From pandemic to endemic

How the pandemic has played out: a Q&A with Dr Adrian Hyzler, chief medical officer, Healix International


Throughout the pandemic, BTN has spoken with a number of industry health experts to understand the cycles, developments, prevention and treatment of Covid-19. Healix International’s Dr. Adrian Hyzler has on several occasions detailed how the pandemic has evolved and how it continues to affect business travel, and he again recently spoke with BTN editorial director Elizabeth West about the path forward.

BTN: We are two years into the pandemic. What has surprised you about its progression and what hasn’t?
Dr. Adrian Hyzler: Such a big question. From the beginning, one thing that has certainly been proved very wrong was that coronaviruses rarely mutate. While that was always the case [before]… all the Covid-19 mutations have been one of the key factors of this virus that has changed the overall progress of it. If that had not been the case, I don’t think we’d be in the situation we are at the moment – I think we’d have got past this much more quickly. So that’s on the negative side. On the positive side, though, is how incredible science has been in developing such amazing vaccines. We’ve seen that the vaccines aren’t 100 per cent what they could be, and they don’t prevent transmission in the way that was hoped. But the way they have pulled back the death rate has been remarkable.

The first time we spoke in 2020, I asked, ‘How long will this last?’ You basically said, ‘forever.’ You were right. Where are we with the idea of Covid-19 becoming endemic, and does that differ among geographies?
I think that’s really the crux, the different geographies. The only kind of definition that makes sense overall for ‘endemic’ is that it’s regular and predictable. We see that with influenza – we know it surges in winter. Or malaria, which surges in rainy seasons. Or tuberculosis, which is sort of year-round. Those are all endemic diseases, and they still cause huge numbers of deaths. It’s not that endemic means suddenly it becomes not a worry. But we are seeing that shift in a number of countries – Nordic countries and even the UK – and this was very much hastened by the omicron variant.

How has omicron affected the progress toward an endemic situation? Omicron is now taking a real toll in a number of Asia-Pacific countries.
It’s true that not every variant took hold in all countries. Alpha was huge in Europe but it didn’t really hit the US badly. Delta didn’t really take hold in in Latin America as badly, so that it kind of had geographical differences depending on seasons, depending on what kind of immunity was already in the populations. But omicron is different in that it seems to have taken off wherever it’s gone. It certainly hit the United States but then you look at New Zealand or Australia, South Korea, even China. Omicron looks like it cannot be stopped. That’s kind of a double-edged sword. Yes, it has caused a large number of deaths because of the huge number of cases. But it’s certainly been milder overall in that you’re still infecting and producing an immune response in a huge number of people. That benefits the background immunity of the populations on top of people who have been vaccinated or have not been vaccinated.

Governments, particularly in Europe, have begun to drop public restrictions on travel. Is it the right time for that?
These restrictions are going, despite high [infection] numbers. It’s just been recognised that those numbers aren’t relevant now. The data itself is being muddied by what testing is being done – so many people are taking tests at home now and they’re not reporting. On the other hand, a lot of people are going into hospitals for one thing but are incidentally tested positive for omicron, so is that a Covid hospitalisation? In the UK it is, but is it elsewhere? So it’s very hard to analyse or compare the numbers now.

Are we seeing success with therapies, and how can that develop?
The Pfizer antiviral has shown incredible efficacy at reducing hospitalisation by 89 per cent in the vulnerable people who are at risk – and that is really part of the jigsaw that we needed to come out of this in a way that doesn’t leave vulnerable people behind. That was always the big issue – that once you take away restrictions, you’re basically saying “good luck” to the vulnerable population. But now we have other treatments, and we have monoclonal antibody treatments that are being redesigned [for the new variants], and more will come online. So we’re starting to see that package we can use to test and treat. These advances keep happening, and the hope is that funding will keep these programmes going in the right direction. Of course, we’d like to see a multivalent vaccine that starts to address future variants.

Since our first conversations, we have talked about vaccine availability and distribution to lower-income nations. Is that still a factor that needs to be addressed to bring down global infections and potential variants?
The availability is not a problem. In fact, India scaled down its production of the AstraZeneca vaccine because there wasn’t demand for it. The bigger problem is going to be persuading people. If we look at some African countries that have got low vaccine uptake, for example, how do you persuade people to get vaccinated when it seems like Covid is passing? Other geographies have low vaccination rates as well; some for different reasons. We need vaccines with easier delivery methods to really reach these places. We’ve talked about the refrigeration and special storage for the first mRNA vaccines; however, we do have protein subunit vaccines now. I’d like to see something where you are not having to use needles, like a nasal delivery.

But also, we’ve been remiss by not establishing the right distribution channels while waiting for these vaccines. The other thing that I thought should have been done was for WHO to [control] a vaccine. That’s sort of happening now with a protein subunit vaccine coming out of the University of Texas… It’s a nonprofit vaccine that doesn’t have a company name with it or the political connotations that come from Russia, China or the West. And it can be manufactured locally. That should be very useful.

We should talk about how all this is affecting business travel. We talked about governments lifting restrictions. Do you see that continuing?
I absolutely think that the business travel is going to escalate quite rapidly. There’s going to be a real domino effect for other countries to do the same thing because they’re not going to want to be at the back of the queue for the economic benefits of business travel. Vaccination will be the key to connecting people in large numbers. People will need to be “up to date” – whatever that comes to mean. It’s definitely a third vaccination dose, but possibly a fourth.

Are Healix clients accelerating their travel and how are they managing it?
Take the simplest example, which would be someone who is up to date on vaccinations and not in a vulnerable category. I just see no reason to restrict travel. Obviously, there are countries in extreme circumstances. Like Hong Kong at the moment, and that’s always going to be [something to look for].

Yet Hong Kong eased restrictions on April 1, so is it up to the corporate to understand government alerts and warnings not to travel to certain locations even if borders are open?
The US Centers for Disease Control and Prevention’s list of travel restrictions is just unbelievable. You know, you’ve basically got 125 countries on the high-risk list, and that includes the whole of Europe, the whole of North America and practically the whole of South America. So I don’t think that is necessarily the greatest list to look at if you’re planning your travel because I certainly wouldn’t advise against travel to the UK. If you came here, you would have no idea that there is a pandemic. Were you to get ill, there would be no restrictions with whatever drugs and intensive care you might need. So those lists seem quite out of date.

Are Healix clients waving those alerts aside and traveling internationally at will?
We look after [major corporations and NGOs] and all their business travellers. We look at virus prevalence in the country alongside an individual’s health vulnerability, so it combines the two and gives a risk. We are doing that with a couple of major financial institutions, and they are not looking at restricting travel at all. They do want to know people’s risk and vulnerability, but they are going absolutely hell for leather with travel at this point and telling us to expect massive numbers of travellers over the next couple of months because it’s all clicking back into gear. There are other issues we are focusing on right now… obviously, in Eastern Europe at the moment. That will put a damper on everything; they are terrible events and have in some way pushed omicron out of the story.