What Will Happen if the Coronavirus Vaccine Fails? A vaccine could provide a way to end the pandemic, but with no prospect of natural herd immunity we could well be facing the threat of COVID-19 for a long time to come. by Sarah Pitt

 

There are over 175 COVID-19 vaccines in development. Almost all government strategies for dealing with the coronavirus pandemic are based on the idea that one of these vaccine candidates will eventually provide widespread protection against the virus and enable us all to return to our normal lives.

But there’s no guarantee that this will happen. Even in the most promising cases, we can’t yet be sure that any vaccine will permanently prevent people from catching COVID-19 and enable the disease to be gradually eradicated or at least contained to limited outbreaks. Vaccines may just reduce the severity of symptoms or provide temporary protection. So what will happen if this is the case?

Some people have argued that when enough of the population have caught COVID-19, and produced an immune response to it, we will have reached “herd immunity” and the virus will no longer be able to spread. But this is a misunderstanding of what herd immunity means and how viruses spread and so is not a realistic aim for COVID-19 control.

Herd immunity is what enables us to eliminate diseases using vaccines. The percentage of a population who need be to be vaccinated to reach herd immunity is calculated using the basic reproductive rate (R0).

This is the average number of people that each person who catches the disease would naturally pass it on to without any medical or public health interventions, taking into account how infectious the disease is and how it is spread.

The higher the R0 number, the more people need to become immune through vaccination to halt the spread. You also need to allow for the fact that some people cannot have the vaccine for medical reasons and some will refuse it.

Numerous diseases have been eliminated in many countries thanks to herd immunity produced by vaccination programmes. But herd immunity is not something that can be achieved by natural infection.

Take the example of measles, which is caused by a virus that has been around in humans for centuries. It is highly infectious – the R0 value is 15. This means that on average one child with measles can infect 15 others. As a result, around 95% of people need to be resistant to the disease for a population to achieve herd immunity.

Most people who recover from a measles infection produce a good immune response that protects them for the rest of their life. And yet, before vaccination, measles was a very common childhood disease. Each new generation of children were susceptible and not enough people naturally became resistant to produce herd immunity.

In the 1930s, there was a temporary herd immunity effect recorded in one location in the US. But this was an exception, and so most countries rolled out universal measles vaccination programmes that have enabled them to come close to eliminating the disease.

Scientists think that the R0 value for SARS-CoV-2 is between 4 and 6, which is similar to that of the rubella virus. The level of vaccination needed to produce herd immunity to and eliminate rubella is 85%.

Coronavirus Natural Immunity

We know that other coronaviruses (including Sars, Mers and some cold viruses), don’t produce a lasting immune response like measles does. And studies of COVID-19 show that, even in hot spots where there have been large numbers of cases and deaths in the last few months, less than 10% of the population show evidence of an immune response from the infection.

This suggests that the natural rates of resistance are a long way from the 85% that could be needed for herd immunity. And that means that, without a vaccine, the virus could become endemic, permanently present in the population like the coronaviruses that cause colds.

Research shows some people can get the same strain of a common cold coronavirus more than once in a single year. And most countries have seen outbreaks of COVID-19 even when they thought they had the infection more or less under control.

So it is possible that the ongoing pattern for COVID-19 will be more local pockets of infection, with even more cases likely during the winter months. Unless the first cases are found and isolated quickly though, these pockets will probably spread over quite wide geographical areas.

This is why it is vital to continue to use public health measures such as social distancing, wearing masks and washing hands to reduce the virus to such low levels that any new outbreaks can be easily contained.

Ideally, if this were successful, the virus might eventually die out because it could no longer spread, as happened with the SARS-CoV virus behind the 2002-2004 outbreak of Sars. But COVID-19 is more contagious and less deadly and so is much harder to control than Sars, so eliminating it this way may not be possible either.

