The Experts Speak Again!

One of my colleagues shared a recent publication from 386 academic, health, non-governmental organization (NGO), government and other experts in COVID-19 response from 112 countries and territories from the esteemed journal Nature (https://doi.org/10.1038/s41586-022-05398-2). The article is entitled “A multinational Delphi consensus to end the COVID-19 public health threat”. Actually, only a minority of the authors were from North America. I am going to look at the six cross-cutting themes on which the authors mostly agreed. They are as follows:1) SARS-CoV-2 is still present among us—despite some governments moving on—requiring continued efforts and resources to save lives; (2) vaccines are an effective tool against COVID-19 but will not alone end COVID-19 as a public health threat; (3) multisectoral collaboration that centres on communities and fosters trust is needed; (4) responsive health systems are crucial for responding to the COVID-19 pandemic and require coordinated government support; (5) adverse forces challenge efforts to end the COVID-19 public health threat; and (6) none of us is safe until everyone is safe.

Let us look at each theme in turn to see how the international experts are doing. Please note that one of my first postings focused on the limitations and malfeasances of the establishment experts in the USA referential to the pandemic. I bring the same skepticism to this document.

First is: SARS-CoV-2 is still present among us—despite some governments moving on—requiring continued efforts and resources to save lives. I agree with this theme. The virus is still with us and it remains a health threat to certain individuals in our society. The risk factors for severe disease are now fairly clear. There is no way that we can expect that the SARS-CoV-2 virus can be conquered or eliminated. Physicians and citizens with interest should continue to learn as much about this virus as possible. It is important worldwide.

Second is: Vaccines are an effective tool against COVID-19 but will not alone end COVID-19 as a public health threat. “Vaccines” is an inclusive term and likely covers more than 10 different vaccines. I would have preferred a statement that vaccines CAN BE an effective tool against … There is a great need for scientific study of each vaccine in terms of safety, efficacy and durability. There are more questions than answers in November 2022 on the vaccine subject. I am a believer in the concept of vaccines. Clearly, smallpox vaccine eliminated a highly lethal viral infection. Polio and measles can have devastating consequences and have largely been suppressed in parts of the world with high vaccination rates. The introduction of a new technology - mRNA vaccines - requires particularly careful study and consideration of all reasonable questions. There is much work to be done.

Third is: Multisectoral collaboration that centres on communities and fosters trust is needed. I think that this statement is a reflection that too much faith and power were invested in a few experts, like Tony Fauci, and it backfired because of the clear lack of collaboration of Fauci and his team with critics and experts with different skill sets. There is an implicit acceptance that our establishment experts have lost the trust of the public and I suspect that this has occurred elsewhere. This is important. However, this group of 386 individuals are all identified as experts. I believe that self-described experts tend to wear blinders and easily drift into elitism. I am a self-confessed non-expert with lots of clinical experience and common sense.

Fourth is: Responsive health systems are crucial for responding to the COVID-19 pandemic and require coordinated government support. Most of the world has government-run health systems, many of which are sub optimally responsive due to bureaucracy. A great example was the CDC’s insistence that only its personnel could develop a fast responsive test for SARS-CoV2 in February 2022. When its efforts failed, the CDC finally accepted the reality and allowed the free market players do what they do best - a highly safe and effective test was developed in short order. Is government support (meaning money) essential? In many countries but this is an example of a difficult generalization across the globe.

Fifth is: Adverse forces challenge efforts to end the COVID-19 public health threat. This theme is probably the most controversial. “Adverse forces” sounds conspiratorial. I would have started by endorsing the concept of serving an informed public, most of whom have limited access to background science and advances. Nonetheless, the experts MUST respect the clients/patients/public and invite questions. Clearly, a line must be drawn on certain questions and ideas. I will stick my neck out on this one and say that some of the conspiratorial thinking that alleges that physicians as a whole have benefited and conspired with “Big Pharma” to bilk the public while pedaling dangerous vaccines. Many publish the total revenue of Pfizer and Moderna implying that revenue is the same as profits. Profit is actually the revenue minus the costs of drug production and drug delivery as well as research and overhead. There is no doubt that these two companies have done well but when one investigates the stock price of Pfizer, it has done well but not so much as to be a leading stock target for investors. Today the stock price is $47 which is 30% below its highest value in the last two years. I am no economist but I am a realist and a skeptic of conspiracies. I see no organized “adverse force” dedicated to and profiting from COVID challenges. Tell me and your fellow readers if I am wrong.

Sixth is: None of us is safe until everyone is safe. I find this to be the silliest and least serious of the six themes. Reading the article, there was a lot of discussion of equity, local and worldwide. There is no doubt that COVID has shown how connected the international community is in an era of global travel. However, in November 2022, with a couple of omicron variants dominating the testing results across the world, the vast majority of the citizens of each country ARE SAFE. For the immunocompromised, there will always be some danger from the mildest of viral infections, SARS or rhinovirus or influenza. Our targets should be realistic and reasonable. Safety is always relative and there should be ongoing surveillance and sharing of epidemiologic and clinical data across countries.

What is my bottom line: I love the idea of a truly broad base of individuals from many countries coming together to communicate to the world the current state of the art. However, experts will always have limits. In this document, there is too much concern over equity and too much opposition to dissenting voices. Because of its venue (the science magazine Nature) and its authorship, its messages will likely not be transmitted widely. There is no emphasis on COVID treatments, which I feel remains an under-emphasized topic for physicians and their patients.

Let fellow readers and me know what you think. Commenting is now available as I just added to the site in the past few days.