UK Edition
'Covid vaccine shortages are very likely - without a plan, it will be a feeding frenzy'
Experts appearing in a new Channel 4 documentary say difficult conversations must be had about medicine and human behaviour in the pandemic
Back in January, when the world was beginning to hear of what looked like an outbreak of mild respiratory illness in the Chinese city of Wuhan, Dr Derek Angus was contacted by a worried former colleague. Zhiyong Peng had worked with him at the University of Pittsburgh School of Medicine in the US and now headed the department of critical care medicine at the Zhongnan Hospital of Wuhan University in China.
“He said, ‘a bomb has gone off and it’s hell here, we’re totally overwhelmed,’” recalls Dr Angus, who is leading trials for therapeutic coronavirus cures and appears in a new Channel 4 documentary Race Against the Virus: The Hunt for a Vaccine. “Even in his early exchanges we were talking about how [the staff] were getting infected [themselves], the patients were infecting other patients in the hospital. This was before anyone knew about how much PPE to use or what it was like.”
Recollections like this feel chilling now. But Dr Angus, the British chair of the Department of Critical Care Medicine at Pittsburgh, was among those who realised early on that something serious was brewing. He asked his former colleague to send any data he had so they could publish a medical journal paper on what was happening. “It was just petrifying to read about,” he says. “Right from the start we began to get very worried that [this virus] made patients as sick as SARS but was potentially much more infectious.”
While most of us carried on with our business as usual, Dr Angus felt uneasy. Taking a flight to the Pacific North West towards the end of January, he wondered whether to keep his distance from others. “I was thinking, ‘is this thing out ahead of us and we don’t really know?’...I remembered those famous pictures of how H1N1 [swine flu] went around the world by airplane and had in the back of my mind those people flying around with this thing.
“When you lie in bed at night, on the one hand you think ‘disaster is coming, I’d better ring the alarm bells and say stop everything you’re doing.’ The other part of you thinks ‘no, it’ll probably be fine.’ It’s human nature.”
That some South East Asian countries were better prepared for coronavirus was unsurprising, he suggests, given the collective trauma they had suffered from SARS. The initial hesitancy of the rest of the world was also understandable, he says.
“There’s an initial hesitancy I’d give everyone a pass for. Then there’s the ‘ok, we’re way past the initial hesitancy stage, it’s quite clear we have a disaster on our hands.’ “At that point some countries really responded and others continued to engage in a sort of delusional [sense of] ‘oh it won’t come here.’”
Was Britain among the delusional countries? “By raw numbers there’s a sense...they could have done better,” he says. “But it’s important to remember some countries just get a terrible brushfire by coincidence - [in] a place like London, because there’s so much international travel, like New York.
“I don’t feel like London looked worse than Paris because the British government was slow and the French government knocked it out the park. If there are 10 or 20 large conurbations across Europe, it will be awful in three or four and others will catch a lucky break.”
Professor Susan Michie, who also features in the Channel 4 film, is less charitable about the British government’s response. A behavioural scientist at University College London (UCL) and Sage advisor, she recalls her horror when prime minister Boris Johnson announced on March 3 that he’d shaken hands with coronavirus patients in a hospital. Did she feel she was watching a catastrophe unfold in slow motion?
“Yes! Going right back to these mass gatherings that were being allowed.” About 150,000 people attended the four-day Cheltenham Festival in March, while most people also carried on commuting to work, even as cases soared elsewhere in western Europe.
“I could see where the risky situations were [and thought] ‘why are people to put their and other people’s lives in danger by cramming on to transport and sitting in unventilated offices all day when they can work from home?’” says Prof Michie.
She suggests the Government has been fatally myopic in its approach - and continues to be. “It’s the same thing now. I did think ‘this is not good’ and I’m thinking that again now. It’s short-termism. One of the problems with politicians who don’t have vision is they can operate in very short-term ways where they think ‘open the economy and hope for the best’ is the strategy, as opposed to ‘drive Covid down so there’s no community transmission’, which is what they’ve pretty well done in Ireland, [are] getting there in Scotland, [and have] done in New Zealand. Then put a really good quarantine situation in for people coming in from abroad. That’s the way to go, and that’s taking a long-term view of six months, rather than a short-term view of six weeks.”
