one dose of vaccine by 21 April

† Anyone over 70 and clinically vulnerable will receive two doses by 21 May

Cumulative deaths

(February 12, 2021 – June 30, 2022)

Cumulative hospitalizations

(February 12, 2021 – June 30, 2022)

* All adults over the age of 50, healthcare professionals and other priority groups will receive at least one dose of vaccine by 21 April

† Anyone over 70 and clinically vulnerable will receive two doses by 21 May

Caution does not undermine the value of a successful vaccination. New data released on Monday showed that Britain’s vaccination program – which has given at least one shot to more than a third of the country’s 53 million adults – has significantly reduced infections and reduced serious illness by even more.

But while the program paves the way for a gradual liberation of the country over the next four months, the government is not treating it like a silver bullet. “Vaccination is taking prices down, but it will not get rid of this,” said Chris Whitty, England’s chief medical officer, on Monday. He added that Covid-19 “is likely to be a problem in the next few winters.”

Epidemiologists have long warned that Covid-19 is likely to circulate for years or even decades and allow society to cope much as it does with other endemic diseases such as influenza, measles and HIV.

No vaccine is 100% effective and no populations will be completely vaccinated. So a big unknown in a vaccinated community is what levels of infection governments will be willing to live with before imposing restrictions, said David Salisbury, former chairman of the World Health Organization’s Strategic Advisory Group of Experts on Immunization.

A Covid-19 patient was treated at King’s College Hospital in London last month.


Photo:

kirsty wigglesworth / Agence France-Presse / Getty Images

“It’s a political and societal question of what is acceptable,” he said.

The British government hopes that Covid-19 will be treated as influenza in the long term. In the last five years, between 4,000 and 22,000 people have died each year from influenza in England. In the past year, Covid-19 has killed 130,000 people in the UK

In the United States, Covid-19 has claimed more than 500,000 lives. Influenza is estimated to have killed between 22,000 and 61,000 people in the United States over the past five seasons, depending on the severity of the outbreak.

The entire adult population of England is expected to be offered a Covid-19 shot by the end of July. The Government of England is currently planning to ease almost all restrictions by 21 June in four graduated phases. But even with good vaccine uptake, the virus will still be present. Children will not be vaccinated so the virus can circulate freely among about one-fifth of the population. Not everyone accepts the vaccine.

Worse things are that infection rates start from a very high base in the UK

As highly transmissible Covid-19 variants sweep around the world, researchers are struggling to understand why these new versions of the virus are spreading faster and what this could mean for vaccine efforts. New research says the key may be the spike protein, which gives the coronavirus its unmistakable shape. Illustration: Nick Collingwood / WSJ

Modelers warn that it can be translated into a leap in cases where restrictions are eased. With a vaccine that is 85% effective and three-quarters of adult British inoculated, about half of the population would be vulnerable to the virus, modeling Imperial College London suggests, because children have not been vaccinated.

A easing of restrictions during the summer will cause infections to increase in the fall. Although the restrictions have not been eased completely until August, Imperial College estimates that it could result in 56,000 deaths by June next year. Modeling from the University of Warwick, which also informed British government policy, reached similar conclusions.

Marc Baguelin, an epidemiologist at Imperial College, says the model is a basic case and could underestimate both vaccine uptake and its effectiveness in limiting the transmission of the disease. Other reasons for optimism include improving treatments for those hospitalized with severe Covid-19, especially reducing the risk of death for younger patients.

On the other hand, the virus could mutate to make the vaccines much less effective. Some vaccines have already shown reduced efficacy against variants identified in e.g. South Africa and Brazil. “It makes the prospect of a third wave much greater,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.

The long-term effects of Covid-19 infection on younger people are still understood. If they hurt, governments may be more careful about letting younger people resume life without vaccination or social distance.

Part of the problem is reflected in simple mathematics. If 90% of a population takes a vaccine that is 90% effective, it leaves 19% unprotected, said David Sarphie, CEO of Bio Nano Consulting, which worked with Imperial College to develop Covid-19 modeling tools for governments and businesses . “Nineteen percent of the British population is 12.9 million,” he said.

A Covid-19 vaccination center in London this month.


Photo:

andy rain / Shutterstock

Subsequent waves of hospitalization and death in Western countries last year show that the disease can cause significant disease, even when relatively few people are exposed to it, said Martin Hibberd, professor of new infectious diseases at the London School of Hygiene and Tropical Medicine.

“Even with the vaccines, there are still a large number of people who will still be vulnerable,” he said.

Medical experts say the prospect of significant levels of serious illness and death, even in a population with widespread vaccine coverage, underscores the need for effective systems to test for the virus and isolate those infected and their contacts. Governments must work hard to improve vaccine coverage and overcome misinformation and hesitation, they say.

In the UK, advisers to the UK government say masks worn or working from home may need to be reintroduced in the winter to curb outbreaks. The government is investigating whether Britons will have to prove they are vaccinated or virus free to resume activities such as going to the pub or office.

Underlining the potentially stony path to normality, the British Chancellor of the Exchequer is likely to extend financial aid to the economy when the government’s budget is presented next week.

Overall, coronavirus “will be something we want to live with,” said Roy Anderson, an epidemiologist and professor at Imperial College.

Write to Max Colchester at max.colchester@wsj.com and Jason Douglas at jason.douglas@wsj.com

Corrections and reinforcements
With a vaccine that is 85% effective and three-quarters of adult British inoculated, about half of the British population will be vulnerable to the virus, modeling suggests. An earlier version of this article wrongly said that half of the adult population would be vulnerable. (Corrected February 23)

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