Walk the talk on immunisation

Clare Taylor: 0:15

Welcome folks to ESWI Airborne. This is your host, Clare Taylor speaking, and this is the place to be to meet the members of ESWI, the European Scientific Working Group on Influenza. Today in the studio, I'm very happy to welcome Professor Roman Primula, professor of Epidemiology at Charles University in the beautiful city of Prague. And we are going to talk today about the important topic of getting vaccinated against COVID-19. Roman, welcome to ESWI Airborne.

Roman Prymula: 0:50

Hello it's my pleasure to be here.

Thank you, Roman. Now, Roman, I'm absolutely intrigued by your biography. You've been a member of ESWI since 2013, and among your many, many professional achievements you have even served as Minister of Health in your home country of the Czech Republic. Roman, can you tell our listeners how did you first get started? What brought you initially to the field of preventative medicine?

This is quite an interesting question because at the beginning I was more oriented to mathematics and I tried to go to different universities, but my parents told me you should go to medicine and, being at medical school, I have decided to combine those two branches and I was looking for a specialty which is quite close to mathematics, and this was the reason why I selected epidemiology, and afterwards I have combined epidemiology with vaccinology and the development of new vaccines, and this was the first step to preventive medicine.

Well, how right you were to follow your parents' sound advice in your choice of studies, which has led to your career. The topic of your doctoral thesis, what was that Roman?

Surprisingly, my topic was hepatitis A and it was a big discussion. Why to choose such a strange topic? Because that time everything about hepatitis A was quite clear. But after a few months a new vaccine was discovered and this brings big attention to hepatitis, and particularly to hepatitis A. So I was lucky that time because the topic was not so old-fashioned as some people supposed.

Good timing there. As well as your studies in the Czech Republic, you have also studied in the UK at the University of Birmingham. What was that like?

It was a little bit different topic because since the very beginning I was also in managerial positions and I got an offer by British Council to be trained in UK for a position of hospital director. And basically I have used this very useful education a few years afterwards, when I was established as a director of a large university hospital and I was in that position for six years.

Where was that large university hospital?

It was in Hradskralove. It's a city with about 100. 000 inhabitants, 100 kilometers far from Prague in the eastern direction.

This is a very senior professional position, but that was not your greatest height if you like, you were also Minister of Health. How did that happen?

It was, I suppose, a little bit of an accident, because there were many politicians. I was never a politician and at that time it was quite complicated to find somebody who is familiar with the COVID issue and who is able to manage the situation. So that time I was in charge of all countermeasures against COVID in the Czech Republic.

You said at that time, so when were you Minister of Health?

It was 2021, starting September.

Okay, and you were chosen for your expertise in virology. Is that right?

Exactly, I was not a politician, so I haven't any political party beyond myself, and it was extremely complicated to introduce some countermeasures which were not very popular and politicians suppose it may jeopardise the trust of people to any respective party. So it was quite a demanding time for me.

Quite a challenging time and they're very different roles, I suppose the policymaker and the scientist. And I would like to dig into this a bit. But maybe I could start by asking you is how did working as a policymaker influence your scientific work?

Definitely. I have just now a little bit experience from the other side and sometimes we may fear that our decision, our scientific results, are not well accepted by politicians. Now I can understand why is that, but this didn't change my opinion, because we should definitely insist on scientific solutions. But sometimes in politics those scientific correct decisions are just not made because it's politically incorrect and it's quite complicated for the public to understand this gap which is there.

One of the places I suppose we can see that is at the European level. I note that you've served on the management board of the European Center for Disease Prevention and Control. What was this experience like?

It was quite also challenging experience because you are on different level and on European level you try to reach almost unanimous decision. What is always very difficult because some countries have different interests and we were discussing for many, many hours to reach some final conclusion, and because healthcare in EU is not definitely directly managed by EU, it's a national responsibility. It was always difficult even to issue some decrees. So we were thinking about some guidelines and finally we have decided to approve some only guidance, very weak recommendation, because not all the parties or all the countries are willing to adapt those recommendations.

