Is the global eradication of COVID-19 possible?

• Looking to the past eradication of diseases, a new paper argues that the global eradication of COVID-19 is possible.
• The paper quantifies the factors affecting eradicability and scores a few diseases accordingly.
• The authors of the paper hope and believe that the international disruption that COVID-19 has caused may drive the world’s governments toward a global solution.

As wealthier nations struggle to get more people to undergo vaccination, lower income nations struggle to acquire sufficient vaccine doses, and new SARS-CoV-2 variants emerge, a newly published paper states that the global eradication of COVID-19 remains possible nonetheless.

Lead author of the paper, Dr. Nick Wilson of the University of Otago in Wellington, New Zealand, pointed out to Medical News Today that skepticism regarding the paper’s conclusion is not surprising:

“[The] reaction is completely understandable at the current point in time, [but] when the plans to eradicate smallpox were announced, and there were still millions of cases globally per year, many people were also very skeptical.”

The paper cites the globally felt disruption resulting from COVID-19 as presenting an opportunity for a concerted international effort. Critical to an eradication program’s success is establishing strong vaccine coverage and staying ahead of rapidly developing variants.

The paper — entitled, “We should not dismiss the possibility of eradicating COVID-19: Comparisons with smallpox and polio” — appears in BMJ Global Health.

The metrics of optimism

The authors of the paper define eradications as the “[p]ermanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.”

The paper presents a preliminary assessment of the eradicability of COVID-19 by comparing it with other worldwide diseases, including smallpox, which has been eradicated, and polio, for which just one of three serotypes persists.

Based on an established scoring system and additional technical, sociopolitical, and economic factors that the authors included, the study compiled a total of 17 variables relating to vaccine-preventable diseases, with a three-point relative scale for each variable. Each of the diseases received a score according to these metrics, with higher values indicating a greater chance of eradication.

COVID-19 scored as being slightly more eradicable than polio.

Smallpox was most eradicable with a score of 2.7. In comparison, COVID-19 scored 1.6, and polio scored 1.5.

Medical challenges

Dr. Robert Kim-Farley, MPH, of the University of California, Los Angeles’s Fielding School of Public Health — who was not involved in writing the article — told MNT: “The single greatest obstacle to true eradication will be achieving and sustaining the very high vaccination coverage (using a vaccine with no or extremely low infection breakthrough) needed to achieve full herd immunity, whereby transmission of COVID-19 in a community ceases.”

Although he is not giving up on achieving higher vaccination coverage through more robust international public health and social measures, Dr. Wilson said that herd immunity is not a requirement for eradication.

“Smallpox was eradicated without achieving herd immunity,” said Dr. Wilson, “but rather by targeted vaccination approaches. It is also notable that countries have also eliminated measles without (quite) achieving herd immunity, and, in fact, the whole of the Americas eliminated measles for a time.”

The paper notes that there is also a “risk of the persistence of the pandemic virus in non-human animal reservoirs,” a phenomenon that is occurring with COVID-19 in the U.S. and elsewhere.

Asked whether current animal reservoirs may doom an eradication effort, Dr. Wilson said we are not there yet.

“If we had the situation of influenza viruses (widespread in wild birds) then obviously eradication would not be feasible,” he noted.

He added that “it is possible to eradicate diseases in some wild animals — for example, eliminating rabies in wild foxes via aerial bait drops containing vaccine (as per Western Europe).”

Dr. Kim-Farley cited what he sees as the three most significant obstacles to eradication success.

Current vaccines, noted Dr. Kim-Farley, “although offering excellent protection against severe illness and death, still have some breakthrough infections that can infect others.”

Identifying cases of often-asymptomatic COVID-19 is also harder, said Dr. Kim-Farley, than it is with smallpox and measles, which “are usually always symptomatic and identifiable.”

Finally, there is “the lack of political will to apply (and the unwillingness of some persons to accept) the strict public health measures, such as required vaccination, required mask wearing, required quarantine and isolation, and required testing.”

The international political challenge

When MNT asked Dr. Wilson whether he thinks COVID-19 eradication will occur, Dr. Wilson answered in the affirmative, adding: “Our article largely focuses on technical issues as to eradication feasibility. The question of whether the global community will attempt it will depend on some international expert group (i.e., at the World Health Organization […] or United Nations-level) making an expert assessment of the technical, socioeconomic, and political feasibility.”

Dr. Wilson said he was concerned about “the current fractured nature of global cooperation” and the “vaccine nationalism” that the paper describes.

Still, he is hopeful that past eradication successes will ultimately inspire the global community.

Dr. Kim-Farley suggests that “it will be feasible to control COVID-19 as per the definition in the article; namely, ‘Control: The reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction.’”

In any event, according to Dr. Kim-Farley, we should still try to eradicate COVID-19.

“We should appreciate that control of COVID-19 is a worthy goal even if we do not achieve true eradication,” Dr. Kim-Farley said. “Effective vaccines and appropriate public health measures can greatly reduce serious illness and deaths due to COVID-19 to such levels that, even if endemic in our societies, COVID-19 does not take a significant toll on our populations due to needless suffering, disability, and death.”

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