Global Eradication of COVID-19 Is Probably Feasible

Global eradication of COVID-19 is likely achievable, and even more so than for polio, public health experts say.

The main challenges lie in securing high vaccination coverage and the response to the emergence of variants.

Global eradication of COVID-19 is likely achievable, and more than for polio, although significantly less than for smallpox, suggests a comparative score of technical, socio-political and economic factors for all three infections, published in the online journal BMJ Global health.

Vaccination, public health measures and global interest in achieving this goal due to the massive financial and social havoc wrought by the coronavirus pandemic are all making eradication possible.

But the biggest challenges lie in securing high enough vaccine coverage and responding quickly enough to variants that can evade immunity, the authors say.

To estimate the feasibility of eradication of COVID-19, defined as “the permanent reduction to zero of the global incidence of infection caused by a specific agent as a result of deliberate efforts,” the authors compared it to two other viral plagues for which vaccines became/are available – smallpox and polio – using a range of technical, socio-political and economic factors that are likely to help achieve this goal.

They used a three-point scoring system for each of 17 variables. These include: factors such as the availability of a safe and effective vaccine; lifelong immunity; impact of public health measures; effective government management of infection control messages; political and public concern about the economic and social impact of the infection; and public acceptance of infection control measures.

Smallpox was declared eradicated in 1980 and two of the three serotypes of poliovirus have also been eradicated worldwide.

The mean (total) scores in the analysis were 2.7 (43/48) for smallpox, 1.6 (28/51) for COVID-19 and 1.5 (26/51) for polio.

“While our analysis is a preliminary effort, with several subjective components, it appears that COVID-19 eradication is becoming possible, especially in terms of technical feasibility,” they write.

They recognize that the technical challenges of COVID-19 eradication, compared to smallpox and polio, include poor vaccine acceptance and the emergence of more transmissible variants that can evade immunity and potentially outperform global vaccination programs.

“Nevertheless, there are, of course, limits to viral evolution, so we can expect the virus to eventually reach its maximum fitness and new vaccines to be formulated,” they explain.

“Other challenges are the high upfront costs (for vaccination and improving health systems) and achieving the necessary international cooperation in the face of ‘vaccine nationalism’ and government-mediated ‘anti-scientific aggression’,” they admit.

The persistence of the virus in animal reservoirs may also thwart eradication efforts, but this does not appear to be a serious problem, they suggest.

On the other hand, there is a global will to tackle the infection. The sheer magnitude of the health, social and economic impacts of COVID-19 across most of the world has sparked “unprecedented global interest in disease control and massive investment in pandemic vaccination,” they point out.

And unlike smallpox and polio, COVID-19 also benefits from the additional impact of public health measures, such as border controls, social distancing, contact tracing and wearing masks, which can be very effective if used properly.

Upgrading health systems to get rid of the virus could also help control other infections and even help eradicate measles, they suggest.

“All these factors together could mean that an analysis of ‘expected value’ could ultimately estimate that the benefits outweigh the costs, even if the eradication takes many years and carries a significant risk of failure,” they write.

Elimination of COVID-19, defined as “reduction to zero in the incidence of infection caused by a specific agent in a particular geographic area as a result of deliberate efforts,” has been achieved and continues for long periods in several jurisdictions in the Asia-Pacific region, which provides proof-of-concept that global eradication is technically possible, they note.

They acknowledge that their study is preliminary and that more in-depth research is needed. The World Health Organization, or a coalition of national-level agencies working together, should formally assess the feasibility and desirability of attempting to eradicate COVID-19, they conclude.

Reference: “We must not ignore the possibility of eradicating COVID-19: Comparisons with smallpox and polio” Aug 8, 2021, BMJ Global Health.
DOI: 10.1136/bmjgh-2021-006810