In the race against COVID-19, vaccination just the first lap

About 200 years ago, the Torah giant, the Tiferet Yisrael (Rabbi Israel Lifshitz – 1782 to 1860) exhorted his followers to be vaccinated against smallpox. The sage was meticulous in fulfilling the mitzvah aseh (positive commandment) of the obligation to avoid the much greater threat to life posed by the disease even if the vaccine itself was far from harmless. In those years, smallpox vaccination was a rather hazardous procedure coming with a mortality of close to 1:1000.

It has been ascribed to the Tiferet Yisrael that he drew up a list of non-Jews who ought to be credited with olam habah (a future in the world to come). Top of his list he put the chosid, Yenner, (Edward Jenner) who developed the first human vaccine against smallpox at the close of the 18th century which saved millions of lives down the years. About 200 years later, that virus was eradicated from the planet by global vaccination.

So, where are we now with our present pandemic – the COVID-19 pandemic? What could the future light at the end of the tunnel look like?

Our current travails with the COVID-19 pandemic are due to a new virus, SARS-Cov-2, introduced into the human population just less than a couple of years back. This is a new pandemic, against which new vaccines were developed at an unprecedented breakneck speed to prevent the resulting new disease. It was a triumph of advanced modern science to develop new vaccines within a year of discovering the causative virus in order to address this formidable new pandemic with urgency. Technologies were employed which had never previously been used for human vaccines. To add to this bewildering mix came the internet and pervasive social media – valuable tools for disseminating important public-health messages, but an equally sinister vehicle for spewing misinformation, conspiracies, and mistrust and, in no small measure, contributing to confusion, anxiety, and, unfortunately, vaccine hesitancy.

So, where do we stand on the eve of Rosh Hashanah 5782 (2021) in controlling the COVID-19 pandemic? As of 24 August (by the time you read this these figures will be quite a bit higher) more than eleven million doses of vaccine have been administered in South Africa with more than 21% of the adult population being vaccinated. Even now, the effectiveness of the vaccination programme is starting to be felt with a small, yet significant, reduction in serious COVID-19 disease and hospitalisation in the country.

What is our expectation for controlling the pandemic with vaccination? It’s interesting that when we look back at the earlier days of the pandemic last year, the scientific community thought that the SARS-Cov-2 virus was as menacing as any new pandemic was feared to be, but that it would turn out to be no more complicated than measles or polio to combat and conquer. We hoped, as with measles and polio, that it wouldn’t take long to develop an effective vaccine to conquer this newcomer.

But that was before the virus uncannily demonstrated its ability to mutate and generate new variants which could escape the protection afforded by vaccination. In turn, the Beta variant arrived, which was relatively resistant to vaccines, and after that, the highly contagious Delta variant, which is now also flexing its muscles for vaccine escape.

Common wisdom dictates that infectious diseases can be combatted in four phases. Phase one is the phase of containment. In this phase, the main damage caused by the offending infectious agent is brought under control. In the case of COVID-19, this is the phase reached by Western developed countries. High vaccine coverage has drastically reduced severe disease which, in the pre-vaccination era, resulted in wealthy countries being brought to their knees and unable to cope with the overwhelming number of critically ill patients, and mortuaries unable to keep pace with burying the dead. But, in spite of extensive vaccination campaigns, infection and illness still persist to a worrying degree. Fortunately, in the majority of cases, illness is mild. Where preventive measures are relaxed, as prematurely occurred in many countries such as Israel, the United States, and several European countries, there have been significant flare-ups. Most public-health authorities would accept this to be an interim phase, as restrictive measures still need to be in place to prevent epidemic waves of illness flaring up.

Only in a future phase two, the phase of control, may we contemplate returning to a pre-COVID-19 life. To enter into this phase, a second generation of advanced vaccines would have to be developed. They would need to provide more effective and durable immunity, be able to be effective against any new variants, and also be able to reduce transmission markedly from infected vaccinated persons. For the latter, the new vaccines will need to effect good immunity in the upper respiratory tract – mucosal immunity. There is, indeed, intensive research into developing this next generation of vaccines. In this phase, restrictions may be relaxed to the point of returning to our pre-2020 lifestyle. Infection and illness won’t totally disappear, but it will be at a tolerable level – perhaps much like the common cold or flu we all accept every winter season.

Phase three, the elimination phase, has been reached with a number of vaccine-preventable diseases. In this phase, infection and illness no longer occur in many parts of the world because of successful vaccination campaigns, although it remains present in other regions of the globe. Examples are polio, measles, and a number of other childhood infections. This phase cannot yet be contemplated for COVID-19. Our best expectation would be to enter into phase two, the control phase.

The ultimate phase four, the eradication phase, has been achieved only with one infectious disease – smallpox. About two centuries after the chosid, Jenner, invented the smallpox vaccine, and following unprecedented vaccination campaigns in every corner of the world, the disease and the virus were finally eradicated in 1980, and the virus formally declared to have been purged from the planet.

Meanwhile, let’s try make the present phase, phase one of COVID-19, as successful as possible. Get vaccinated, and continue to maintain all infection-prevention measures religiously so that we can safely look forward to phase two – maybe some time next year?

• Barry Schoub is the chairperson of the Ministerial Advisory Committee on COVID-19 Vaccines. He is professor emeritus of virology at the University of the Witwatersrand, and was the founding director of the National Institute for Communicable Diseases. He writes in his personal capacity.