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HEALTH

WHO interview: ‘If our behaviour returns to normal Europe risks new waves of Covid-19’

The Local sat down with the man at the forefront of the World Health Organisation's quest for a coronavirus treatment to ask whether reopening our societies will create a second wave and what happens when populism meets science.

WHO interview: 'If our behaviour returns to normal Europe risks new waves of Covid-19'
"Social distancing is not very social" . AFP

In the world of science, John-Arne Røttingen is somewhat of an international superstar. 

In 2015, the Norwegian epidemiologist led the steering group of the groundbreaking study that helped produce a vaccine for Ebola at record speed.

If the stakes were high back then, they are even higher now.

Røttingen, who heads the Norwegian Research Council, is directing the WHO's international study into Covid-19 treatments and an eventual vaccine.

The study, Solidarity, is a clinical trial in multiple countries to achieve a treatment for Covid-19 as rapidly as possible.

Four different drugs – hydroxychloroquine, remdesivir (previously used to treat Ebola), lopinavir/ritonavir (a licensed treatment for HIV) and and lopinavir/ritonavir + interferon – are being tested on 3,500 hospitalised patients in 17 countries simultaneously. 

It is a massive international effort to try and compress years of work into months, to find a solution to the highly contagious virus Covid-19 which has killed nearly 400,000 people worldwide, pushing countries into an economic turmoil that could have long-lasting and devastating impact.

The Local: European countries are easing restrictions on social distancing, reopening societies slowly. Are we risking new waves of infection?

Røttingen: We are very vulnerable to new rounds of infection. To achieve herd immunity, at least 50 percent of the population in a country needs to have had the virus. No European country has those levels yet.

The “R” (virus reproduction rate) is important. If we manage to keep it below 1, we will avoid a resurgence. 

The Local: We’ve seen European countries taking different measures to contain the virus. Sweden kept things largely as normal, while southern European countries like France, Italy and Spain imposed strict nationwide lockdowns. What’s the best option?

Røttingen: It's a misunderstanding that Sweden did nothing to limit the spread of the virus. The population followed a lot of health precautions even if they didn't go into lockdown.

But our societies need to be prepared to impose restrictive measures earlier than they did last time. 

It would be better to begin with the measures that are less harmful for the economy and the society at large. We know that closing schools is very expensive, but probably not very efficient in reducing the spread of the virus. 

The Local: It seems like we here in the south of Europe are struggling more than people further north to keep up with these social distancing rules. 

Røttingen: Yes, in Nordic countries we sometimes joke that, when they told us that we can stop having to keep two metres between each other, we said “phew, finally, we can go back to our usual five metres”.

In France, the doctor Didier Raoult (on the picture) has been distributing hydroxychloroquine as a coronavirus treatment to patients in his hospital in the French southern city Marseille. Photo: AFP

The Local: What are the most efficient steps countries can take to stem the spread of the virus?

Røttingen: Social distancing. Reducing use of public transport and avoiding large gatherings. 

If our behaviours return to normal I believe that we will see new waves and will need new rounds of restrictions. It's an important balance to strike between resuming social life and taking health precautions.

The Local: So basically we can keep working and going to school but we have to stop everything that’s fun?

Røttingen: Yes, social distancing is not very social is it.

This is why testing is so crucial. We need to continue our efforts to develop a vaccine, continue testing and contact tracing, and we need to keep up social distancing and general hygienic measures. 

The Local: Will we ever get a vaccine and, if so, when?

Røttingen: There is a big, global race to get a coronavirus vaccine going on with more than 100 drugs being tested right now.

In a best-case scenario, we get a vaccine approved early 2021. Then we need to produce the quantity to begin to vaccinate people, which means we are quickly moving into late 2021, early 2022. 

But all this depends on decisions that are being made right now.

The Local: What kind of decisions?

Røttingen: You might have seen the initiative by the WHO together with French President Emmanuel Macron, German Chancellor Angela Merkel and other state leaders, which works to set up a large-scale development, production and distribution of vaccines.

If we manage to set this up now, we will be able to begin to vaccinate earlier than we usually would.

The Local: What kind of vaccine are we talking about? Will it be a one-time vaccine that will make you immune against the coronavirus for years, or a short-term vaccine that we’ll need to take again and again?

