Coronavirus

David Nabarro of the WHO: lockdowns alone can’t end the Covid-19 pandemic

David Nabarro of the WHO analyses worldwide actions against the pandemic. Lockdowns alone aren’t a sustainable response to stopping Covid-19.

The Collins English Dictionary selected “lockdown” as the word of the year. “Our lexicographers chose it because it is a unifying experience for billions of people across the world, who have had, collectively, to play their part in combating the spread of Covid-19,” Harper Collins publishing house explained.

“Lockdown” is word of the year

In fact, lockdowns have generally been among the first measures put in place to halt the spread of the coronavirus pandemic. Stopping people from moving and coming into contacts with people outside their households was meant to flatten rapidly-growing infection curves, which pose a significant risk for health systems. However, after months of restrictions and their tentative easing, a growing number of nations worldwide are now facing a second – or even a third – surge of infections, which is filling hospitals once again. The US recorded seven consecutive days of more than 100,000 new cases and reported the biggest single-day increase in hospitalisations since the 10th of July. The UK is in lockdown, as well as France, Germany and Italy, which has just hit one million total cases.

milan, stazione centrale
Milan’s Central Station during the first national lockdown in Italy, 8 March 2020 © Emanuele Cremaschi/Getty Images

Economies are suffering due restrictions on movement and shop closures. In this context, leaders are facing a new challenge: finding a way to protect their citizens without jeopardising their economies. We spoke to David Nabarro, special Covid-19 envoy for the World Health Organization (WHO), during Youth4Climate Live, a series of virtual meetings between young environmental activists from around the world promoted by the Italian Ministry of Environment in collaboration with the Office of the UN Secretary-General’s Envoy on Youth and Connect4Climate, the World Bank’s environmental programme of which LifeGate is a media partner. Doctor Nabarro attended the fourth session, Driving nature-based solutions, discussing the examples provided by nature to develop efficient strategies for climate change mitigation and adaptation. The next session will be held on the 18th of November.

What is the right balance between protecting people against this virus and economic concerns?
Economies won’t be able to recover and thrive unless the virus is held back. If the virus is multiplying rapidly, this will undermine their potential to be strong. So, from my perspective, dealing with the public health challenge is needed for stronger economies. At the same time, I’m very keen that efforts to deal with the virus pay attention to the reality that it is a threat to poor communities. Deal with the virus, protect the wellbeing of poor people and then economies can be strong. Fail to deal with the virus and economies will suffer.

You’ve said multiple times that we need a new approach to fighting Covid-19. What should this be?
My understanding of the approach that is needed very much reflects what I’m seeing in East Asia and countries like New Zealand. They’ve put in place the necessary steps to defend themselves against the virus, to hold it back. They did that through three things: the first is making sure that people everywhere are fully engaged in and contributing to the defence against the virus. Secondly, they established a locally integrated public health response that is spread right across the nation, but at a community level. Thirdly, there aren’t constant political debates about what to do with the virus: they put the response to the virus above politics and everybody agreed to establishing a consistent narrative over which all political sides come together. Three things: people, local-level systems and totally united political actors in countries and between countries. That is the approach I and my colleagues at the WHO are pushing for very strongly. If you don’t do this fully, then you’re always at risk of a big surge of Covid-19 cases.

And if that surge gets stronger?
Then you may have no choice but to go into total restrictions on movement or a lockdown. However, the lockdown slows the virus but doesn’t get rid of it, while it badly affects the economic wellbeing of poor people. Lockdowns shouldn’t be the principal means through which countries try to control the virus. Instead, you can use a lockdown to buy time while you get organised but the main way of dealing with it is: one, people behaving in ways that avoid them catching the virus; two, community-level integrated public health responses; and three, a leadership approach where dealing with the virus is put above and away from politics.

Lockdowns shouldn’t be the principal means through which countries try to control the virus.

David Nabarro, WHO

two people hugging during lockdown
Lockdowns shouldn’t be the principal means through which countries try to control the virus © Al Bello/Getty Images

What should people do?
The five things everybody ought to do are:

  1. Always maintain physical distancing of at least two metres. And be really careful about that.
  2. Wear well-fitting face protections.
  3. Always practise good hygiene: hand washing, cough etiquette, surface cleaning.
  4. Isolate yourself as soon as you have any symptoms that you think might be Covid-19. Don’t wait for a test, isolate immediately and get yourself tested while you’re isolating. And make sure that all contacts isolate while they’re waiting for their tests.
  5. Protect people who are particularly vulnerable.

