‘If you prioritise public health, you’ll get much better outcomes’

History has proven that an elimination, or ‘zero’, approach to any new pandemic must be the default response, says Professor Michael Baker.

Baker is an epidemiologist at the University of Otago, Wellington, in New Zealand, and was part of the team that advised Jacinda Ardern’s government on the pandemic response.

He argued that with the frequency of pandemics predicted to increase – due to climate change and greater encroachments on the natural world – we must learn these lessons quickly.

Baker said: “Elimination should be the default option whenever you see a new pandemic. In other words you try and stamp it out as fast as you can. It seems to be blindingly obvious, but that is not what the world is doing at the moment.

“It just has got this default setting of ‘we can't stop a respiratory pandemic’. But actually, China demonstrated that you could. And that's what inspired me to promote elimination in New Zealand and then internationally. And I still think it's the by far the preferred option for the UK.”

Baker said that putting short-term imagined economic benefits ahead of public health has been shown to be “a terrible false dichotomy and a terrible error”. In the UK’s case he said it was a “terrible blunder” that cost thousands of lives as well as the British economy.

He said: “If you prioritise public health – I'd say sustainability as well, and equity – ultimately you'll get much better outcomes for the economy and obviously population wellbeing. After all, the economy is there to serve the public, not the other way round… If you prioritise those goals, good economic performance, prosperity, will also follow.”

Baker, who has won several awards for his COVID-19 response work, including the Public Health Champion Award, he added: “This process must result in major changes to the way governments prioritise public health, the infrastructure they have and their decision-making processes.

“And also support for global health institutions – supporting the World Health Organisation, and international treaties. All of that infrastructure needs to work at a global level.”

Many have argued that a zero-COVID approach couldn’t work in the UK, which Baker rejected. Given the political will, he said, the UK had all the “tools” it needed to pursue elimination including some of the best health and scientific resources in the world.

He compared the UK’s handling of the pandemic to countries with long complex land borders such as Vietnam with a population of over 100m people, and fewer resources, yet far fewer deaths. Other countries such as Cambodia, Laos, Mongolia, also with complex borders, responded well.

Baker and his colleagues will be analysing GDP data further but expect to find elimination approaches work best for both economy and health.

“The evidence is very much in favour” of elimination, he said, “and it's much better than the alternative. We often say it's the ‘least bad alternative’ because it still requires a lot of disruption and a lot of effort, a lot of resources. But actually our economy and the economies of countries pursuing elimination are performing much better than those that are trying to suppress the virus.”

The success of the vaccine – which Baker described as a “bonus” as it was not certain from the start that a vaccine would become available – could allow something called “progressive elimination” an approach being used currently to tackle measles globally.

Global vaccination will mean fewer sustained transmissions in more countries and this could be extended across the globe to eradicate it completely, although this would take years. He said the picture wasn’t yet clear if this approach was desirable or feasible. If it is discovered, for example, that young people develop complications such as long COVID countries may act.

The success of the vaccines also mean that a version of the herd immunity idea that derailed the UK at the start of the pandemic is once more on the table. Baker described this as the default option if countries do nothing. Already recent data has shown that half the UK population has antibodies for COVID-19 from vaccination or infection.

This approach involves vaccinating the vulnerable, with boosters each year. The virus would circulate and children would develop immunity at a young age when it’s not a serious infection, and it would join the other four common coronaviruses in circulation. It would become unusual to die from the infection but it would still happen occasionally, like with influenza.

Concern has been raised that the virus could mutate faster than our scientists can tweak the vaccines for it, but Baker is confident that we will be able to keep ahead. He said: “Obviously you are always in an arms race with an infectious agent and you are having to reformat the vaccine to try and keep ahead of the virus. I’m pretty confident we will be able to because, particularly, these new RNA vaccines can be reformulated quite quickly.”