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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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OPINION & ANALYSIS

Why Sweden’s Nobel prizewinner would be a great dinner guest

It is not only Svante Pääbo’s contribution to evolutionary biology that makes him so interesting, but his own personal story as well, says David Crouch.

Why Sweden’s Nobel prizewinner would be a great dinner guest

Elite scientists are maybe not so high on our list of fantasy dinner guests. Too much homework before the conversation. But the more I find out about Svante Pääbo, the Swedish winner of this year’s Nobel prize for medicine, the more I am convinced he would be great company. 

A modest man with a delightful smile, who likes beer and schnapps with lunch and listens to rock band Talking Heads, Pääbo comes across as warm and approachable. When he won the Nobel, his colleagues at the university threw him in a pond. His book Neanderthal Man is peppered with praise for students and colleagues who helped him along the way. 

He is also skilled at explaining in simple and engaging terms what his research means for all of us. At a time when immigration is such a hot potato, Pääbo reminds us that the history of our species is one of movement and mingling of populations. 

It is not only Pääbo’s contribution to evolutionary biology that makes this clear, but his own personal story as well.

Aged 19, his mother Karin fled her native Estonia in 1944, joining tens of thousands who escaped the Soviet occupation. She worked as a cleaner and a cook in Kalmar, then studied chemistry in Lund, where she met Svante’s father. 

But he was married. Karin brought up her son alone in Stockholm. The father visited on Saturdays when his family thought he was at work.

Svante followed in his father’s footsteps by becoming a researcher. A surreptitious experiment in the lab with a piece of liver from ICA set him on a path towards discovering how to extract and study DNA from long-dead animals. At Uppsala University he was also a gay rights activist, before he fell in love with the “boyish charms” of a female colleague at Berkeley, with whom he went on to share his life and have two children. 

Pääbo says it came as a surprise that his bisexuality was considered unusual, and the fact that it didn’t cause him any problems he contributes to the high self-esteem that his mother had given him. “The realisation that my feelings were not quite what the majority society expected forced me to change my rather complacent attitude and led over time to me becoming more open,” he said in a talk on Swedish radio. “Not only to myself, but also for the idiosyncrasies of others.”

Pääbo developed the ideas and techniques that enabled the DNA of our closest genetic relative, the Neanderthals, to be fully decoded and compared to human DNA. His work shows that, as early humans moved east and north from Africa some 70,000 years ago, they mingled and mated with Neanderthals, their mixed children living in human communities and passing on their genes. 

“From a genomic perspective, we are all Africans – either living in Africa or in quite recent exile,” Pääbo says. But many of us have Neanderthal DNA, around 2.5% of the total – we are more Neanderthal the further you get from Africa, in fact. “The lesson is that we have always mixed. We mixed with these earlier forms of humans, wherever we met them, and we mixed with each other ever since,” Pääbo says.

Swedish scientist Svante Paabo swims in a pool at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany. Photo: Matthias Schrader/AP/AFP

Pääbo’s research has relevance for modern medicine because he has enabled scientists to examine how viruses have changed with time. Last year, he and his team made headlines when they reported that people with a Neanderthal variant of their third chromosome were at a higher risk of suffering severe consequences from contracting Covid-19.

As a dinner guest, I think Pääbo would bring the outlook of a person who has experienced both east and west. The Stasi, the east German secret police, investigated after he was given tissue samples from Egyptian mummies at a museum in East Berlin. He moved from California to live and work in Munich, and then the former east-German city of Leipzig. Some of his seminal work is on samples found by Russian researchers in a cave in Denisova, a remote spot in Siberian mountains near the borders with Kazakhstan, China and Mongolia. 

It is wise to avoid politics at dinner parties, but Pääbo might also have something interesting to say about Sweden today. 

Julia Kronlid, newly-elected to the post of vice speaker of parliament, is a senior member of the Sweden Democrats and someone who does not accept the theory of evolution. In 2014, she said in a widely cited interview: “I do not accept the theory of evolution’s claim that humans are descended from apes. One can question the scientific nature of it because it is so far back in time.”

By all accounts, Kronlid appears to be a nice person, whatever you think of her politics or beliefs. Hopefully, she celebrates the Nobel prize for medicine as a great Swedish achievement. And wouldn’t it be nice if she and Pääbo could sit down to dinner together sometime soon?

David Crouch is the author of Almost Perfekt: How Sweden Works and What Can We Learn From It. He is a freelance journalist and a lecturer in journalism at Gothenburg University.

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