Given that at least 700,000 people have died from COVID-19 worldwide so far and many people are reporting long-term illness as a result of the disease, if the virus does become endemic we should still try to prevent as much infection as possible. A vaccine could provide a way to end the pandemic, but with no prospect of natural herd immunity we could well be facing the threat of COVID-19 for a long time to come.

Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, Fellow of the Institute of Biomedical Science, University of Brighton

Coronavirus: Why Health Care Should Shift Focus From Treatment to Prevention Instead of returning to “normal” after the COVID-19 pandemic, Canada should adopt a health-care system that focuses on prevention and the social determinants of health. by Kaitlyn Kuryk

 

COVID-19 has placed a spotlight on the inequities of Canada’s current “curative” health-care system and the problems associated with viewing health policy in isolation from social factors.

Post-COVID, we should not “go back to normal.” Instead, we should push for a health-care system that values prevention and acknowledges that all policy is health policy.

We need to ensure that we address all factors that can produce and maintain health, not just help people once they’re sick. To best address population health, there needs to be a balance between preventive and curative measures, equitable access to social services, policies that emphasize the social determinants of health and a move away from the “sickness care system.”

What was normal? Curative health care

The curative approach to health care focuses on curing and treating the individual once they have been diagnosed with an ailment. The Canada Health Act defines “health” narrowly, and only ensures that “medically necessary” services are provided.

Aside from being reactive, there is no firm definition of what constitutes a medically necessary service, and what is deemed medically necessary can change depending on the context in which it is provided. Services deemed not medically necessary include prescription medications, optometry, dental care and physiotherapy, among others. Even further removed from the medically necessary definition are social determinants of health, including safe housing, income security and an adequate social safety net.

With the curative approach it’s impossible to have a population that is well, since that was never the goal of the system. There is also an argument that the curative approach to health care does more harm than good, as evidenced by medical errors, negative pharmaceutical interactions and the medicalization of everyday life experiences.

The curative approach focuses on disease in the individual, rather than looking at social aspects and proximate factors that may impact the disease. Now, with COVID-19, there is no cure for the disease and so the curative approach already falls short.

Where normal failed

The advice given to the Canadian public as the best way to stop the spread of COVID-19 is to stay home whenever possible, and wash their hands frequently. Although this may sound like good advice, it cannot be practised by all Canadians equally.

Canadians are told to stay home as much as possible. But what if they don’t have a home? Do they take a chance on a homeless shelter, where overcrowding is inevitable? Although on the surface, this may seem like a housing policy issue, a labour policy issue or an economic policy issue, it is truly a public health policy issue.

The privilege of owning a home is highlighted by the federal government, which allowed for mortgage payments to be deferred for eligible homeowners while no similar policy was put in place to defer rent payments. Instead, that decision is left to the individual landlords, and negatively impacts those with a lower socioeconomic status.

Further, access to clean water is not available to all Canadians, as 61 Indigenous communities across the country are under boil-water advisories. Evidently, access to social determinants of health are not equally distributed.

At the federal level, short-term financial measures have been put in place to help Canadians stay afloat, such as the Canada Emergency Response Benefit (CERB). With more than three million Canadians out of work, COVID-19 has highlighted how precariously many Canadians were living.

While these economic efforts may be useful right now, they’re merely Band-Aid solutions that are unlikely to have any lasting impact on the social determinants of health. Like the curative health system, they are reactive, not proactive; curative, not preventive. That means many of the factors that contribute to the spread of COVID-19 cannot be effectively managed because there’s no adequate social safety net in place.

Creating a ‘new normal’

When health and economic systems are in disarray, there’s no better time to reconstruct from the bottom up. There is no doubt that a preventive approach to health care would not only lead to a healthier population and more equitable access to social services, it would also be less expensive than our current system in the long term.

As the largest chunk of GDP is spent on health care, shifting money to other policy areas that influence the social determinants of health will require major restructuring. Because we have a federal health system, change often occurs slowly and large-scale reform rarely occurs at all. This is demonstrated by Canada’s lack of a national pharmacare program, mental health strategy and national home-care program, despite them all having been discussed for the last several decades.

