While Malta has reached a herd immunity level of just under 90%, many countries are still way off the mark, and the world may never manage to reach herd immunity. As a result, Covid might turn from a pandemic into something endemic, which means that it could be here to stay, Deputy Prime Minister and Health Minister Chris Fearne said on Indepth.

He explained that Covid-19 is something we might have to learn to live with, like other diseases, with its spread controlled by booster shots. 

“Herd immunity is a mathematical formula. It’s not a magical number that you can just make up. It changes according to several factors, including the variants of the virus and the reproduction rate, also referred to as the r-factor.”

When the original strain of the Coronavirus hit, the reproduction rate was 2.5, so herd immunity was established to be around 60%.

“At the time we decided that we needed at least 70% of the population vaccinated to reach a high herd immunity level. But with the emergence of the more transmissible variants, the reproductive rate increased, so the herd immunity requirement increased as well. With the Delta variant, it has climbed to 90%.”

Fearne said that Malta is practically already there, with Malta having vaccinated 89% of its eligible population.

“But the situation around the world is very far off the mark. In all likelihood, the world will never reach this herd immunity level, which means that Coronavirus will not remain a pandemic but become endemic – it will remain with us. We have to have booster doses available and be up to date with what is happening, because we will be living with it.”

“While before we thought community transmission would stop if we reached a 70% herd immunity rate, with this mathematical formula, you have to vaccinate the entire population. Even then, we must keep in mind that the vaccines we have are not 100% effective. The chances are that we will need to take a booster shot from time to time. Covid will stay, but this does not mean that we will remain paralysed by it. It will become part of our life, like other diseases out there. We must learn to live with it.”

 

Vaccination drive

Fearne said that, while Covid is still very much with us, our high vaccination rate means that the effects are less severe, and fewer people need hospital admission.

He also noted that, unlike other EU countries that are postponing non-essential surgery, Mater Dei Hospital is back to normal and is catching up on medical procedures that had slowed down as a result of the pandemic.

“Naturally, Covid remains the main focus as, globally, Covid-19 cases are the highest ever. In countries where the vaccination rate is still low there are many hospital cases, and the Delta variant has left a disaster.”

In Malta, almost 89% of people aged 12 and upwards are fully vaccinated (people who are residents in Malta).

“This is the highest rate in the world. Many countries have not even begun giving the vaccine to children. This is making a huge difference because, while vaccinated people can still contract Covid-19 due to the Delta variant, they are mostly mild cases. The possibility of complications and ending up in ITU are very low when you have taken the vaccine. For those 10-11% who are not vaccinated, however, the risk remains.”

Fearne said that most of the 42 people being treated in hospital on Thursday, when this interview was conducted – including three out of four ITU patients – are not vaccinated. 

Asked why some vaccinated people still contract the virus, Fearne said there are two reasons.

“The first is that the Delta variant is more aggressive. It can be contracted more easily and can be transmitted in cases where the other variants would not have. Secondly, because the vaccine is not 100% effective. It is around 85% to 90% effective against the Delta variant. It was over 90% effective against the other variants, but even there, it won’t always work.”

The authorities are currently identifying the cohorts that will be given a third (booster) shot.

“From 13 September we will start administering the booster doses to people who are immunocompromised or immunosuppressed. Roughly speaking, these are people who are suffering from some forms of cancer and are receiving strong chemo or radiotherapy treatment, people with HIV, or persons who take high doses of steroids or immunological medicine. The vaccine is not as effective on these people, so they need a third dose. They will soon receive an appointment for their booster shot.”

Elderly people living in care homes will also be given a booster shot, which will be administered to them at the facilities.

Fearne said that there are currently no plans to give a booster shot to the general public, but the authorities are looking into whether other vulnerable groups should get it.

 

Walk-in clinic success

A few weeks ago, the health authorities embarked on a campaign to reach people who had missed their vaccine appointments or who had simply not shown any interest in taking the jab. This included the introduction of two walk-in clinics – one in Malta and the other in Gozo – and a mobile unit. People can show up without an appointment.

Fearne said this initiative was a great success. “We gave the vaccine to 51,000 people. We would have lost many of them had we not started this initiative.”

He said the people reached included students who were sitting for exams when they were called up, elderly persons who had not managed to register for the vaccine, and people without a fixed address. Many of them visited the walk-in clinics after receiving an encouraging SMS by the health authorities. 

Pregnant women – there are currently around 2,000 – are now also being encouraged to take the vaccine, after the recommendation by doctors changed from one of caution to encouragement.

Asked about children aged 11 and under, Fearne said there is currently no vaccine that is approved for use on this cohort, but the European Medicines Authority is looking at the Pfizer and Moderna vaccine to see if it could soon be administered to children.

“If that happens, we have the necessary logistics to vaccinate this cohort as well.”

 

Anti-vaxxers

Fearne was also asked about the recent protest by a group of anti-vaxxers, who say they are being discriminated against, and who blame the government and the media over the Covid-19 “hoax.”

He said a distinction must be made between private health and public health. While the government cannot force anyone to take the vaccine, it has the right to take steps to protect the wellbeing of the community.

“If I want to smoke, I can do so as well because it is my decision. But if I want to go to an office with four other people and decide to smoke in a closed off space, that would not only affect my health but also the health of those other people. In this case, it is no longer a private decision but a matter of public health. The government may legislate and say: listen, you can smoke as much as you want but you can’t smoke in a closed off space where there are other people.”

“When it comes to taking the vaccine against Covid-19, the decision is a personal one. If you decide you want to take the vaccine to keep yourself and those around you safe, you have every right to do so, but if you don’t want to, then don’t. However, if you decide not to take the vaccine against Covid, you might be a danger to others as there is a risk of getting the virus and spreading it. In this case, the government has a right, as well as a duty, to intervene to prohibit these people from doing certain things. For example, if you do not get the vaccine, you cannot go abroad and come back without quarantine. You cannot go to mass events. This is done to protect the people around you. The decision whether or not to take the vaccine is yours, but the decision which involves the safety of the public is a decision that falls under public health.”

 

Standing events – did government mislead?

Last week, nightclub owners said that they had been misled into thinking that standing events would be allowed from 16 August onwards. However, Fearne told this newsroom that operators in the entertainment industry were always warned that the situation could change and that nothing was set in stone.

“Months ago, they had asked us for a long-term roadmap. We made it clear that we could not really plan in the long-term, and that such a roadmap would be subject to change. When we drafted this roadmap for the period June, July, August – it was a time when we had very few cases. We had said that, if the situation remained the same, we could consider going to standing events in August. But the situation did not remain the same. We did this not out of pique, but because of public health considerations.”

Fearne noted that there are various forms of standing events. One could be talking about a 1,000-person music event, or a corporate event for 50 people.  

“It doesn’t mean that neither of them will ever take place again, or that parties will not take place. They will, eventually. But we have to act cautiously – we must not lose what we have achieved.”

The government and the Malta Entertainment Industry and Arts association (MEIA) are currently discussing holding a standing event that would serve as a ‘test case.’ Those attending would have to agree to doing a number of PCRs after the event. “If all goes well, we could start expanding this concept, but we must be cautious, be mindful of the data and not be arrogant.”

In the meantime, the limit for seated events will increase to 300 per cluster as from Monday. One event can have more than one cluster. The number will increase to 500 per cluster by the end of the month.

As from tomorrow, quarantine for vaccinated people will go down from two weeks to one, given that they test negative after seven days.