What if the vaccine or drugs don’t save us? Plan B for coronavirus means research on alternatives is urgently needed



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Tammy Hoffmann, Bond University and Paul Glasziou, Bond University

The curve of the COVID-19 epidemic has been flattened in many countries around the world, and it hasn’t been new antivirals or a vaccine that has done it. We are being saved by non-drug interventions such as quarantine, social distancing, handwashing, and – for health-care workers – masks and other protective equipment.

We are all hoping for a vaccine in 2021. But what do we do in the meantime? And more importantly, what if no vaccine emerges?

The world has bet most of its research funding on finding a vaccine and effective drugs. That effort is vital, but it must be accompanied by research on how to target and improve the non-drug interventions that are the only things that work so far.

Debates still rage over basic questions such as whether the public should use face masks; whether we should stand 1, 2 or 4 metres apart; and whether we should wash our hands with soap or sanitiser. We need the answers now.




Read more:
Drugs don’t cure everything – doctors can be helped to prescribe other options


What about non-drug intervention research?

Across all health research, non-drug interventions are the subject of about 40% of clinical trials. Yet they receive far less attention than drug development and testing.

In the COVID-19 pandemic, millions of dollars have already been given to research groups around the world to develop vaccines and trial potential drug cures. Hundreds of clinical trials on drugs and vaccines are under way, but we could find only a handful of trials of non-drug interventions, and no trials on how to improve the adherence to them.

While holding our breath for the vaccine …

We all hope the massive global effort to develop a vaccine or drug treatment for COVID-19 is successful. But many experts, including Ian Frazer, who developed Australia’s HPV vaccine, think it will not be easy or quick.

If an effective vaccine or drug doesn’t materialise, we will need a Plan B that uses only non-drug interventions. That’s why we need high-quality research to find out which ones work and how to do them as effectively as possible.

Aren’t non-drug interventions straightforward?

You might think hand washing, masks and social distancing are simple things and don’t need research. In fact, non-drug interventions are often very complex.

It takes research to understand not only the “active components” of the intervention (washing your hands, for example), but also how much is needed, how to help people start and keep doing it, and how to communicate these messages to people. Developing and implementing an effective non-drug intervention is very different from developing a vaccine or a drug, but it can be just as complex.

To take one example, there has been a #Masks4All campaign to encourage everyone to wear face masks. But what type of mask, and what should it be made of? Who should wear masks – people who are ill, people who are caring for people who are ill, or everyone? And when and where? There is little agreement on these detailed questions.

Washing your hands also sounds simple. But how often? Twice a day, 10 times a day, or at specific trigger times? What’s the best way to teach people to wash their hands correctly? If people don’t have perfect technique, is hand sanitiser be better than soap and water? Is wearing masks and doing hand hygiene more effective than doing just either of them?

These are just are some of the things that we don’t know about non-drug interventions.

Existing research is lacking

We recently reviewed all the randomised controlled trials for physical interventions to interrupt the spread of respiratory viruses, including interventions such as masks, hand hygiene, eye protection, social distancing, quarantining, and any combination of these. We found a messy and varied bunch of trials, many of low quality or small sample size, and for some types of interventions, no randomised trials.

Other non-drug options to research include the built environment, such as heating, ventilation, air conditioning circulation, and surfaces (for example, the SARS-CoV-2 virus “dies” much more rapidly on copper than other hard surfaces).

Are some of the things we are doing now ineffective? Probably. The problem is we don’t know which ones. We need to know this urgently so we’re not wasting time, effort, and resources on things that don’t work.

At a time when we need to achieve rapid behaviour change on a massive scale, inconsistent and conflicting messages only creates confusion and makes achieving behaviour change much harder.

What about the next pandemic?

If a successful COVID-19 vaccine is developed, we’re out of the woods for now. But what happens when the next pandemic or epidemic arrives? Vaccines are virus-specific, so next time a new virus threatens us, we will again be in the same situation. However, what we learn now about non-drug interventions can be used to protect us against other viruses, while we wait again for another new vaccine or drug.

We have had opportunities to study non-drug interventions for respiratory viruses in the recent past, particularly during the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003 and the H1N1 influenza pandemic in 2009. However, the chances for rigorous studies were largely wasted and we now find ourselves desperately scrambling for answers.




Read more:
Size does matter: why large-scale research is a must for public health


What about research for Plan B?

To prepare for the future and Plan B, the case where a vaccine doesn’t arrive, we need to conduct randomised trials into non-drug interventions to prevent the spread of respiratory viruses. The current pandemic is presenting us with a rare opportunity to rapidly conduct trials to answer many of the unknowns about this set of non-drug interventions.