That brings us really to our central topic of today, and one that is very much at the intersection of policy, science and society. Vaccination, in particular vaccination against COVID-19. First Roman, please tell us why is this important to you?

I think since the very beginning of my professional life, I was involved in vaccination and in development of new vaccine. For me it is basically one of the major tools how to fight infectious diseases and maybe the most powerful tool. When we were exposed for the first time to COVID and to SARS-CoV-2 virus, we were thinking that it will be quite important to develop in a very short period vaccine against this disease, and we were successful in reality from the global point of view. But we may see that not everything is on the appropriate shape as we expected since the very beginning. It means we should have certain efficacy, we should prevent the disease, but just now we have not sterile immunity. We are able to reach a very high efficacy against serious disease and this is the major breakthrough of the immunisation. But on the other side, we are not able to limit efficiently the spread among people. And this is our goal for the future to bring new vaccines, second generation vaccines.

That is indeed the holy grail that we have touched on in other episodes of ESWI Airborne. You mentioned already that the appointment to Minister of Health was in recent time and, as a professor of epidemiology, living through this pandemic must have been an extraordinarily busy time for you. So how else have your professional activities changed since the beginning of 2020?

Let's say it was a completely different life, because for the first two weeks I was able to sleep just two or three hours a day and I have supposed in the past that this is not possible, that you will die. But it never happened. So I'm still alive and it's quite interesting, but if you are exposed to such an extreme situation you sometimes may reach just incredible performance and we were able to survive it and really it was quite demanding and afterwards it was not so frequent. We were able to sleep five hours and it was quite normal for me. So we have survived the situation and we have many experience how we are able to shift the whole system towards big computerisation. We have all the system just now online and many years ago we have supposed it's almost impossible, but within few months we were able to establish it and this is my major positive experience. On the other side, we were facing some strange attitude of the people. At the beginning almost everybody was dedicated to the joint fight against the disease, but a few months later some were on the opposite side and they were thinking that COVID-19 disease doesn't exist and it's some nightmare coming from other countries just to sometimes compromise our people and so on. So it was quite demanding.

Yes, there are some very interesting themes around this extraordinary achievements and a reminder of just how hard people have worked to make those extraordinary achievements, including the development of the vaccine and many other achievements for in the sake of public health. But that last point that you came to I suppose the anti-vax movement, as it's known broadly did this take you by surprise?

Yes, I think it was not so surprising. But I should say what was surprising it was extent of the issue, because since the very beginning of my immunisation career we were facing some people who were not very willing to be immunised. We had in my country mandatory system for 10 diseases, so they were fighting against mandatory immunisation and so on. But it was just a small percentage of population, maybe 3 to 5%, no more. But during the COVID outbreak it started to rise and we were able to find maybe 20-25% of people who are really fighting in the late stage of the disease or outbreak against immunisation and they suppose that immunisation is nonsense, it jeopardises their health and we may use different tools, some treatment or natural immunity not to be immunised, because immunisation may bring us some side effects which are worse in reality than the immunisation itself or even worse than the disease. And such strange opinions were not so rare.

Yes, so you were not so surprised that the anti-vax sentiment existed, but the level, the percentage that it rose, to the extent of it, was surprising indeed. Maybe something to do with people being stuck at home and asking their computers questions instead of their neighbors, perhaps I don't know.

Yeah, it was funny because during the maybe third or fourth months, the people were closed at homes and they were looking for everything in any connection to the disease and if somebody was spreading some strange information via social networks, they were immediately looking for it and spreading to other people. So it was quite a danger and I may suppose that social networks play not very positive role during the outbreak.

Indeed, yes, to be continued I think that discussion, but there is certainly a difference between an interaction online and speaking in person with your family, your friends and your associates. And, in that resistance, if you like, with the anti-vax sentiment, do you see a lot of variation across different countries, or are we talking about the same kind of themes come up?

