Why Complete Elimination Strategy of COVID virus is not feasible?

Synopsis: The empirical evidence shows that the idea of the complete elimination of COVID viruses in a selected few countries is not feasible. Rather, it will only increase the socioeconomic disparities thereby making the goal of elimination infeasible.

Background

1. A recent article published in The Lancet has advocated for “elimination strategy”, it is also known as the zero-COVID-19 strategy for eliminating the virus.
2. Zero-COVID-19 strategy means that the replication of the virus will be reduced to the least so that no new cases will occur in a defined geographical area.
3. The elimination strategy has the following three elements,
   • Rapid reduction in the number of infections to zero.
   • Creation of virus-free green zones and
   • Prompt outbreak management when new cases occur occasionally.
4. Rich countries are working on this strategy by vaccinating each and every citizen.
5. However, this strategy of the complete elimination of the virus is not suitable for every country.

Why this strategy is not suitable for all countries?

Complete elimination of the virus by vaccination is only suitable for geographically isolated countries such as New Zealand. It can afford strict border control measures. Even here, it is difficult because of the following reasons,

• First, the virus will be in circulation in the countries from each other. So, the threat of a Virus outbreak will stay for a while.
• Second, the Virus is mutating at a very fast pace. Universal vaccination will not be helpful against new variants. It is difficult to consistently upgrade vaccines.
• Third, a zero-COVID-19 strategy will worsen global health inequities. The idea of creating green zones for free travel will benefit richer countries and alienate poorer nations.
• Fourth, the experience from the elimination of other diseases shows that the complete elimination of the COVID virus is not possible. For example,
  • • Measles and neonatal tetanus are present for more than 20 years. It caused nearly 25,000 newborn deaths in 2018. Despite the global efforts for vaccination it still remains a major public health challenge in the developing world.
    • Polio, eradicated from Southeast Asia, is still endemic in Afghanistan and Pakistan.
    • Also, according to immunologists surveyed by the science journal Nature the Covid virus will become endemic in certain countries.

What are the Solutions?

Instead of isolated strategies for a few countries, global leadership and resources to vaccinate the vulnerable population are required.

• First, disease control measures should be implemented globally. The vaccine coverage for vulnerable populations across the globe should be increased.
• Second, the current pace of vaccination needs to be increased by 4.3 times to vaccinate 6.4 million persons per day.
• Third, along with this, mapping of elderly and persons with comorbidities needs to be done on a priority basis for vaccination.
• Fourth, there is a need to strengthen epidemiological and genomic surveillance for COVID-19.
• Fifth, a plan for the goal of achieving Universal Health Coverage (UHC) is required. Because the COVID-19 pandemic has reversed the gains made in other health programmes like tuberculosis control.

Thus, the idea of eliminating virus in a selected few countries should be replaced with a pragmatic goal of controlling COVID-19, not elimination. Since the zero-COVID-19 strategy comes with zero evidence of feasibility, focusing on it will result in wastage of our attention, funds, and time.