Zania Stamataki, senior lecturer in viral immunology, University of Birmingham
We have worked flat out around the world since COVID struck, to develop, test and deploy the fastest vaccines in the history of humankind. Immunity to coronavirus after natural infection is short-lived, but the approved vaccines are impressively effective. We don’t know the duration of vaccine-induced protection yet. What would happen if we throw caution to the wind and stop taking any precautions to restrict transmission after vaccination?
Well, the vaccines don’t work for everyone. A small percentage will still suffer severely, and if we increase the number of infected people, the number of severely affected will also rise. The vaccines don’t make our bodies impervious to infection, instead, they kick off an early immune response that reduces the chance of mild or severe disease. And more importantly, they help us avoid hospitalisations and death. The vaccines also reduce transmission to others.
Is it possible to become infected after vaccination? Yes. Is it possible to transmit infection if you are fully vaccinated? Also yes. Will you know you have become infected? Some show symptoms, some don’t.
The important point is that we are dealing with an RNA virus that mutates and eventually will generate variants that evade vaccine-induced responses. It has already mutated into variants with reduced susceptibility to antibodies (beta variant) and increased transmissibility (alpha, delta). The delta variant is in more than 90 countries and is the dominant variant in the UK, with over 53,000 new cases reported on July 17.
Do we really want to encourage the generation of vaccine-escape variants for the sake of a few sensible decisions? Wear your mask when you can’t keep your distance. We have miles to go before we sleep.
Dominic Wilkinson, consultant neonatologist and professor of ethics, University of Oxford
The fundamental ethical challenge for public health is the need to balance the health of the community against the burdens of interventions and the effect on personal freedom.
There are many things that we could do to improve public health. For example, smoking leads to 74,000 deaths in England per year and over 500,000 hospital admissions. Should we ban the sale of cigarettes (or alcohol, or fast food)? That depends on whether the benefit of doing so would outweigh the infringements to people’s personal liberties.
This same balance has been at stake throughout this pandemic. Lockdowns have been effective, but they have had negative effects on the community’s physical and mental health, on education and the economy.
With rising cases of the delta variant, we could prevent some deaths by keeping COVID restrictions for a while longer. Indeed, we could prevent the most COVID deaths by reversing previous decisions and returning to a stricter lockdown.
Yet the key issue is one of proportionality. Is it proportionate to continue to enforce social distancing, tell people to work from home, limit public gatherings? There are different ethical views on that question. However, perhaps there are some things we can agree on. We are not out of the woods yet. Measures are being relaxed now, but they may have to be reintroduced depending on what happens. Some measures (for example mask-wearing on public transport or in indoor spaces) represent a minimal incursion on personal liberty, and should continue.
Francois Balloux, chair professor, computational biology, UCL
Four major forces are driving the dynamic of SARS-CoV-2: human behaviour, seasonality, viral evolution and rates of immunisation in the population (provided by prior infection or vaccination, or both). Together those four forces will dictate changes in case numbers in any place and time.
Governments have no control over seasonality. They also have far less control over viral evolution than is sometimes assumed. For example, it is often claimed that the circulation of SARS-CoV-2 in a partially vaccinated population may favour the emergence of new viral vaccine-escape variants. This is a reasonable evolutionary hypothesis, but there is no empirical evidence supporting it. All four variants of concern (alpha, beta, gamma and delta) emerged in mid to late 2020, before any population on Earth benefited from significant vaccine immunity.
Conversely, governments can try to encourage high rates of vaccine uptake. In this regard, the UK response to the pandemic can be considered to have been a success with over 90% of adults having antibodies to SARS-CoV-2 by July 2021. Governments can also enact non-pharmaceutical interventions (such as quarantine, isolation or lockdown) to reduce contact rates among people, thereby limiting the ability of the virus to spread.
The UK set up a roadmap of the progressive lifting of social distancing measures in place. The decision to go ahead with the scrapping of residual measures in place on July 19 has been received with dismay by many, given the ongoing surge of delta variant infections. I suspect this decision is less radical than many may feel. Except for the reopening of nightclubs, the relaxation of remaining measures may not drastically alter current behaviour.
In democratic societies, the perceived level of threat is probably more important in shaping individual behaviour than government regulations. I would expect that if the epidemic situation worsened, most people would spontaneously revert to a more prudent behaviour.
Zania Stamataki receives funding from the UKRI, The Academy for Medical Sciences and the Birmingham Children's Hospital Research Foundation. She is a Medical Research Foundation intermediate career research fellow.
Dominic Wilkinson receives funding from the Wellcome Trust; also from the UKRI/AHRC as part of the UK Pandemic ethics accelerator ukpandemicethics.org
Francois Balloux receives funding from the UKRI and the Wellcome Trust.