In response to COVID-19, every Canadian province declared a state of emergency, and so it wasn’t deemed necessary by the federal government to invoke the Emergencies Act. However, invoking the act may have been an opportune time to expand the definition of medically necessary services and pass sweeping health reform measures, such as national health programs, without pushback from the provinces.

Health policy should be all-encompassing and consider the bidirectional relationship between upstream (preventive) and downstream (curative) measures, and it should be analyzed in the context of social determinants of health, including gender, race, education and socioeconomic factors.

Canada should seize the opportunity for collaboration between the provinces and among government, private sector and community groups. Now is the time for integrative policies over reactive measures; public programs over privatization; and embracing preventive measures to avert illness. Now is the time for change. We should never go back to “normal.”

Coronavirus Has Exposed the Limits of Philanthropy Charitable tax incentives enable the super-wealthy to redirect billions in tax dollars away from government programs toward their private philanthropic foundations and the causes they choose to support. by Adam Saifer

 

Against the backdrop of the WE Charity scandal — and revelations of political nepotism and charitable shell corporations — Canadian philanthropic foundations have quietly distributed more than $100 million in emergency funds to support communities most impacted by COVID-19.

In the process, however, philanthropy has revealed its limits as a mechanism for addressing the societal inequalities magnified by the pandemic.

The health and economic impacts of COVID-19 have been disproportionately felt by racialized, Indigenous and working-class communities. This reality reflects pronounced inequalities in Canadian society that have been exacerbated by decades of tax cuts for corporations and the wealthy, alongside austerity policies and the hollowing-out of the welfare state.

Less attention, however, has been paid to the concurrent history of charitable tax incentives that enable the super-wealthy to redirect billions in tax dollars away from government programs toward their private philanthropic foundations and the causes they choose to support.

These policies represent a far greater threat to ordinary Canadians and the legitimacy of the charitable sector than the drama of the WE Charity scandal.

What are private foundations?

Private foundations are privately run, privately funded and tax-exempt organizations that facilitate the charitable donations of the wealthy. When individuals give to their private foundations, they receive a charitable receipt they can use as a credit against the income taxes they owe the government.

Since 1995, the federal government has further incentivized this process by raising the maximum charitable tax credit someone can claim from 20 per cent to 75 per cent of their annual income, and by extending the charitable credit to apply to donations of stocks, bonds and mutual funds.

These policies have led to massive growth in the sector. Between 1995 and 2019, for example, the number of Canadian private foundations increased to approximately 5,915 from 3,000. And from 2008 to 2017, the total assets of private foundations grew to $49.6 billion from $16.82 billion.

A considerable amount of these assets is concentrated in some of Canada’s most celebrated foundations, including the Lucie and André Chagnon Foundation ($1.96 billion in assets), the McConnell Foundation ($629 million in assets) and the Rossy Family Foundation ($538 million in assets).

This expansion, however, occurs at the expense of government tax revenue. Philanthropic donations are dollars that have been redirected away from universal social services toward the causes of a philanthropist’s choosing.

Foundations are also only required to distribute 3.5 per cent of their total assets to registered charities in a given year, despite the fact that the financial assets of private foundations currently grow at approximately 10 per cent annually.

These policies have contributed to an underfunded social safety net, and a philanthropic sector scrambling to fill in gaps that they are not well-equipped to handle. Philanthropy cannot operate anywhere near the scale that the public sector does. It cannot, for example, fund universal pharmacare or implement a nationwide affordable housing program.

And the vast majority of private foundation dollars find themselves in the pockets of universities, research centres and large cultural institutions.

Wealth taxes and private foundations

Philanthropists who want to aid in the recovery process and make sure the most disadvantaged in society are not disproportionately affected by future crises need to think about philanthropy — the allocation of private resources toward a public good — differently.

