Peter Piot: Vaccination passports a one-way street

Peter Piot, a special adviser on coronavirus to the President of the Commission Ursula von der Leyen, is a world-renowned epidemic expert who has worked for decades to fight HIV in Africa and is one of the leading scientists who discovered the Ebola virus in 1976.

He has worked with the United Nations for decades on health issues and has been a leader in many pandemic preparedness organizations. At this stage one would say that he is the right person in the right position, with his adequacy not being open to political interpretations.

The Belgian expert spoke to Kathimerini Cyprus' Yiorgos Kakouris via video conference from London where he is a professor at the School of Health and Tropical Medicine, and from where he advises President Von der Leyen, Commissioner Kyriakidou and the Commission's mechanisms for dealing with the coronavirus.

Just today (Wednesday) we were informed in Belgium that there would be delays in deliveries of vaccines which could mean an even slower rate of vaccination. People's psychology keeps being affected. We need a realistic assessment. What is the target for percentage of people that need to be vaccinated and when can we realistically expect it to be reached in the worst case scenario?

I agree with you, this is a great issue because to be frank, vaccination is the only way out of this epidemic so it's crucial. And basically most companies have overpromised and under-delivered and that is the issue. I can understand that, because nobody has ever tried to produce and manufacture so many vaccines in such a short time. So I think we collectively underestimated the challenges.

I must say I had underestimated the fact that we could have vaccines so fast. It has come much faster than I expected, and I've been working in infectious diseases for nearly 45 years.

When we got the vaccine, we thought it would become available everywhere, and that has not been the case. And as we know this has even had political consequences. The whole deal of the European Commission with the vaccine producers was that if they would have delivered they would have been heroes. And now that they could not be delivered they say that it's a fiasco.

I believe that now that vaccination systems have been created, we can come out and say let’s hold off three more months with the measures.

On the positive side, I am quite optimistic that in the second quarter there will be far more vaccines becoming available. Hopefully there will be an approval of the additional vaccine by J&J. I don't want to anticipate but it looks like results will be positive, so in a few weeks’ time we should have approval of that. I understand they can start delivering in April.

Moderna has delays, also Astra Zeneca is the big one that we all hoped for. But the good news is that Pfizer/BioNTech are on target now. They had a slight problem. I think honest communication is quite important but we need vaccinate faster and there's no doubt about that.

I checked the data for Cyprus, and Cyprus is in the middle range, not too bad in the European zone, but again I think it's not doing too badly. One thing that I knew about Cyprus in terms of Covid was the testing. I think you did some of the best and most efficient and effective testing and tracing strategies. I compare with the UK where the testing was a total disaster and the vaccination is going very well.

Can we predict when measures will begin to be lifted significantly?

On Monday PM Boris Johnson announced a roadmap up to June with some easing of the measures, starting with opening schools on March 9. But then the rest would depend on a number of criteria. And the most important are of course new infections, hospitalisations and deaths. We expect vaccines to improve the numbers.

And I've had a Covid myself and I was hospitalised. I feel really sympathetic to that.

I am relatively optimistic and the reason I'm saying that is that in the UK we had 70 thousand cases per day. Now yesterday for the first time it was under 10 thousand. Still a lot of cases and still hundreds of people dying. But it shows that with the measures in place and the lockdown we can even bring this variant under control. That's hope-giving news. But we'll have to see.

I would say that it's important that all countries and also at the level of the Eu we have a system in place that we say if the number of infections fall below - and I don't want to give a number -, the number of hospitalisations, the number of deaths, fall below a certain level then we can start relaxing but in a programmed way.

The big challenge in this epidemic has been the uncertainty. But I am optimistic that it will be much better, but I can't put a date on it. And by the summer it should be not going back to completely normal but it should be much better.

What are the real dangers of the variants? Because current discussions on the matter are causing panic.

First of all, that's what viruses do, they mutate. No virologist was surprised by that. They can be more transmissible, that's what we've seen with the British variant. If they transmit more rapidly, it means we need to be extra rigorous in our measures to have the same result. And we need to probably vaccinate a larger percentage of people in order to have herd immunity.

The second point, and that's the one that the world is more worried about, is will (the variants) escape the natural immunity, in other words, whether you could get reinfected and whether vaccines could be made ineffective.

But it is not an all or nothing thing. For example in South Africa, where we had the most experience with what could be a nasty variant, vaccines are less effective, we know from J&J vaccine, Novavax and AstraZeneca. All of them have lower protection in general. However, AZ in particular offered only 10% protection. That doesn't really work. But J&J in their trial had enough people - older or that developed severe disease in their control group - and there the vaccine was highly effective in preventing severe disease, hospitalisation and death. At the same level as the results of the trial in the US. So we have to look at each vaccine separately. But we cannot be complacent because one of the lessons of this epidemic is not to take anything for granted, act early, don't wait until it comes and falls over you.

