Most of the world may face Covid without a vaccine

Klaus Stohr has urged governments for many years to prepare for the grim possibility of a pandemic.

In 2003, he played a key role in a World Health Organization investigation that swiftly identified a coronavirus as the cause of SARS. Stohr also sounded the alarm on the pandemic potential of avian flu, bringing countries and companies to the table to increase production of vaccines in case it began spreading widely in people.

In Covid-19, which has killed almost 600,000 people, the world faces the crisis that the virologist has long feared. Stohr, who left the WHO to join drugmaker Novartis AG in 2007 and retired a couple of years ago, paints a sobering picture. He spoke with Bloomberg by phone, and his remarks have been edited for clarity and readability:

Bloomberg: How do you see the pandemic advancing before a vaccine potentially is available?

Stohr: The epidemiological behavior of this virus will not be that much different from other respiratory diseases. During winter, they come back.

There will be another wave, and it will be very serious. More than 90% of the population is susceptible. If we do not tighten again to a serious lockdown or similar measures, the virus is going to cause a significant outbreak. Winter is coming before the vaccine. There will be an increase in cases, and there will be problems containing it because people seem not very amenable to more constraints in their movement and freedom.

"It's not the vaccine that's going to end the pandemic. The virus will end this pandemic by burning every piece of dry wood it will find"

Bloomberg: When do you predict vaccines may arrive?

Stohr: Countries like Germany may have a significant amount of vaccine by the beginning of next year and a rollout that may take four, five, six months for the elderly. The strategy may be different for a country like Brazil, Argentina or Chile, which may never get a single dose of a vaccine and still has to cope.

The world will be divided into two groups, those with vaccines and those with no vaccines.

Bloomberg: How do you see worldwide immunity ramping up as vaccines are introduced and the disease spreads?

Stohr: I would assume that by the middle of next year a significant portion of the world will have antibodies. That will increase gradually over time. Then there will be a third wave, and when that is over, I would think that 80% of the world may have antibodies if lockdowns are not instituted, which I doubt.

Klaus Stohr. Photo: Bloomberg

Bloomberg: What does that mean for vaccines under development?

Stohr: We're in a big, big quandary. We have to throw all the resources we can afford toward the development of a vaccine. On the other hand, I believe common sense tells us vaccines will not be available for the majority of the world.

There may be, by the end of this year or beginning of next year, a half a billion doses available. The world population is 7.5 billion. Particularly in those countries which have insufficient infrastructure and struggle with their health-care systems and have huge populations, what vaccine are they going to have?

Bloomberg: A number of groups, including the WHO, are focusing on equitable access. Won't that help tackle those concerns?

Stohr: It would be irresponsible not to do anything. Nevertheless, the majority of the world population will not receive a vaccine. The virus will continue to spread, and it could take two to three years before the virus has affected a large majority of the population.

It's not the vaccine that's going to end the pandemic. The virus will end this pandemic by burning every piece of dry wood it will find. The fire will not go out before the last susceptible person has been affected.

Then the question is what role will any vaccine play afterward.

"We cannot do the ostrich policy here and hope that some miracle will happen and the virus will disappear. The perfect strategy isn't available"

Bloomberg: You seem optimistic researchers will succeed in coming up with vaccines. How do you assess the prospects and potential risks?

Stohr: The coronavirus is not a particularly difficult virus to handle. Even the conventional vaccines could make a difference, and we have different approaches, vector vaccines, mRNA. That is very promising.

In the past, when a vaccine is introduced, you have a gradual increase in its use, in the number of people immunized, and if anything comes up, even very rare events, they will be noticed pretty early. But here, a vaccine will be used in large amounts, possibly hundreds of millions of doses, in a relatively short period of time, six months to a year. So the question is if there is anything possibly lingering in the vaccine that cannot be detected in the large-scale safety testing during the approval process.

It could hit many, many people. If you immunize 500 million, and it's only 1 in a million who is affected, you still have a significant number of people who may have safety problems, so that is something that has to be addressed. But one has to balance the concern about the impact of the disease against the concern of the possible impact of the use of the vaccine.

Bloomberg: You've said countries need to adjust their strategies. What is the best approach governments can take?

Stohr: We have to find a way to open our community in a way that supports our long-term medical goal, which is the least number of casualties over time, knowing that you cannot avoid the spread of infection. There is no other tool available. If you've got a medical problem, you go skiing, you break your leg, your knee ligament is torn, no problem, go to the doctor and get it fixed. We have no fix here.

We have to live with this virus and we have to find a proper way to ensure that when we are through with this we look back and say we did the best to prevent death and disease. But we cannot do the ostrich policy here and hope that some miracle will happen and the virus will disappear. The perfect strategy isn't available.

Bloomberg: You've tackled other viruses from SARS to bird flu, are there any lessons from the past that are relevant today?

Stohr: Since 2003 we've been talking about pandemic planning. Some countries developed these plans and used them. I believe those who had a decent pandemic plan were a couple of steps ahead. But there are still countries with no plans. The learning is get your pandemic plan ready.

It may be clear that only those who will have vaccine production on their soil will have access to vaccines during the pandemic. I hope it's not going to turn out this way, but I fear it will. That hopefully will result in more investment into pandemic preparedness and vaccine preparedness in the coming years, so that the next pandemic will be addressed better than this one.

Disclaimer: This article first appeared on Bloomberg.com and is published by special syndication arrangement.