What should happen at the local level?
When we talk about integrated services at the community level, we mean getting information about where the virus is through very well organised testing. We need to get all the different people together to figure out where the risks are, and why they’re at risk. So you basically conduct epidemiological detective work. Then you need an integrated response coming from government, local authorities, civil society, religious institutions, schools and universities, as well as businesses of all shapes and sizes, and the media.

We need an integrated, collective, community-based local response that should be focused on quickly isolating people thought to have the disease, and quickly finding and isolating their contacts. It should be a collective effort because it is only by working together that we’ll get on top of the virus. And if an outbreak does build up suddenly, yes, you’ll need to restrict movement, but at the same time you’ll need to find people with the disease and restrict them. You don’t just restrict movement without dealing with the virus and trying to interrupt transmission.

It is only by working together that we’ll get on top of the virus.

David Nabarro, WHO

This is the way we should treat all diseases and Covid-19 is just an example. At the moment, I don’t believe that governments are following this approach, except for East Asian countries. They’re showing the rest of us what to do. In Europe, everybody is being invited to go into lockdown. And of course, we have to. But we should also be saying to governments: “What are you going to do during the lockdown that will make sure that when we come out of it we don’t have to go back into it after two months?”. If not, this isn’t the route to a sustainable future. Hold back the virus though well-organised defences involving people, local authorities and governments working together.

Lockdown in Milan
Lockdown in Milan, Italy © Vittorio Zunino Celotto/Getty Images

What about vaccines?
A vaccine is a substance that results in a person developing antibodies and cells that are capable of dealing with the virus and neutralising them. Coronaviruses are quite difficult candidates for vaccines. Over the decades, we’ve had very few examples of successful efforts to develop vaccines against them. At the same time, we also don’t fully understand whether or not people have long-duration immunity after they’ve been exposed to the virus. Therefore, we don’t want anybody to assume that safe and effective vaccines will be produced. We have about ten candidate vaccines at the third phase of clinical trials, which assess whether they work. We still don’t have an answer. We’ll probably have an answer on safety and efficacy sometime in the first six months of next year.

Once you have a vaccine that is found to be safe and effective, you have to manufacture it in large quantities, then offer it to everybody and hope you’ll get an uptake from all the seven billion people in the world. We’ve only managed to get everybody vaccinated against one disease and that is smallpox. We tried to vaccinate everybody against polio, and we’re still struggling. We’re trying to vaccinate everybody against measles, and it is actually going backwards. And one of the reasons for this is that a larger number of people in many countries refuse to get vaccinated. So, I’m hopeful that there will be a vaccine, but it will take some time to get it implemented. What I’m saying to people is: please don’t assume that suddenly a vaccine will come and then we can just go back to what we used to be. We have to bring the vaccine in alongside the other non-medical measures I described. It will be an extra intervention, but it won’t be an alternative.

The vaccine will be an extra intervention, but it won’t be an alternative.

David Nabarro, WHO

Can humanity change course after facing such a challenge? What should we expect from the future?
After having seen what is going on in many countries in Africa and in East Asia I’m convinced that humans will work out how to deal with this virus and will be able to get over it. I’m most impressed that in New Zealand a leader who has shown exemplary capacity for ensuring that people can get on top of the virus has been voted back into power with an increased majority.

My hope is that we’ll see more examples in the coming weeks of humans supporting leaders who get it right. If leaders who get it wrong end up being supported, then I should be quite depressed about the future of humanity. But at the moment, I’m optimistic and very pleased with the kind of community-level responses that I’m seeing in many countries. What is slightly concerning to me is that the responses, for example in my own country (the UK, ed.), aren’t as good as they should be. This is worrying because these are advanced countries with a lot of scientific expertise and experience. I’m hopeful that in the upcoming weeks and months we’ll see people and governments in Western Europe and North America developing quality of action, ensuring people and public healthcare know what to do, but most importantly putting public health above politics.

I’m optimistic. I believe humanity can change in facing this challenge. We have to, we have no choice.

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