So basically, if we are talking about vaccine hesitancy, we may see that this is a big issue around the globe and I'm just deeply surprised that this movement is relatively well organised because they are spreading information around the countries. They are translating PowerPoint presentations, sending different movies and I have real experience with one case from UK. This was not in connection to COVID disease but to human papillomavirus immunisation and at that time they published that 16-year-old girl died because of immunisation and just one week later they recognised that it was a cancer disease in late stage. But nobody published that and it was just used how to fight against immunisation. So it's a very danger. We should have good arguments, but on the other side I met may see recently that there are some people who are really not willing to argue with you and they have local experience. They have their own experience and they are not willing to correct this experience.

So you think direct confrontation or argument may not always be the best way to counter the sentiment? Do you have any opinion on how it can be influenced or how we can turn the tide here?

My not very good experience is that if you are asked by media to fight against those people or at least to argue with those people on screen, they are always using a certain format of this discussion and you have one opponent at least or there are two pro and two cons. And what's happening? If you're representing 90% of population and those people are representing 10% of population, it's always some discussion which is almost 50 to 50, because it's difficult on a very short time regimen to prove anything. And those people who are listening to such a discussion suppose okay, maybe it's something correct on the arguments of those people against and this is quite demanding. So I should say that for state media it should be better probably format to explain it, but not such a big discussion, because in a relatively restricted time format it's not possible to reach a final positive conclusion.

Yes, it may be necessary to address the issue of balance with what is in the common good. Now I also note, Roman, that part of your training was in a military school of medicine, and I am curious as to how you see the role of the military during public health crises.

Yeah, I was trained at the military medical school, which was affiliated to civilian medical schools, but a couple of students were exposed also to specialised military subjects besides regular medical subjects, and the military was always prepared for certain crises, and in those crises the importance of infectious diseases is definitely going up.

What kind of crises are you referring to?

I'm referring even to war crises, but sometimes to humanitarian crises, because the military was involved in peacetime in many humanitarian crises and we were sending our field hospitals to that region, for example after earthquake, and definitely a component of people was taking care for infectious diseases. And if you have broken infrastructure, all infectious diseases, particularly those with oral spread, may jeopardise oral effort and they may even increase the number of casualties there. So this was the reason of the school how to be prepared for such type of situation.

And is that where most virologists are coming from in the Czech Republic?

Yeah, that's true, because we were not a special hygiene epidemiology medical school, what was the case in the past. Just now, all medical schools are just general and this was the only component a little bit specialised, but we should complete all the requirements for general medicine as well. But besides that, we have a little bit shorter holidays, always by one month, and during this period we were trained for this specialised purposes.

And this is certainly, it's this expertise that brought you into the role of politics. So you are a scientist, you're also a politician. How do you see the responsibilities of scientists and of policy makers in advocating for vaccination?

As I have mentioned already, the responsibility is a little bit different. I think scientists should definitely bring all the information, all knowledge which is available, and they should be advisors to politicians, because the final decision is a political one and sometimes a correct scientific decision is not correct political decisions. And this is always a fight when you try to show your results or your opinion supported by experts, by many experts, and sometimes it may happen that it's not accepted, that it's a certain level of frustration for scientists, but this is reality.

This is reality and sometimes it can change quite quickly, right? A week is a long time in politics. So where are we at now currently in Europe with the level of vaccination?

This is quite interesting because, if you may compare different countries in Europe, general immunisation coverage or uptake of vaccine is about 75% in EU. But you may see certain west to east gradient and I think the best immunised countries are Portugal or Spain. They have more than 80, or Portugal even more than 90% of immunised population. But if you are going to East, for example in my country, we have 64%. But if you go to Ukraine, which is just now afflicted by a war conflict, they have only 34% of coverage and it definitely triggers some discussion. What is the importance of immunisation and if the figures differ finally, if the country is well immunised or it isn't.