One way is to follow the lead of groups like Resource Movement that are using their wealth, power and influence to support a growing list of voices across Canada advocating for a tax on extreme levels of wealth.

The super-wealth tax proposed by the federal NDP would tax net wealth above $20 million at a rate of one per cent. Based on numbers from a recent report by the Office of the Parliamentary Budget Officer, this would apply to roughly 0.2 per cent of Canadian families who own approximately 15 per cent of all wealth in Canada.

Most Canadians are in favour of such a tax. A 2019 Ekos poll found majority support for a wealth tax across party lines and age groups, while a May 2020 Abacus poll found three in four Canadians endorse a wealth tax.

For a wealth tax to work, however, it must apply to the billions of dollars sitting in privately controlled foundations as well. This would signal an important step toward a fairer and more equitable society.

While philanthropists would still receive tax receipts for donations to their foundations, they would be incentivized to either distribute these funds quickly to charitable organizations, or pay a small tax on their wealth each year to contribute to a more robust social safety net.

In either case, a wealth tax would ensure that private foundations are working for the taxpayers who subsidize their charitable giving.

Philanthropy is best suited to act fast in times of crisis. But what COVID-19 has made clear is that the challenges we currently face — the gaps in income support, health and education, long-term care programs and housing — are not novel crises.

They are the product of decades of growing inequalities and a shrinking social safety net, in part hastened by a focus on private over public welfare funding.

Why One Retired General Says Embrace the F-35 (And Forget the F-15X) The U.S. Air Force must prioritize the acquisition and modernization of the 5th generation F-35 fleet -- and leave behind Cold War era platforms. by William R. Looney

 

Tactical air power investments must be prioritized to the programs that will survive and deliver lethality in any future conflict.

The United States Air Force maintains the largest and most technologically advanced air force in the world. Attaining and maintaining air superiority has been a top priority of U.S. military leadership since World War II. This has resulted in a never-ending pursuit of advanced technology to deal with the current and projected enemy threat.

Recently, a proposal has been put forth to produce a variant of the F-15 to add to the United States Air Force’s current fighter inventory. To some, this has resonated positively. However, upon further investigation, the rationale and validity of this proposal fall apart.

As a former F-15 pilot, I love the aircraft. It was my first and the only front-line fighter I flew throughout my 40-year career and 2500 plus F-15 flying hours. It pains me greatly to write this article, but decision makers must accept what I have – the F-15’s air superiority days have come and gone! The 5th generation era has arrived, and the global near-peer threat is evolving to meet that capability.

The F-15 Eagle, designed in response to the Air Force’s requirement for an aircraft dedicated solely to the air superiority mission, was first flown in the early 70s. Like the P-51 and the F-86, that were the greatest air superiority fighters of their generation, the F-15 was the greatest air to air fighter of its generation – the 80s and 90s. However, like the P-51 and the F-86, the F-15 has been surpassed by a more capable fighter. Like it’s legacy aircraft counterparts, the F-15 is a fighter built for the threats of its timeframe – the 20^th century. Not a fighter built in anticipation of what capability and survivability would be needed in the 21^st century.

The average age of U.S. Air Force aircraft, including fighter jets, is currently at a record-setting rate due to restrictive defense budgets of past administrations. Therefore, it is more imperative than ever for the USAF to replace the aging fleet with the most technologically advanced, survivable fighter that delivers the maximum performance within budget allocations, and more importantly, that can continue to be modernized with leading-edge technology.

Wisely, the U.S. Air Force has invested in the F-35 Lightning II, the most advanced stealth multi-role operational fighter aircraft in the world. This 5^th generation aircraft is transforming air combat with distinctive speed, range and weapons capacity coupled with stealth, sensor capability, information fusion and network connectivity that brings unprecedented capability to warfighters. 