Røttingen: That’s difficult to say because how long an immunity lasts depends depends partly on how quickly and how much the virus is changing and partly on the properties of the vaccine.

Chances are we will see new outbreaks, perhaps not every year, but every two-three years. But right now it's too early to say.

 

Head of Norwegian Research Council John-Arne Røttingen is directing the WHO's international study into Covid-19 treatments and an eventual vaccine.. Photo: WHO

 
The Local: Tell us about the WHO study into possible treatments. What kind of results are you seeing?

Røttingen: We ourselves are not allowed to check the results. There is an independent committee overseeing the process, and analysing the results in intervals as they come.

We will stop the study as soon as we know that a drug is efficient – or as soon as we see that it is either not having the wanted effect or that other, unwanted side effects emerge. 

The Local: Hydroxychloroquine, one of the drugs you are testing, has been hailed as a miracle cure by some, while others claim its proponents are charlatans.

Røttingen: We have seen that several leaders including US president Donald Trump and Brazil’s President Jair Bolsonaro, have spoken out in favour of hydroxychloroquine. 

One big question about hydroxychloroquine has been whether it has serious side effects or not.

A study in The Lancet, (which concluded that hydroxychloroquine had dangerous side effects, before doubt was cast on it) had some methodological weaknesses and potential failures in their dataset. 

We were very unsure whether we should stop the branch of hydroxychloroquine or not, but we decided to put the brakes on it until we had analysed our data. We have now made the decision to resume the hydroxychloroquine arm of the study after our independent data and safety committee advised continuing.

The Local: Is it dangerous that populism is interfering with science?

Røttingen: Yes. It’s a shame that these kind of scientific questions become political.

In South America patients are often being offered the drug as a treatment even though it isn’t approved as an efficient treatment for Covid-19 yet. This complicates things for us because we can’t include patients who have already been taking one of the treatments into our study. 

The Local: What role does WHO play in all this?

Røttingen: The WHO plays a crucial role as a neutral and normative actor, which always stands on the shoulders of science. All its guidance are based on neutrality and independent data. 

But we know that the WHO is suffering from political pressure, and member states use the institution to push their own agendas. I have argued for separating science from politics in the WHO, to protect its scientific role. 

The pandemic shows us how much we need this kind of scientific, global institution. 

 

Member comments

  1. Brought to you by the same guys who said on January 14th that there was no sign of human-to-human transmission, praised the Chinese for their transparency, and touted the Imperial College Model used to justify the lockdown. If there are no big spikes in America this week, then all bets are off as far as the experts are concerned.

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HEALTH

Who can get the monkeypox vaccine in Germany – and how?

The monkeypox virus continues to spread in Germany and the vaccines panel is recommending that three groups of people get a jab. Here's who can get one - and how.

Who can get the monkeypox vaccine in Germany - and how?

What’s the current monkeypox situation in Germany? 

The monkeypox virus is still spreading in Germany, with 2,982 confirmed cases of the disease recorded by the Robert Koch Institute (RKI) as of Tuesday.

The virus, which causes small lesions on the skin alongside flu-like symptoms, is primarily transmitted through close physical and sexual contact. The vast majority of cases have so far been found in gay men, though five women have also had the virus in Germany to date. 

On Tuesday, the RKI reported that a four-year old girl in Baden-Württemberg had contracted monkeypox from two adults in her household but was asymptomatic. Before that, two teenage boys aged 15 and 17 were also found to have picked up an infection. 

READ ALSO: Monkeypox in Germany: Two teens ‘among new infections’

With the number of cases rising globally, the World Health Organisation (WHO) has declared the situation an “emergency of international scope” – the highest alert level possible.

This is a sign for members of the WHO like Germany to implement containment and preparation measures, such as rolling out vaccination campaigns. For its part, the Robert Koch Institute (RKI) is tracking the cases and has put out an information sheet about the best practices for avoiding the measures and what to do in the case of an infection.

What should people do if they contract the virus?

If people think they have a monkeypox infection, the first thing they should do is seek the advice of a healthcare practitioner such as a GP or sexual health advice clinic. However, the RKI advises people to phone the clinic beforehand to let them know they believe they may have the virus.

In confirmed cases of monkeypox, people should self-isolate at home until the lesions on their skin scab over and peel over, but for a minimum of 21 days. They should avoid physical contact and sharing items like hand towels or bed sheets with others and should wear condoms during sex for at least eight weeks.