Of these kind of percentages, just so our listeners have an idea, what percentage do we need to be at for herd immunity or what you would consider sufficient control of the virus?

For COVID-19, it's difficult to say that we may reach some concrete figure because I do not suppose that we have herd immunity for the disease, because we may see that the disease is spread around even if you are immunised and let's say, for lay public explanation of heart immunity is something that we have circle of immunised people or immune people around you and you are protected via direct contact with those who are infected and may infect you. But with COVID disease it's quite complicated because if you are even in contact with fully immunised people with three-dose regime and with booster dose, still you may be infected and this is complicated. But on the other side it's quite important to reach as much as possible in coverage because, particularly for older people, we may see a real impact on serious scores of the disease and we may see that many people were really saved due to vaccines because those who are naive are more exposed to deaths and more exposed to serious causes of the disease and to hospitalisation.

That's the situation in Europe, but I think the pandemic really brought home to many of us just how globalised and interconnected the world is today. The very fact that this could spread from Wuhan all over the world so quickly. What's your view on the need to get the vaccination rate up in countries outside Europe and indeed in developing countries?

I think that COVID-19 is a real global issue. It's not directly a local problem in Europe or in the US Because, frankly speaking, if we will be so selfish and we will just take care for us, if we will be so selfish and we will just take care for us, what's happening in other countries it will be massive spreading of the virus and the virus will be generating new mutations and afterwards those new mutations, new variants, may really jeopardise ourselves. So we should really prepare a global approach, we should prepare global provisions and global plan for immunisation and we should develop probably second-generation vaccines which will be more potent against currently circulating variants. I may say that I was not fully satisfied with the policy in EU because they developed many, many doses and countries just to secure enough vaccines for themselves. They should buy more than needed and those vaccines were definitely locked in some other countries developing countries and I think it was possible to solve it, for example, with a higher price, not to purchase 20 million doses, just needed 10 million.

The selfish approach is not a practical or pragmatic approach in this case. Roman, what do you most want to see happen in the next year? On COVID-19 vaccination?

I think this is also a very strange approach. If you go to the population you may see that if there is wave of the disease, everybody is willing to be immunised. But if there is a period in between they suppose okay, risk is gone and we do not need to be immunised. And this is the case just now. Omicron wave is going down and people are stopping to be immunised and they will be waiting until autumn and probably we will have another wave. I hope that it will be just another Omicron and nothing completely new and in this case we are able to control it with second-generation vaccines just directly approved for Omicron variant. But on the other side, what may happen and it's difficult to exclude it that we may face also some completely new variant of the virus and in this case we need new vaccines. We need once more again very strict epidemiological countermeasures and it may trigger another round of the fight against COVID. But I hope that we may see in the last period a relatively mild course of the disease and we hope that this moment will be stable and we will not face some breakthrough variants which very complicated clinical course.

To be seen. Roman, let's check in towards the end of 2022 and find out what happened next. Thank you so much for being with us in the studio today. That was really interesting.

Thank you very much for inviting me and I hope that you will finally win the fight with COVID-19.

And thanks to all of our listeners. Please keep on tuning in to ESWI Airborne, the viral podcast series, where you can hear all about the latest on pandemics, vaccination, influenza visualising viruses and so much more. You're getting your news directly from the expert group of virologists and members of ESWI, the European Scientific Working Group on Influenza. Until next time, dear listeners, stay safe.

Aida Bakri: 29:28

ESWI Airborne is brought to you by ESWI, the European Scientific Working Group on Influenza and other acute respiratory viruses. These episodes would not be possible without the team's efforts and we would like to extend special thanks to our ESWI secretariat, our technical and IT teams, our arts team and our host, Clare Taylor. The podcasts are recorded virtually and we thank our guests for their participation in this inspiring series. Talks are adapted to a global audience and are intended to be educational. For any specific medical questions you may have, these should be addressed to your local general practitioner. Many thanks to our sponsoring partners and thank you for listening.

Walk the talk on immunisation

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