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Public-health power couple takes on Brussels

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Brussels’ newest residents could just be its coronavirus cure.

The EU capital is still grappling with the fallout from delays to its vaccination program, while national capitals debate how to reopen and convince people to get the jab in the first place. Enter famed virus-hunter Peter Piot and wife Heidi Larson, an expert in vaccine hesitancy, who are moving to the city to tackle just these issues.

The pair have been bigwigs in public health for years, Larson as a leading expert on why people refuse to get jabbed after founding the Vaccine Confidence Project in 2010; and Piot as a world-famous microbiologist who co-discovered Ebola and has spent the past 11 years running the London School of Hygiene & Tropical Medicine.

The world’s new normal has prompted their relocation from London, with Larson moving the Confidence Project’s home to Brussels so it can still apply for EU grants and work on collaborative projects, and Piot working closely with Commission President Ursula von der Leyen as a special adviser on the COVID-19 pandemic response.

The two took an hour out of packing up their home in London to speak to POLITICO from different floors of their house about vaccines — why governments should rethink their ideas about achieving herd immunity; how countries’ shifting guidance on the Oxford/AstraZeneca vaccine caused confidence issues outside Europe; and why EU leaders got such a bad rap in the early months of the year. 

VDL would have been a ‘hero’

The backlash over the poor rollout across the EU was a “trauma,” Piot said. “It exposed the politicians in such a ferocious way.”

“In that position, you’re extremely vulnerable,” he explained. “I was often shocked how wrong the information was, and then particularly here in Britain, where the media are super anti-European.”

But Piot also gave credit to von der Leyen for keeping her cool amid the backlash to the EU’s vaccination campaign, while he was much more “stressed.” He explained: “She’s a politician, and I’m not.”

“She handled this quite well,” he said. “What we discussed is [that] you need a longer term view. If AstraZeneca would have delivered what they promised, she would have been a hero.”

That’s clearly not what happened — and now, the EU is awaiting a first decision from a Belgian court in its lawsuit against the drugmaker for a massive failure to deliver on time. 

For Piot, where the EU erred was in poor messaging about how many doses it was exporting.

“The truth is that [the EU is] the only region that is exporting half of [its] vaccines,” he said. By contrast, he noted, the U.S. blocked exports for most of the year, and India, “the pharmacy of the world … they’re not doing it.”

“What could be presented as quite a success story … turned out to be something that was not perceived as such,” Piot continued. But he now sees the EU turning a new page: “Vaccine coverage in most European countries [is] catching up very rapidly with the rest … [of] high income countries.” 

Signs of trouble

Despite the acceleration of vaccination campaigns since January, countries are seeing worrying signs. Both Bulgaria and Romania have fallen far behind their EU neighbors in part because their citizens are worried about the safety and efficacy of the vaccines. And other countries are facing the problem of dropping demand. Lithuania’s vaccination rate, for example, is falling because everyone who wants a vaccine has already gotten it. 

Vaccine hesitancy is coming from both the far right and the far left, and especially from people who identify with populist parties. Larson sees the biggest amplification of anti-vaccine sentiment online comes from people against the idea of the government having any control — whether it’s masks, social distancing, vaccine passports or vaccines themselves. 

That doesn’t mean governments’ encouragement to get vaccinated always backfires. For some people, if they’re faced with the prospect of getting cut off from activities they would otherwise enjoy, like concerts, they might change their mind and get vaccinated. 

But the problem is with the hard-core opponents. “The scale of the epidemic and its threat has not changed [their] minds,” she explained. “They see what’s going on, but they just are not with this vaccine issue.”

Is mandatory vaccination the solution? Larson noted that the first compulsory vaccination campaign was in the 1800s, when the U.K. required the entire population be immunized against smallpox — an effort that also inspired the first anti-vaccination league.

For her part, Larson doesn’t oppose making vaccines mandatory, especially for people who work with vulnerable populations and can infect others. But she suggests these rules should be generally “setting specific,” like requiring certain vaccines for kids to go to school. 

In the U.S., vaccine hesitancy has become so worrying that some experts warn the country will never achieve herd immunity. Exactly where that lies remains disputed, though: Scientists first said this is reached when between 60 percent and 70 percent of the population is vaccinated, but some now say it’s closer to 90 percent, reflecting the fact that some variants are especially contagious and that people have to maintain other mitigation efforts to decrease exposure.

Piot counsels against a one-size-fits-all approach and says, more broadly, he has always been “skeptical about this fascination with herd immunity.” More often than not, herd immunity varies from region to region, city to city, he explains — it’s not one estimate for an entire country.

The more important point, he added, is that densely populated areas “will always be a risk for resurgence of infections.”

Look on the bright side

That all said, the vaccines are working, said Piot. He applauds the EU’s deal for 1.8 billion BioNTech/Pfizer vaccine doses, to be delivered through 2023, because it’s likely people — especially vulnerable populations — will need booster shots. But Piot also emphasized the EU needs to have a broad portfolio of vaccines. 

“Don’t put all your eggs in one basket,” Piot said. “We don’t know. A year from now we may have a completely different conversation because of [a new] variant, or it may all be fine. Anything in between is possible.”

He declined to say whether the EU is walking away from AstraZeneca too soon by not signing another contract — the U.K., by contrast, is in talks to buy more — but he emphasized the bloc shouldn’t bet solely on mRNA vaccines. Protein-based vaccines like Novavax, which just boasted a 90 percent efficacy rate, along with a candidate in the works from Sanofi, could be promising.

There’s also the concern that the world is heading for a two-tiered vaccine hierarchy in which the wealthy countries get the more effective, easier-to-retool mRNA vaccines, while poorer nations get rejected doses like Oxford/AstraZeneca. Piot said “that’s unfortunately how it looks.”

But he also emphasized the Oxford/AstraZeneca vaccine — and especially the one-shot Johnson & Johnson jab — could prove especially useful in the global south because they are cheaper and easier to use. 

Still, wealthy countries, mostly in the EU, have seriously damaged the reputation of the Oxford/AstraZeneca vaccine elsewhere. Larson said countries’ back-and-forth safety guidance eroded vaccine confidence, specifically in Nigeria.

Some countries, including Sudan and the Democratic Republic of the Congo have even refused the Oxford/AstraZeneca vaccine and sent doses elsewhere, partially due to hesitancy and the fact that doses are set to expire.

She summarized the thinking as: “They’re going to have all these problems and then send their vaccines to us? No, thank you. It doesn’t even work against the South African variant.”

Instead, she noted, preference is rising for the J&J vaccine because it requires a single dose, “but more importantly, it didn’t have those problems that AstraZeneca did.” 

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial. 

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