We need to work with the companies that already produce vaccines that are effective against other variants. The problem is we don't know yet what is in the pipeline. Will there be completely crazy variants or not? Probably we will go to a fairly predictable set of variants like we know for influenza, for the flu, and then the vaccine developers can work on that and get ready.

So at the moment I would say we are fine, but we cannot take the risk. One scenario could be that let's say by the end of the year we have a second generation of vaccines that are also fully active against new variants, because there will be more variants coming. And also the more we sequence, the more we will find. That's why the UK was the first, they sequenced a lot here, but now it Europe it started also.

Also when vaccinated you get a booster, and the question is will we need it every year, every five years, every ten years. Honestly, no one can tell you. I hope it's not every year because of the logistics and the cost of it would be quite enormous.

Do you see things returning to normal as before or will we be subject to more pandemics?

I think we will become societies that learn to live with Covid, like we learnt to live with influenza. With mass vaccination, most people for most of the time will be safe. But now and then we will have outbreaks, maybe due to a new variant, or maybe because not everybody will get vaccinated.

We'll go to some kind of normal but not completely. So we’ll go down to very low levels, with everyone vaccinated, and then we’ll still have outbreaks but hopefully not very radical ones, and that will depend on the new variants.

This also requires some investments. That's what's behind this HERA incubator (took the name of a Greek goddess) because Europe needs that also. We need an organised way of stimulating those that develop vaccines, mostly in business but also in academia/research groups, specifically for the variants. And that will be a test I think for Europe to see whether we can come together and join forces because even bigger countries are kind of small when it comes to such a major enterprise.

Has the Commission learned its lessons from mistakes during the first rush for vaccines, development, and procurement?

It was definitely not perfect. I would say on the one hand I think that the approach to buy vaccines for all member states was the right one. Because I always think you have to take the counterfactual. If that was not done and every country went on their own, then the Commission would have been criticised for not doing it. And smaller countries in particular would have had a hard time. They would have paid far too much. Already now we are in trouble with international competition.

I think that one of the lessons is that Europe was not ready for this epidemic, health is not a competency of the EU, and I think that's right for healthcare systems, every country has its own and it would be a nightmare to organise it and don't think there is a need to that.

But when it comes to epidemics, we need a health union, that's for sure. That's something that should have been organised a long time ago.

When you think about it, no vaccine has been tested out on a large scale in Europe. It was in the UK, US, SA, Brazil. And the reason is that we did not have this collaboration. We didn't have what they call in the US, a BARDA. This is what HERA will be. We supported and invested a lot in Europe in BioNTech and that was the first vaccine on the market, but we didn't have the means.

I think that the mistakes from my perspective were more related to export bans and all that. But I understand it also. Because the US has a law preventing the export of anything that can be used for vaccines. This can only work if all the countries have open borders with each other. But I also understand the emotional and political reactions. I think that we need to learn from our mistakes and the fact that we were not ready as a union on the research and development side. I think that we need a stronger mandate for the European medicines agency and a European centre for disease control.

Are there any developments in efforts to secure vaccines for non-EU countries and the western Balkans through COVAX?

Let’s not forget that the ACT accelerator and COVAX is an initiative first launched by VDL and then with Gavi, CEPI and then WHO. I think it's the right thing to do. But it has been struggling with money, but also the same problem as the EU. And that is getting the vaccines. There are contracts for billions of doses, but they are not delivered.

In a few months COVAX will come at a cruising altitude. All the problems are right now. There is the African Union that have made deals with companies. I was quite involved with that and was pleased to hear that last week at the G7 that VDL announced this package to support Africa with vaccine deployment, with manufacturing. In the end what they need is manufacturing in Africa. But again that's not solving the problem today but I think next year.

There is also what President Macron has said about sharing a percentage of the vaccines we have. I am personally in favour of that but I think it would be a hard sell in many countries because we don't have enough vaccines yet in each country. I think Norway has committed to that, and again it's probably something that will materialise but later on.

As regards the opening up of economies and the proposal for vaccination passports, do you consider this safe and likely to happen?

The train has left the station. It will happen. In Israel they are using it even domestically, if you want to go to cinema or the gym. I think that if you go to certain countries they ask for yellow fever vaccine certificate. So I think it will happen but we need to make sure - there are many questions. It has to be absolutely safe because there will be opportunity for counterfeits.

Scientifically speaking, we don't know how long the protection lasts. So it will have to be something that we say from the moment we give it, it is valid for 6 months or 12 months for example.

There are also equity issues, people that have not been able to be vaccinated, for a medical reason, tiny minority, this can be an exception combined with testing. Or people that are against vaccination. And then there are those who vaccination has not yet reached.

I think we will become a world where vaccination certificates will be required for international travel all over. We can't wait too long because countries will make bilateral agreements. I am a pragmatist. It will happen so let's make sure it's the best. If we don't deal with it then we say why, it will happen anyway. Not only in Europe but the world. Maybe this is not going to be the official position of the EU, but I am an advisor.