Prof Michie, director of UCL’s Centre for Behaviour Change, would like to see more involvement of behavioural scientists in the messaging given to a now confused public. Communication, she says, was “fairly good up until the change of message to ‘stay alert’, and then the messaging got vague, confusing and after that it’s really never recovered.”
The day after I speak to her, and after new restrictions are suddenly imposed in Northern England, the Government releases its latest slogan: “Hands, face, space.” It is instantly mocked by a fed-up and fractious public.
“Right at the start of this pandemic [I said] if only we had half an hour every day of behavioural scientists talking directly to the population about how to develop new habits, because that’s what is needed in order to get out of this,” sighs Prof Michie. “It would be relatively cost-free to do it. Then one could draw on the science to help build up these population-wide new habits.”
But instead of politicians drawing more effectively on the science, she accuses the Government of using it for their own ends.
“A lot of scientists got quite cynical about the use of that phrase ‘following the science’, because it was being used almost to set up scientists as a scapegoat,” she says. “They follow the science when it’s convenient for their agendas. For example, when they wanted to change [the social distancing rule] from two metres to one, Sage had consistently said one metre is 20 to 30 times riskier than two metres, and so what they did was instead of taking Sage’s advice, they quietly set up their own Downing Street review with some scientists and economists. We never heard the evidence on which it was based, but basically Sage was sidelined. A lot of scientists feel the political strategy comes first and science is rather being used.”
While political and economic considerations must of course play a part in decision-making, the problem in Prof Michie’s opinion is the lack of transparency and honesty, which in turn has led to the Government losing public trust. The Government, for its part, has stressed that its overwhelming priority has been to keep the country safe, protect the NHS so it can cope under the pressure, and save lives.
As for the medical battle against the virus, Dr Angus is hopeful that even before we have a vaccine, the deadly power of Covid-19 can be reduced by a cocktail of therapies, just as happened previously with HIV.
“There’s a big difference between having no known cure and having something that works a bit,” he says. “Not only does it affect the total [mortality] numbers, it manages people’s sense of threat and fear, it changes the mindset of healthcare providers and I think we’ve already begun to move from the complete fear and panic of February and March into a new mode.”
Although his hospital currently contains more Covid patients than it did in March and April - about 50 intubated Covid patients on any given day - the healthcare system is coping. “It would be much better if there were no cases, but the fear has changed,” he says.
Mortality is also lower at the moment, he adds, which “might be a combination of a change in the case mixture of who’s getting sick [the hospital is seeing more younger patients] and hopefully a change in the way in which we’re caring for patients,” he says.
The need for fair distribution of any successful therapeutic drugs, and of an eventual vaccine, is something he’s acutely aware of. He favours the idea of a weighted lottery system, “where everyone weighs in on the ethics of it.”
Difficult conversations about who should be prioritised will be needed both within and between countries. It might be decided that frontline workers should be at the front of the queue, says Dr Angus. “But equally you have the question of underrepresented minorities who appear to have a disproportionate burden of the disease. You could say that they should have a chance... The point is to write out your ethical principles of fairness and be entirely transparent about it.
“It’s highly likely, given the sheer scale of infection, that we’re going to face legitimate shortages. Without a transparent and explicit system, it will be a feeding frenzy. Those that have power and influence will seek to guarantee access, whether that’s at the international level or even within countries.”
Meanwhile, the British government at least must do better at stamping out Covid transmission, argues Prof Michie.
“At the moment what we’ve got is total unpredictability [regarding] which part of the country will be hit next,” she says. “This whack-a-mole approach is really misguided. I think it will be damaging to the economy - and it will lead to a lot of lives being unnecessarily lost.”
Race Against the Virus: The Hunt for a Vaccine is on Channel 4 on Monday August 3 at 9pm