Jeremy Farrar: Until we are all safe, no one is safe. Covid is a global problem

T he world has entered a year which will be far less predictable in its outcomes than the one that has just ended. That is the stark warning from Jeremy Farrar, head of the Wellcome Trust and one of the world’s leading experts on infectious diseases.

Farrar argues that even though 2020 was utterly transformed by lockdowns, travel bans, social distancing measures and the deaths of more than 2 million people from Covid-19 across the globe, such outcomes were predictable once details of the disease were revealed. Crucially, that is not going to be the case for 2021.

“From last January onwards, we knew this was a novel virus for which we had no immunity. We knew it was transmitted from human to human, and while it often triggered no illness at all it could also end in death. Once we knew that last January, then 2020 became predictable. Unfortunately, we are now entering a year whose outcome is far less predictable. The virus is evolving and changing, and so that is reducing our capacity to cope with it – and that means we are really going to be stretched.”

A particular worry for Farrar is the prospect that immunity supplied by the current vaccines might wane significantly throughout the year. Just how long protection lasts is still not known, and finding out is now an urgent goal for researchers, he believes.

“What we must not do is go into the winter of 2021 in the northern hemisphere with immunity waning in people. That would be an absolute disaster. The trouble is that we still don’t have long-term efficacy data on these vaccines.”

There is therefore an urgent need to launch robust randomised trials, carried out in a transparent way, to uncover the truth. These will reveal how well the current vaccines are going to protect people over the coming year.

“In fact, we need – very quickly – to establish three key features about Covid vaccines. The first is the length of time for which they provide protection. But we also need to know how effective they are against current variants and also understand how useful vaccination is in reducing the risk of new variants becoming widespread.”

Farrar acknowledged that Britain has demonstrated considerable adroitness in its vaccine policy and also in the quality of its genomic surveys which have swiftly uncovered the existence of worrying new strains of the virus. However, it was crucial that the nation shared that knowledge and expertise with other countries and made strenuous efforts to help individual countries in Africa, Central and South America and South Asia in their battles against Covid.

“This is not charity. This is not stamp-collecting. This is absolutely crucial for understanding how new variants are developing and evolving around the world. It is enlightened self-interest,” said Farrar.

“The world needs to know where new variants are appearing. If they appear, they will end up in the UK in the end. Yes, we can close our borders and buy ourselves time. But at some point, if a variant has sufficient biological advantages, it will spread around the world and into every nation.”

In addition to sharing knowledge and expertise, Farrar argues that it is also crucial to ensure there is equitable access to vaccines. Immunising a lot of people in a few countries while leaving the virus unchecked in large parts of the world would simply allow more variants to emerge in these places. And the more that happens, the higher is the risk that the virus will evolve to an extent that our vaccines, treatments and tests are no longer effective.

Unfortunately, just as these issues are being aired, increasingly bitter national quarrels are erupting over approaches to the way that Covid-19 should be tackled – in particular, over disputed rights to vaccine supplies. This weekend, Britain is locked in a battle with the EU and some of its member nations, including France and Germany, over access to vaccine stockpiles. The new variants have changed things dramatically and tension is rising across the world, says Farrar.

“We are now faced with mounting levels of vaccine nationalism and that isn’t in anybody’s interest because, until we are all safe, no one is safe. We’ve got to understand this is a global problem that must be dealt with globally.”

The world is poised between two scenarios, says Farrar. “In the worst, vaccine nationalism spreads and we end up in a world of haves and have-nots. New variants emerge and develop immunity to treatments and vaccines, and we end up going back into the cycle of lockdowns of the first quarter of 2020.”

“The other scenario is that we commit to making vaccines, treatments and diagnostics available across the planet. We get virus transmission down everywhere, vaccines continue to work and we drive down the amount of virus circulating to such a degree that its evolution slows down dramatically. We can do that, but only by sharing.”