Chinese and Russian Surface-to-Air and Air-to-Air threats are proliferating in quantity, advancing in capability and being deployed to critical areas of U.S. interests. To survive in the modern battlespace, a fighter must have stealth, advanced 360-degree sensor capability, advanced electronic warfare, and the ability to connect to sea, air, and space assets. The F-35 does all of these things – the F-15x can do none of them.

Some say 5^th Generation fighters make 4^th Generation fighters better; this is true, but the corollary is true that while protecting 4^th Generation fighters, 5^th Generation fighters are sub-optimized. Where 4th generation fighters are forced to adapt to an advancing battlespace, the F-35 was specifically designed to operate in it. With stealth, electronic avionics systems and infrared sensors – capabilities the F-15 does not have – the F-35 defines the battlespace that adversaries are striving unsuccessfully to adapt to.

For those in favor of bolstering 4^th generation aircraft for Homeland Defense, they need to keep in mind that in the worst case scenario of an attack on our homeland, we will see highly advanced enemy 4th generation aircraft and even 5th generation aircraft.

The 5^th generation fleet is growing as the F-35’s capabilities are proving reliable where it matters most for the U.S. Air Force:

• The F-35 fleet is growing at a pace unmatched by any fighter in the world. By 2023, about 1,000 aircraft will be operating from over 40 bases and ships. In less than six years, more than 600 aircraft will be integrated into global operations, while supporting the stand up of about 25 additional bases and ships.

• The F-35 weapons system reliability continues to improve, and newer jets are now averaging greater than 60% mission capable rates. A number of operational F-35A squadrons have nearly 70% mission capable rates, which are among the highest in the USAF fleet.

• By 2023, the F-35’s will have Technology Refresh 3 capability, which will further widen the capability gap between F-35s and 4th generation aircraft.

Today’s battlespace is a complicated multi-domain fight with space, air, ground and cyber assets. Only the F-35 can lead this modern battlespace in capabilities and modernization, and remain within budget allocations.

Faced with funding shortfalls and sequestration, the Air Force opted to continue 4^th generation investments because the threat environment allowed it, and the cost to acquire and to operate legacy jets was much more affordable than advanced capability aircraft like the F-35. That is no longer the case.

The price of an F-35A is now $90 million, which is less than the reported price that the political leadership of the Pentagon will reportedly pay for legacy generation fighters – and the operations cost has started down the same cost reduction curve that the unit cost has already demonstrated. Recent international competitions and DoD analysis have shown that all 5^th generation fleets will be more cost-effective than mixed fleets.

Additionally, just as the government and industry drastically reduced F-35 production costs, F-35 sustainment is also estimated to be reduced by more than 40 percent.

Though the F-35 program has been criticized in the past on cost – as traditionally occurs with new military programs – by 2025 the cost to operate an F-35 per year is expected to be about equal to any 4^th generation fighter – including the F-15. Also by 2025, the F-35 is anticipated to cost $25,000 per flight hour – which is equal to or less than any 4th gen fighter. Additionally, while some have reported the actual cost to acquire the F-15X will be $80 million – this is without any external sensor pods, targeting pods and pylons to carry weapons and fuel.

F-15X advocates have stated that the aircraft will cut operations and sustainment costs in half compared to the F-35; however, that is not necessarily the case. First and foremost, buying new F-15s will require the Air National Guard to maintain multiple aircraft sustainment systems for decades to come, rather than eventually sun setting their F-15s all together and only paying to operate and sustain the 5th generation F-35.

According to reporting, a new F-15X will cost nearly $100 million to acquire in the 2020 budget. In 2020, the F-35A is estimated to cost $80 million. As Bloomberg recently reported the initial cost for 8 F-15X aircraft would be $1.2 billion. For that same price, the Air Force could acquire 15 of the significantly more capable F-35As.

From a unit cost perspective, there is no debate – the F-35 is by far the more affordable option, by nearly $20 million.