Concentrating all our funding, efforts, and resources into vaccine and drug research may turn out to be a devastating and costly mistake in both healthcare and economic terms. The results will be felt not only in this pandemic, but also in future ones.The Conversation

Tammy Hoffmann, Professor of Clinical Epidemiology, Bond University and Paul Glasziou, Professor of Medicine, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The budget is the government’s Plan B, but what’s Plan C if polls stay bad?



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Scott Morrison addresses the media on Sunday.
Julian Smith/AAP

Michelle Grattan, University of Canberra

The government inoculated itself against the post-budget polls. Budgets don’t produce bounces, people said. The Conversation

True for the most part – though there were Newspoll bounces (three points or better) in 1996, 1999, 2000, 2009, and 2012.

Nevertheless the fact that the first four post-2017 budget polls were all bad must have been a disappointment for Malcolm Turnbull. Newspoll and Fairfax-Ipsos on Monday both had the Coalition trailing Labor 47-53%; on Friday two ReachTEL polls, for Sky and Channel 7, had it behind 47-53% and 46-54% respectively.

Given that polling has found that the main budget measures are in themselves popular – from which Turnbull appears to be taking heart – the government might have hoped for something better in the voting results.

“Polls are not news,” Turnbull told a news conference on Monday, though he admitted to John Laws: “I do take notice of the polls naturally”. His throwaway “not news” line just invited a rerun of the clip from the day he challenged Tony Abbott, when he pointed to the Coalition losing 30 Newspolls on the trot. This week marks his loss of a dozen of them in a row.

Accepting, however, that bounces are not the norm, the Coalition backbench will be holding its collective breath in coming months.

Treasurer Scott Morrison said Australians will be absorbing the budget “over time”. From the government’s point of view, he’d better be right, and they will need to absorb it positively.

If there is not a clawback for the Coalition later this year – and of course factors other than the budget will be feeding into public opinion – things will be looking pretty dire. Some predict Turnbull’s leadership will be in the frame unless the numbers improve; on the other hand, another change would be extremely hard.

Budgets disappear quickly but not before an intense selling effort. On Monday night Morrison was mixing it at a Sky News forum on the New South Wales central coast, where the audience ranged from One Nation supporters and the party’s NSW senator Brian Burston to local Labor MP Liesl Tesch, who scored a question.

Morrison was tackled on debt, housing (at length), the banks, immigration and identity politics. A woman bluntly told him his reference to “mum and dad investors” in the property market was “ludicrous – they are all investors”. A man who described himself as editorial cartoonist to Mark Latham’s Outsiders declared the government had shifted too far to the left and wanted to know “when we’ll get the government we voted for”.

As he’s done in and since the budget, Morrison stressed eschewing ideology and just “getting things done”. The Liberals believed in investing in education and sustainable services, he said; the difference between a Liberal and Labor budget was “the Liberal budget is paid for”.

Morrison reiterated that the banks should absorb the levy the budget has placed on them. The audience thought it would be passed on – something Turnbull admitted earlier in the day the government could not actually stop, although “there are plenty of factors that will inhibit them from doing so”.

For those watching the Liberal Party’s internals, one of the notable reaction to the budget has been Abbott’s. Given that, at its core, the 2017 budget is about trashing the remnants of the 2014 Abbott-Hockey effort, one might have expected him to be much more critical, though his words have had an edge.

He said on 2GB on Monday (in the spot formerly occupied by Morrison): “We would have liked to have had a savings budget. The Senate doesn’t like savings budgets as they showed in 2014, so instead we’ve got a taxing budget but this is the best that the budget can do in these circumstances.”

In contrast, his former chief-of-staff, Peta Credlin, has been bitterly critical, saying on Sky “the budget is about the Liberal Party junking everything that it has stood for”.

One assumes Abbott’s views are much stronger than he is expressing. So why is he being careful, when often he’s anything but?

Credlin said she thought “he’s trying hard not to be accused … of fuelling an anti-Malcolm sentiment”.

If those polls don’t turn around, Abbott doesn’t want people being able to point fingers of blame at him. He’d been keen for all the responsibility to be squarely on the shoulders of the prime minister and his treasurer.

The government has been candidly admitting that this budget, so out of character for a Coalition government, is not its preferred choice. In other words, it is Plan B. But if Plan B doesn’t help do the trick with the polls, it is not clear what Plan C would be.

https://www.podbean.com/media/player/55eic-6aa7da?from=yiiadmin

Michelle Grattan, Professorial Fellow, University of Canberra

This article was originally published on The Conversation. Read the original article.