Healthy people with no pre-existing conditions are generally fine to remain at home with someone who has contracted monkeypox, but those with weakened immune systems, pregnant women, elderly people and children under the age of 12 should move out for the duration of the isolation. 

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

What monkeypox vaccines are available? 

The smallpox vaccine Imvanex, which has been available in the EU since 2013, was approved for use against the monkeypox virus on July 22nd, 2022. 

People are generally protected against monkeypox for at least two years after their first dose of Imvanex, but doctors recommend a second dose after a four-week interval in order to make this protection permanent. 

The vaccine is generally seen as a preventative measure but can also be used up as a so-called post-exposure measure to lower the risk of getting ill after contracting the virus. In this case, the vaccination is most effective up to four days after exposure. 

Who are monkeypox vaccinations recommended for? 

So far, the Standing Vaccines Commission (STIKO) has recommended that two primary groups of people get a monkeypox jab: men who have multiple male sexual partners and people who work in infectious disease laboratories. 

As mentioned, the vaccine can also be used to ward off illness or prevent a severe course shortly after someone has been exposed to the virus. 

READ ALSO: German vaccine panel recommends monkeypox jab for risk groups

Nurse laboratory monkeypox PCR

A nurse sorts monkeypox test samples in a lab. Photo: picture alliance/dpa/EUROPA PRESS | Carlos Luján

Is there enough vaccine to go around?

Not currently.

In May, the German Health Ministry preemptively ordered 240,000 doses of the vaccine – but so far just 40,000 of these have been delivered. 

This is far too little to cater for the estimated 130,000 people who fall into one of the target groups for a jab.

The remaining doses are due to be delivered in August and September, though some pressure groups are already calling for more to be ordered. 

On Friday, the German Aids Federation (DAH) called on the government to secure at least one million doses of the monkeypox vaccine in order to help stamp out the virus in Germany. 

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board.

This can only be done if as many people in risk groups as possible are vaccinated, he added. 

How can people book a jab?  

At the moment, this varies quite a bit from state to state, with some issuing the jabs via the local health authorities and others supplying the doses to specialist HIV clinics and hospitals.

In Saxony-Anhalt, Bremen and Hesse, vaccinations are primarily organised through the local health authorities, so this should be your first point of contact to enquire about a jab if you live in these states. In Frankfurt am Main, however, a handful of specialised HIV clinics are also carrying out vaccinations, according the FAZ newspaper. 

In Saarland, too, appointments should be booked through the health authorities, though they are carried out at Saarbrücken University Clinic. In Hamburg, jabs are being administered solely at infectious disease clinics.

UKE university clinic Hamburg

The main entrance to the University Clinic in Hamburg, where monkeypox patients have been treated for the disease. Photo: picture alliance/dpa | Axel Heimken

Berlin offers the most diverse range of vaccinations and, with 8,000, has the largest number of vaccine doses available. Vaccinations are given in HIV specialist practices, counselling centres for sexual health as well as in several hospitals. A list of vaccination centres has been compiled by the German Association of Outpatient Doctors for HIV Treatment. Neighbouring Brandenburg organises vaccinations through the local health authorities as well as through GP’s practices.

In three federal states, only hospitals are responsible for monkeypox vaccinations. In Saxony, hospitals in Chemnitz, Leipzig and Dresden have been vaccinating since the end of June. In northern Schleswig-Holstein, outpatient clinics in Kiel and Lübeck are responsible. Neighbouring Mecklenburg-Western Pomerania is administering its doses exclusively through the University Medical Centre Rostock.

Several federal states have opted to roll out monkeypox vaccinations through both HIV clinics and hospitals. These include Bavaria, which has more than 3,500 vaccination doses available, as well as Rhineland-Palatinate, Lower Saxony and North Rhine-Westphalia, for which a list of all vaccination centres was recently published.

What else should people know? 

The monkeypox vaccine is perfectly safe, but people can experience a few side effects for a day or two afterwards, including soreness on the vaccination arm, fever and headaches. 

People with HIV should talk to a specialist before getting the vaccine, because the effectiveness may vary depending on your Helper T cell count. 

For more information on the clinics offering jabs, the German Aids Federation has published a helpful Q&A along with a list of clinics in each of the federal states, which can be found here (in German).

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