Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and one of the world's leading virologists, says the much-anticipated prospect of millions of vials of C-19 vaccine being available in September or October, “highly unlikely,” reports Chris Bateman for MedicalBrief. “We have to think of societies living with C-19, just like with HIV,” he said.
The world needs to learn how to deal with an acute epidemic such as the coronavirus and “plan years ahead, because of the challenges of developing successful vaccines. This was said by Professor Peter Piot, a global pioneer in developing Ebola vaccines and antiretroviral (ARV) treatment for HIV. The 73-year old microbiologist narrowly escaped with his life after suffering rare symptoms of a C-19 infection three months ago. He is only now recovering from post-hospital-discharge atrial fibrillation and lingering fibrosis of the lungs.
He told a webinar last Thursday, (4 June), part of a series hosted by Discovery Health in conjunction with MedicalBrief, the Desmond Tutu HIV Foundation, the SA Medical Association, the SA Private Practitioners Forum and the Unity Forum for Family Practitioners, that until or unless a vaccine was developed, “we have to think of societies living with C-19, just like with HIV. I’m thinking more and more of harm reduction, while bringing down new infections and mortality,” he said.
He said it would be impossible to have a functioning healthcare system with the C-19 epidemic going on, because of all the other diseases, making long term planning essential while concurrently dealing with the current pandemic. There were no short cuts to coming up with quality, peer-reviewed solutions. Rigorous, large scale clinical trials testing candidate drugs, (where a reasonable hypothesis existed), were non-negotiable – because of the millions of people who might suffer harm were this was not done.
He found the much-anticipated prospect of millions of vials of C-19 vaccine being available in September or October, “highly unlikely,” given that the rate of success for similar vaccines was well below 10% – with very few companies in this high-risk business. Trials were also hard to run, given the shifting nature of the disease, he said. He was advising the European Commission President, Ursula von Der Leyen, to provide public money to develop manufacturing capacity so that if a vaccine emerged, there would quick, equitable access.
Professor Piot was highly critical of US President Donald Trump saying that if a vaccine was developed in the US it would stay there, raising the historic HIV spectre of access to ARV’s. “With (C-19) therapeutics, I’m less concerned about availability, but we do need to work on that now before a vaccine,” he stressed.
Professor Piot, described in the Financial Times as, ‘the Mick Jagger of Microbiology,” told his audience that, “Many people think COVID-19 kills 1% of patients, and the rest get away with some flu-like symptoms.
But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We’re learning while we’re sailing. That’s why I get so annoyed by the many commentators on the side-lines who, without much insight, criticise the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair.”
He said that, coming from the HIV tradition, he’d seen how people living with HIV played a big role, especially in South Africa, something almost total absent with COVID-19 where public discussion centred on data and flattening the infection and mortality curves. His experience of being infected and the publicity it generated completely changed his perspective as feedback from those with similar, until then rare symptoms, began pouring in.
Strongly backing the use of versatile oxygen versus ventilators in treatment, he said it was vital to address patients with symptoms similar to his, who fell, “in between those who have a bit of a flu which is over in 5 days or week, and those in the 1% bracket who’ll die – plus the belief is that infected people over 70, (he’s 73), will die soon anyway. I want to show what’s in between, which has been hugely neglected, because we think this is a respiratory virus which mainly affects the lungs.”
He said the virus caught the world by surprise, with those countries most affected by the H1NI and SARS pandemics, (Hong Kong, Singapore and South Korea), faring best as their populations proved compliant with masks, hand hygiene and social distancing and their response systems in place. In stark contrast, political C-19 denialism among political leaders, best exhibited in Brazil and to a lesser extent, the US, was akin to the Mbeki Aids denial years in South Africa.
The analogy he used in describing global preparedness and most C-19 responses was one of a hospital practicing a fire drill while it burnt down. He remains a firm advocate of investing billions in preparedness around health care infrastructure, and therapeutic and vaccine research protocols. “The same thing could happen again in 40 or 50 years-time. It’s a bit like San Francisco talking about the ‘Big One,” (an earthquake), destroying the city sometime in the future,” he added.
Stressing preparedness, he said that for C-19, finding an anti-viral therapy, (AVT), quickly and using it as a pre and post exposure prophylaxis was vital, while the use of both AVT and immune-suppressants early on would be hugely effective. However, if used too late they would have no impact. He said the development of two vaccines for Ebola was “great news,” but for C-19, testing seemed to be extraordinarily difficult to organise, with it being rationed in the UK, something he had a direct, traumatic experience of.
“This is simply bad policy. Government institutions only test symptomatic people. Yes, we know how many uncertainties there are, but asymptomatic people can transmit the virus; it’s probably very contagious two days before symptoms show, and yet they deny access to testing and centralise it! Testing should be in pharmacies and at point-of-care. We also need a system with rigorous quality assurance and validation of those tests, which complicates life as well,” he added.
He said herd immunity was misunderstood and only worked if a minimum level of individuals was rendered immune through vaccination. For measles, (for example), this meant 90% of a population being vaccinated to protect the unvaccinated. Protecting the vulnerable while exposing the younger, less infection prone to the virus seemed like a sensible strategy, yet Sweden’s herd-immunity policy left them with the biggest C-19 mortality in Europe.
“We’re no longer in the Middle Ages – we shouldn’t let the natural course of an infection go. There’s no way that by some miracle, one fine day it will disappear. As long as there are susceptible people in the world, the virus will look for people – a virus’s very reason for living is to find a host!” he added.
[link url="https://www.dailymaverick.co.za/article/2020-05-31-over-70-of-surgeries-in-sa-will-be-cancelled-or-postponed-due-to-covid-19-how-will-we-catch-up/"]The Piot webinar can be accessed here[/link]