... and other virus to come. Peter currently teaches medical students at UNSW.
Globally, the dilemma faced by many governments has been real and has been difficult. We, in the health area, have had no doubt where our priorities lay. We are health people, and the health challenges posed by this pandemic have been great and immediate. People have been dying of this infection. Many others, including some of us, have become very sick. Infection has been widespread. In some countries hospitals have been overwhelmed. Some countries have run out of oxygen for people who could not breathe properly. Many countries did not have adequate supplies of personal protective equipment to protect those of us who work with the sick. The public health systems in some jurisdictions were inadequate.
In addition, Australia was held hostage by overseas countries. No matter that we had signed contracts for certain vaccines; supplies were taken by some nations (mostly rich) for themselves. – and we just had to wait. It makes one wonder about the unalloyed benefits of free trade and global arrangements.
People seemed to forget that this has happened before. In World War I Australia had no salicylate because phenol was being used for explosives. Bayer had the exclusive right to produce acetylsalicylic acid but the patent was voided and the Nicholas firm flourished.
But, let us return to the dilemma. There has been major economic damage. There have been many people unemployed. here has been recession and, as government revenue goes down, many of the activities to help people in need have been truncated. And although the Jobseeker payments by the Government helped alleviate immediate and great suffering, they left our children with great debts to inherit and to service. So, governments wanted to preserve as much of the economy as they could, while at the same time meeting the health agenda. It is possible to understand (but not to agree with) the governments that favoured the economic, over the health, agenda – they have done less well overall than those countries that listened to us.
Zoonoses (animal diseases that can infect people) have appeared every decade or so. Just think of HIV, SARS. MERS, Ebola, Zika, and so on. They will continue to appear. We teach our young medical students about HIV, partly to teach them relevant things about retroviruses, but partly to prepare them for the inevitability that there will be other new viruses and other zoonotic diseases.
The present strategies are unlikely to work as some politicians seem to believe they will. The virus has behaved predictably, and variants have appeared. It is likely that other variants will appear too. The virus will not disappear and will be with us for many years. It took five years for Australia to cope with the influenza pandemic of 1919 – and the virus did not disappear. As new variants appear, the vaccines will need to alter – which is what happens now with the influenza virus. We are likely to need a regular booster as antibody levels fall and as new variants appear. After all, we have annual influenza shots and we know that antibody levels fall after about three months. It is for that reason that doctors give influenza vaccine to people at the beginning of winter – so that antibody levels are high during the colder months.
The benefits from a high vaccination rate are likely to be twofold. First fewer people would become very sick and need intensive care unit (ICU) treatment. Our hospitals and our ICUs are likely to be able to cope. Secondly, the infection rate would go down – but it would not disappear. If we have learned anything from influenza, it is that the virus continues to change, and we make a guess late each year about which of the variants of influenza virus will come to Australia in the coming winter and need to be put into a vaccine.
And, when we open our international borders, as we will have to do eventually, the virus is sure to come in. Already we are seeing in quarantine facilities a high rate of infection in people returning to Australia from overseas; when we open our borders that infection rate will be for the whole community to bear.
So, let us get vaccinated. Fewer people will die. Our hospitals will cope. But do not imagine that we are going to be rid of this virus. It is here. It will stay. And we just have to work out ways of living with it.
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UNSW School of Population Health