There are more than 140 vaccine candidates in the pipeline - but there is no guarantee of success. Photo / AP
There are more than 140 vaccine candidates in the pipeline - but there is no guarantee of success. Photo / AP
OPINION:
There's something quite likeable about Charles Dickens' character Wilkins Micawber. He's knee-deep in debt, blindly optimistic and perennially of the opinion that "something will turn up" to solve his problems. But you wouldn't want him running a country.
It's a pity, then, that New Zealand is enduring an electioncampaign populated almost entirely by Wilkins Micawbers. Covid-19 is the defining issue and every main party's plan to save us from self-imposed isolation through a heavily shuttered border is a vaccine. It hardly seems to matter that developing that vaccine is beyond our control and entirely uncertain.
What will happen if there is no vaccine? Or if a vaccine or vaccines take years to emerge? Or if efficacy is too limited to achieve herd immunity?
No major party is yet prepared to tell the electorate that the benefits of isolation have limits, and that we cannot sensibly remain holed up behind our considerable moat indefinitely. Nor has any party been honest enough to talk to New Zealanders about the almost undoubtedly erroneously high Covid-19 mortality figures (frequently undifferentiated by age and existing illness) that were produced by epidemiologists' models early in the year.
It seems the population's fear, now thoroughly fanned, is too politically dangerous to douse. That gives hope for a vaccine tremendous potency, and it also has the effect of sidelining any sensible discussion of how to proceed without one.
Should it bear repeating, the problem with the status quo elimination track is that all-but-closed borders shave 5 per cent off our annual GDP, by Treasury's recent estimates. And that figure fails to capture other myriad losses, from family separation (New Zealand currently bars most foreigners from entry) to the handbrake on New Zealand businesses, particularly those that aim to grow abroad. At higher alert levels, the cost is considerably higher.
Such is the undifferentiated thinking of New Zealand politicians that there is broad agreement: we must wait for a safe and effective vaccine to deliver us from this limbo.
As a plan, its defining characteristic is hope. In fact, that's the word the World Health Organisation's director-general Tedros Adhanom Ghebreyesus used this week: "There is hope that by the end of this year we may have a vaccine." He said it twice: "There is hope." Good. We all know the world's clever people are looking for a vaccine, that there are over 140 candidates in the pipeline, and that these projects have money to burn.
But there is also fear, and indeed likelihood, that this hope will be met with disappointment. First, there is the inconvenient historical fact that many vaccine searches have failed even after decades of effort and billions of dollars spent. HIV and Zika are prominent examples. As Richard Feachem, director of the Global Health Group at the University of California, San Francisco, wrote recently in the Financial Times, there may never be a vaccine.
He also laid out what properties a vaccine would need to largely banish Covid. It will need to have a high efficacy, for a protracted duration of protection, and a dosing schedule that is not too demanding. And it must be possible to manufacture billions of doses, bearing in mind the risk of serious supply chain difficulties, including the limited supply of ingredients.
Efficacy (meaning that the person who takes the vaccine is protected from the disease), should any vaccine make it through trials, is a huge question mark. The US regulator, the FDA, has said it will approve a vaccine for use even if it is only 50 per cent effective — meaning a product that prevents the disease in half or more instances where it is administered or it reduces the disease severity by 50 per cent or more.
That's nothing like the vaccines that eradicated smallpox and that effectively keep at bay diseases like measles and polio. Those have over 95 per cent efficacy.
A lower efficacy vaccine would be useful, but the extent of that utility would depend on many factors including the proportion of the New Zealand population willing to roll up its collective sleeve and be jabbed.
Fifty per cent efficacy across a population that's 50 per cent inoculated, for example, provides 25 per cent immunity. Under such a scenario, it's conceivable that herd immunity, whereby the old and the sick are well protected, remains elusive.
Since we cannot predict the likelihood of a silver bullet vaccine, it would be sensible to prepare for the alternative.
That would require the Government, however it is constituted after October 17, to provide a new reckoning of the number of deaths the country would likely suffer if mitigation measures were deployed to shield the most susceptible. It should take account of advances in Covid-19 treatment.
The Government has been too fond of referring to the virus "raging beyond our borders". The next one should be more honest: the virus, though spreading abroad, is demonstrably losing its bite.
As early as June, studies showed that steroids like Dexamethasone (and other drug therapies and hospital protocols) reduced Covid deaths considerably in hospital settings. Much as it galls Donald Trump's opponents, it is likely that a cocktail of drugs, including steroids, helped to minimise the severity of the US president's Covid case.
There is reason for optimism. The improvements in treatment have been gradual, but they should help us to start passing the burden of managing Covid-19 back to health systems. At the same time, we can move towards easing blanket restrictions at the border.
Incremental improvement is our best route back to normalcy, but hope for a vaccine is blinding us to it.
