UM expert: Smallpox holds lessons for COVID, future epidemics – Detroit News

After Michigan’s COVID-19 cases topped 3 million with over 41,000 deaths and as the highly contagious XBB.1.5 subvariant of the virus looms, many Americans have moved to what they consider a new phase of the pandemic.

But a University of Michigan epidemiologist argues that there are still lessons to be learned from the pandemic and they should be used to prepare for future crises. In a session of the UM School of Public Health’s “Ahead of the Curve” speaker series, epidemiologist Larry Brilliant called the U.S. response to COVID-19 “shameful” but said it can teach the world how to respond better to the next pandemic.

Brilliant, a Detroit native who once worked as a medical officer on the World Health Organization’s smallpox eradication team, said lessons from smallpox eradication can still be applied to COVID-19.

Smallpox, which killed at one time one in three people who got it, was responsible for over 300 million deaths in the 20th century alone and is widely regarded as one of the deadliest viruses in human history. The smallpox vaccine was the first successful vaccine to be developed, and the disease was eradicated in 1980.

“Because it was so bad, the world came together and agreed that there’d be universal vaccination of every child born in the world and all countries subscribed to that. There was hardly any exception,” Brilliant said during an online talk late last week.

Ring vaccination, or the strategy of stopping the spread of disease by vaccinating those most likely to be infected, was the key to eradicating smallpox, the epidemiologist said.

“In the real world, a small amount of vaccine in the face of a deadly disease would go either to the person who came and clamored for it or the brother or sister or the prime minister,” Brilliant said. “(Our) moral duty was to allocate the vaccine first and foremost to those most vulnerable of contracting the disease. … They were the people who lived in the same household or were neighbors in the case of smallpox.”

But ring vaccination requires huge disease tracking and contact tracing efforts.

“We had to go house to house, we had reward posters, we had to go to marketplaces and all throughout India our team of 150,000 people made 2 billion house calls,” Brilliant said, referring to his WHO experience.

The Omicron and XBB.1.5 variants of COVID-19 are more infectious than smallpox was, and it was difficult to get people to cooperate with contact tracing in the United States so the ring vaccination approach wasn’t as successful, Brilliant said.

When the COVID-19 vaccines were approved, wealthier countries such as the United States also took a disproportionate amount of doses, Brilliant said.

“I think there’s hardly any country in the world that could take great pride in the response that they had to COVID,” Brilliant said. “The western world, the wealthy world, put advanced purchase agreements in place locking up the supply.”

“The failure of companies like Moderna to allow proximate manufacture of the vaccine in Africa has was one of the factors that has led to the creation of new variants, certainly Omicron with all of its mutations,” he said.

The Trump administration made the deal with Moderna, building on a partnership with the National Institutes of Health, to give it an extra $1.5 billion in exchange for up to 500 million doses of the COVID vaccine. The agreement gave the United States first rights to a shot aided by its taxpayers. The deal allowed a small company that at one time struggled to raise money to become a bigger health company, according to a Politico report.

In March 2022, Moderna promised to “never enforce” its patents for COVID vaccines against manufacturers that are based in or producing in 92 low- and middle-income countries, which are members of the Gavi COVAX Advance Market Commitment that aims to get financing for vaccines to go to those areas.

The omicron variant of COVID-19 was first identified in South Africa in November 2021, according to the Centers for Disease Control and Prevention.

Another lesson from smallpox eradication is the importance of transparency, Brilliant said. By reporting numbers honestly and owning up to mistakes, public health entities can build up public trust, he said. The United States could have done a better job controlling misinformation and disinformation at the national level, he argued.

“With public trust, public health can do anything. Without public trust, public health can’t do almost anything and we squandered public health trust,” Brilliant said. “Politician after politician failed to allow transparency and honest communications, alternative facts.”

Moving forward Brilliant said there is reason to be optimistic but the COVID-19 pandemic is not over yet.

“Half of all the colds that you get are coronaviruses. … It may be that having 500 (COVID-19) subvariants is a signal that this one’s running out of gas and that there are very few mutations left to be had,” Brilliant said. “I think there’s a low probability that we will get a super bad variant out of COVID at this stage, but it’s a low probability with a highly consequential event. And I don’t think we’re paying it enough attention.”

hmackay@detroitnews.com

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