If I had it my way, the F-15 would fly forever, and so would I. However, the cold, hard REALITY is that time marches on, and the F-15’s mission as the front-line fighter is complete, and my fighter flying days are over! The United States leaders must develop budgets for America’s future fighter fleets that look to the future, and not be lured into investing in a 47-year-old aircraft that is more costly and less capable.

Instead, to ensure our military and USAF maintains its air superiority against any threat, not just today but for decades to come, tactical air power investments must be prioritized to the programs that will survive and deliver lethality in any future conflict.

Rather than clinging to Cold War era platforms that are quickly being outpaced by the enemy, the USAF must stay the course to prioritize the acquisition and modernization of the 5th generation F-35 fleet, focus on operational readiness and invest in next-generation air dominance technology— we must not deviate from investing in 5th generation fighters. Our future, our country’s future, and our warfighter’s success and survival depend on it.

General William R. Looney III (USAF Ret.) served 40 years in the United States Air Force and retired as a 4 Star General. During his career, he commanded an F-15 squadron, 2 F-15 fighter wings, and an Air Expeditionary Force (AEF) in Southwest Asia in addition to numerous other command tours.

Why India's Nuclear Weapons Program Should Be Feared (It Could Kill Millions) Over 100 nukes and counting. by Michael Peck

 India’s nuclear missile force is relatively young, but it is advancing quickly.

India has 130 to 140 nuclear warheads—and more are coming, according to a recent 2018 report.

“India is estimated to have produced enough military plutonium for 150 to 200 nuclear warheads, but has likely produced only 130 to 140,” according to Hans Kristensen and Matt Korda of the Nuclear Information Project at the Federation of American Scientists back in 2018. “Nonetheless, additional plutonium will be required to produce warheads for missiles now under development, and India is reportedly building several new plutonium production facilities.”

In addition, “India continues to modernize its nuclear arsenal, with at least five new weapon systems now under development to complement or replace existing nuclear-capable aircraft, land-based delivery systems, and sea-based systems.”

Unlike the missile-centric U.S. and Russian nuclear forces, India still heavily relies on bombers, perhaps not unexpected for a nation that fielded its first nuclear-capable ballistic missile in 2003. Kristensen and Korda estimate India maintains three or four nuclear strike squadrons of Cold War-vintage, French-made Mirage 2000H and Jaguar IS/IB aircraft targeted at Pakistan and China.

“Despite the upgrades, the original nuclear bombers are getting old and India is probably searching for a modern fighter-bomber that could potentially take over the air-based nuclear strike role in the future,” the report notes. India is buying thirty-six French Rafale fighters that carry nuclear weapons in French service, and presumably could do for India.

India’s nuclear missile force is only fifteen years old, but it already has four types of land-based ballistic missiles: the short-range Prithvi-II and Agni-I, the medium-range Agni-II and the intermediate-range Agni-III. “At least two other longer-range Agni missiles are under development: the Agni-IV and Agni-V,” says the report. “It remains to be seen how many of these missile types India plans to fully develop and keep in its arsenal. Some may serve as technology development programs toward longer-range missiles.”

“Although the Indian government has made no statements about the future size or composition of its land-based missile force, short-range and redundant missile types could potentially be discontinued, Files with only medium- and long-range missiles deployed in the future to provide a mix of strike options against near and distant targets,” the report noted.

India is also developing the Nirbhay ground-launched cruise missile, similar to the U.S. Tomahawk. In addition, there is Dhanush sea-based, short-range ballistic missile, which is fired from two specially-configured patrol vessels. The report estimates that India is building three or four nuclear-powered ballistic missile submarines, which will be equipped with a short-range missile, or a bigger missile with a range of 2,000 miles.

It’s an ambitious program. “The government appears to be planning to field a diverse missile force that will be expensive to maintain and operate,” the report points out.

What remains to be seen is what will be the command and control system to make sure these missiles are fired when—and only when—they should be. And, of course, since Pakistan and China also have nuclear weapons, Indian leaders may find that more nukes only lead to an arms race that paradoxically leaves their nation less secure.