Professor Heymann spoke about Covid-19 and what’s likely to happen next, at an ARENI Global In Conversation session.
In a hurry? Here are the main takeaways:
There are three types of new disease that can afflict human beings – but nobody knows which one Covid-19 belongs to. And as the world’s demand for protein rises, more diseases are probably on their way.
That was the sober assessment of Professor David L. Heymann CBE, the Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine, speaking to senior journalist Karina Robinson. The occasion was an online ARENI Global In Conversation session, recorded in July 2020.
Ms Robinson asked whether the UN was right to predict a world that will grapple with more zoonotic diseases (diseases from animals) in future because of increased contact with wildlife, including through unsustainable farming practices.
“In order to understand emerging infections, or those from animals to humans, it’s useful to put it into three different categories of what might happen,” said Professor Heymann.
The nature of the problem
Professor Heymann, now working with the WHO to combat Covid-19, spent 22 years working with the World Health Organisation (WHO) in Geneva, on secondment from the Centers for Disease Control and Prevention. He has been at the forefront of battling AIDS, malaria, measles, tuberculosis and polio, and he also coordinated the global response to SARS.
He said there are serious new diseases that don’t spread widely, such as rabies. There are diseases like Ebola and SARS which cause serious outbreaks, but which disappear. And then there’s the third category, “which comes from an animal and finds a human a comfortable host,” he said. These are the diseases that are in it for the long haul, like influenza or HIV – and maybe the new coronavirus. “We don’t know the destiny of this virus, but maybe we have to get used to living with it, without a vaccine or drug.”
Fortunately, Professor Heymann said we already understand how to live with Covid-19: “Physical distancing. Just respect that one metre distance. Frequent washing of hands,” he said. “Wearing a mask even if we’re not sick, because we might be on the way to becoming sick.”
Professor Heymann also said the most effective thing governments could do was contact tracing. Surprisingly, he said the WHO recommended doing this instead of imposing lockdowns – and that countries that took the advice have “had an easier time in keeping the reproductive number at a low level”. Unfortunately, medical authorities first believed that Covid-19 was a respiratory illness like influenza and chose lockdowns over contract tracing.
As the northern hemisphere moves into colder weather, the big question being asked is whether a second wave is on its way. Professor Heymann said this isn’t likely, simply because ‘second wave’ is the wrong term to use – it came from the great influenza pandemic of 1918, (where the disease roared back after restrictions were lifted). “This virus is different. Better terminology is not ‘second wave’ but ‘resurgence’,” as people spend more time in doors, giving the virus more chance to spread.
A resurgence is not inevitable, “if contact tracing and disease detection systems are in place”. A lot of what happens next also depends on individual behaviour: “We can interrupt transmission and prevent communities from being infected,” by maintaining distance and hygiene.
What hopes of a vaccine?
Professor Heymann says that while vaccines normally take time to develop, the world has never focused such effort focused on the hunt for a single vaccine. “There are two basic types of vaccines,” he explained. “One takes genetic information from the virus and splices it onto a living virus that doesn’t cause illness, but that can reproduce in humans.” This will provoke the immune system to create antibodies against the virus; the Oxford Vaccine Group is in the last stages of trialling a vaccine of this type.
A second promising approach is to find an antibody that “prevents the virus from hooking on” to a receptor in human cells.
Professor Heymann added that China had already developed a vaccine that it was testing on its military, but which can’t yet be used in the West because China’s regulatory regime is so different. “Regulatory agencies in Western countries will never compromise on safety,” he said.
Ms Robinson then raised the issue of whether novel diseases could be used as bioweapons. Professor Heymann explained that after the post-9/11 anthrax outbreaks, “the US provided billions of dollars to a research group called BARDA (Biomedical Advanced Research and Development Authority) that has provided funding to companies around the world to develop vaccines for organisms they fear may be used for bioterrorism” – and that’s why we now have a vaccine for Ebola. Serendipitously, the vaccine happened to be available when Ebola broke out in West Africa and so was available for use. “We need to make sure that the public health community and the bioweapons community are speaking together and mutually benefiting from the money that’s being spent,” he said.
Other organisations involved in preparing for future pandemics include CEPI, the Coalition of Epidemic Preparation Innovation in London. “There’s lots of money going into research. Hopefully the Coalition will continue to support vaccines and get a head start for the next outbreak,” though Professor Heymann also said that “policy makers have a short memory – during the SARS outbreak in 2003, the Chinese government began to invest money into research into markets where live animals were sold”. This research showed that market workers had higher antibodies to these viruses than the general population. At the time, this pushed many companies to develop vaccines and diagnostic tests. Unfortunately, “after the outbreak was declared over, the money dried up”.
What the wine trade can do
Even if a vaccine is around the corner, we may be living with Covid-19 for a long time. Professor Heymann said that one thing wine associations should consider is to open a discussion with the government, because “you need to understand how governments feel” and how they can contribute to what the government is trying to do. “If the winemakers or restaurant associations have been excluded from government talks, they need to find a way to get into those talks,” he advised.
But in the meantime – physical distancing, hygiene and masks. It’s that simple.
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