Written by Philip Boucher, Mihalis Kritikos, Silvia Polidori and Gianluca Quaglio,
Striking the right balance between managing the health-related risks of the Covid‑19 pandemic and mitigating the possible socio-economic impacts of the containment measures is a delicate political exercise, being performed on the basis of imperfect data. This was one of the main conclusions reached at the first-ever online event in the history of Parliament’s Science and Technology Options Assessment (STOA) Panel, which took place on 23 April 2020. The meeting, moderated by Chair of the Panel Eva Kaili (S&D, Greece), was focused on the current pandemic crisis and the main scientific pathways that have been developed to manage its effects. Joining the discussion were: Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control (ECDC); Professor John Ioannidis, C.F. Rehnborg Chair in Disease Prevention at Stanford University; Professor Paolo Vineis, Chair of Environmental Epidemiology at Imperial College; Jean Stéphenne, Chairman of the Supervisory Board of CureVac – a pioneering clinical stage biopharmaceutical company in the mRNA-based drugs field (including a potential vaccine for Covid‑19; and Marko Russiver, co-founder of Guaana, a hackathon and ideation platform. Participants discussed the effectiveness of the measures to combat the health crisis, the reliability and comparability of the data grounding the various national strategies and the timeline for the development of an effective treatment and/or vaccine.
Most of the speakers argued for the need to take extreme care in removing lockdown measures (or ‘Phase 2′), and when discussing the timing for the development of an effective treatment and/or vaccine. One of the main findings of this online experts’ meeting was that data upon which national strategies are grounded remain imperfect and do not allow experts to reach solid conclusions about the behaviour of the virus, or develop long-term strategies. All the speakers recommended caution when implementing Phase 2 and suggested that the latter would be better limited, initially, to certain geographical areas. Each country should have implemented adequate testing and solid contact tracing and should further develop credible epidemiological indicators and offer the highest level of protection to those people most at risk – health personnel and people living in nursing homes – until such time as an effective vaccine is discovered.
More specifically, Professor Ioannidis presented data on the relative risks of Covid‑19 infection among people less than 65 years old in Europe which show that those under 65 years of age had a 34- to 73-fold lower risk of dying of Covid‑19 infection than those 65 years and older. He argued that a vast proportion of infections are asymptomatic or mildly symptomatic (they remain unnoticed and untested), and that the risk to death from Covid‑19 is very low, and largely confined to subjects with pre‑existing diseases. His main suggestions centred on the need to implement draconian infection-control and hygienic measures in hospitals and nursing homes, and associate the gradual removal of lockdown measures with continuous epidemiologic surveillance, as well as paying closer attention to studies on Covid‑19 treatments that are performed without a control group or without randomised trials.
Professor Vineis highlighted the need to move to Phase 2 in a step-wise fashion. Transition policies need to take account of the recent analysis by Imperial College London researchers of the likely impact of multiple public health measures on slowing and suppressing the spread of coronavirus. He proposed a strategy based on ‘test-trace-isolate’ measures, with particular emphasis on high-risk and fragile subjects and on the measurement of a series of indicators that could define when a country is ready for a gradual re-opening. He argued in favour of interaction between integrated informational systems, mathematical modelling and a sound network of public health professionals, as the tools required for a safe transition to Phase 2. He also questioned the accuracy of immunological (serological) tests as a credible means of estimating the prevalence of infection and the development of herd immunity.
Dr Ammon explained the data collection strategy at ECDC, which relies on event-based surveillance, data reported by EU Member States and population-based surveillance to address the massive information requirements of Member States and the EU institutions. The ECDC is also encouraging countries to implement participative surveillance systems, engaging citizens through mobile apps, online questionnaires, hotlines, and in other ways. She presented evidence indicating that, in 20 EU/European Economic Area (EEA) countries, the initial wave of transmission appears to have passed its peak. Dr Ammon, nevertheless, stressed that caution should be exercised when starting to lift some of the measures that have been implemented in the Member States and that ECDC has provided guidance to the European Commission on the recently published joint European roadmap towards lifting Covid‑19 containment measures.
Jean Stéphenne highlighted the range of relevant measures, including lockdown, masks, diagnostics and treatments, but pointed to the importance of developing a vaccine as the ultimate solution to the crisis. He set out the key elements in an ambitious vision towards the development and production of an mRNA vaccine (mRNA vaccines represent a promising alternative to conventional vaccine approaches because of their high potency, capacity for rapid development and low-cost manufacture.) During the first development phase, there is a need for sufficient investment capital (~€1 billion) and research subjects (~500 for first-stage testing, then ~17 000 for second-stage testing). He anticipated that CureVac could begin production of the vaccine in the first quarter of 2021, based on conditional approval, itself based on a benefit/risk assessment.
Marko Russiver reported that hackathons organised on their platform have generated 30 solutions to problems associated with the coronavirus crisis within a rapid timeframe, with eight of the solutions already in use. The hackathon approach has spread quickly, and is being scaled-up to a global platform that has already helped over 200 000 people worldwide. They have run over 50 hackathons in the last month, escalating into a ‘global hack’ with ideas coming from 98 different countries. He described teams comprising individuals of eight different nationalities, whom have never physically met, collaborating and building tools to respond to the crisis in an innovative way.
In the discussion that followed, the participants highlighted the need for continuous assessment of the entire range of prevention and containment measures before entering Phase 2. In his concluding remarks, STOA second Vice-Chair Ivars Ijabs (Renew Europe, Latvia), highlighted the need to pay particular attention to the quality and comparability of the data submitted by the Member States. The current pandemic crisis should be seen as an opportunity to strengthen the capacity of the current risk management structures to respond to public health emergencies in a coordinated manner.