The Colombian Óscar Franco is one of the most influential epidemiologists. Professor at Harvard and soon at the University of Utrecht (Netherlands), the magazine “Global Health and Pharma” recognized him as “Academician of Epidemiology of the Year” in 2020. He has more than 800 scientific articles published in high-impact journals and an H-index of 104 (web of science) and 132 (Google Scholar). In this interview with FARO, he analyzes the current moment of the COVID pandemic.
–We are in the third summer of the pandemic and once again we hear that it is over and we are back to the new normal. Unfortunately, that was not the case.
–We have been talking about pandemic and post-pandemic for almost the same time. Pandemics can end for two reasons: first, because the virus stops affecting people, which happened with the so-called Spanish flu. But the pandemic can also end when we normalize it as a society. The pandemic is a socio-cultural phenomenon, it affects not only our physical health, but also our mental health, the economy and people’s behavior. It ends when we as a society normalize it or when the World Health Organization officially declares it over.
-How long will it last?
-At first I said that until 2023 or 2024. I think I still follow that prediction. But it all depends on how much we remain conscious in terms of behavior as human beings, as people are becoming more relaxed with the conditions to prevent the virus. It’s not over yet.
–The current approach to the pandemic, at least in the West, is what has been called in Spain the “flu”. It sounds like what the controversial Great Barrington Declaration stood for, or Sweden’s policy in 2020: that the elderly population protect themselves and the rest of society lead normal lives. Is this strategy flawed?
There is no perfect approach, they all have flaws. Today, we have vaccines that prevent the most severe forms of disease and death; and variants that are not the same as those at the start of the pandemic, that of Wuhan and that which emerged in northern Italy and severely affected Spain and Italy, among other European countries. Circumstances have changed. It is another virus with a different behavior and now the flu is an inevitable phenomenon because the severity of the virus has decreased and the level of contagion has increased. A large part of the population is protected by vaccines against serious diseases and mortality. That’s not to say there won’t be more deaths and hospitalizations, but that’s how society is adapting. This approach could change at any time if the virus continues to mutate as is and a much more serious, as well as contagious, variant emerges.
– Vaccine experts disagree on whether to immediately apply a second booster dose of the vaccine to the vulnerable population or wait for formulations suitable for omicron.
-It’s true, and new variants appear every time that vaccines can respond to in a lesser way. Reinfection is increasingly common. The game is not over and the rules of the game change according to the evolution of the score. Right now we are one of the most contagious variants we have had in contagious diseases in general. Vaccines have been effective in preventing serious illness and death, but they do not prevent infection. The new variants defend themselves better and better against them. The recommendation of the vaccine continues for the population over 60, people with comorbidities, suffering from hypertension, heart disease… For the rest, hopefully we have a vaccine that is universal for all coronaviruses or less for most variants.
– There is a scientific race to obtain vaccines that protect against all coronaviruses, as you just mentioned, and intranasal sterilizing vaccines that would prevent contagion. Will it be possible to achieve this?
-The pandemic has taught us that the impossible is possible. The example is that we have produced several vaccines in less than a year. In August 2020 we had Sputnik. Technology has advanced. Ain’t new [la ARNm], had been in development for 30 years, and what the pandemic did was channel resources. This same technology will allow us to develop much broader vaccines in terms of variant coverage and even other viruses in a single application.
–Many scientists call for ventilation and air filtering systems to be installed in public buildings. Will the paradigm change with the cleaning of the air, the same way the water changed when in 1854 John Snow [considerado el primer epidemiólogo moderno] discovered that cholera came from contaminated sources?
-I hope so. In the past, diseases were said to be transmitted through polluted air, this is what the miasmatic theory of disease said. The Romans took care of it with sewers, with sanitary systems that eliminated waste water. Modern architecture, for example, Le Corbusier, reflects the need for ventilation against tuberculosis. People’s behaviors have changed, and all of this is reflected in economic, social, housing and behavioral systems. This pandemic will leave us with positive things, in addition to the negatives that we already know.
–Are governments taking the ongoing COVID problem in its fair measure or are they underestimating it?
–Rather than undervalued, the situation is unknown. It is not known how many people are affected, how badly and how to manage it. We don’t yet know what the burden we are facing is. Because of this lack of studies and because time is so short, we still don’t know the long-term effects. It means that there are not enough plans for the future. Over time, as we learn more, governments will respond.
–It is speculated that this coronavirus could be persistent and cause other long-term illnesses, such as hepatitis C viruses, Epstein-Barr [asociado a la esclerosis múltiple] and HIV. Should we remain cautious or is this an unfounded fear?
-As long as the pandemic continues, we must remain cautious. We relax too much, thinking that the pandemic is over and the situation is settled. Not only is it not over, but it will have an impact not only on health, but also on our way of life, the economy, the architecture, our behaviors… We don’t know if the long COVID can have long-term effects on our health, whether the virus persists or whether it may affect people’s risk in other ways. Only time will tell, but caution is in order.
– What surprised you the most in this pandemic? Has it changed the paradigms of epidemiology?
-As a scientist, what this has shown me is that medicine and health are part of a complex set of circumstances and factors that surround decision-making to manage a pandemic. We don’t make decisions as scientists, our job is simply to investigate, provide knowledge and communicate it. Decisions are made by politicians, and they have to play with a lot of factors that include not only health, but also economics and security. As an epidemiologist, what I have seen is that this arrogance that we had as a species is wrong, we are vulnerable as humans, and the globalization that we have achieved is good and bad. Globalization is not new, but it has accelerated. What happens in one part of the world can happen very quickly in another. We saw it with Wuhan, with India and with the new variants. We have also learned that these years of dedication and research have put us in a much better position to deal with a pandemic like this. The flu of a century ago, misnamed the Spanish flu, killed between 45 and 100 million people, and now we’re not talking about the same levels. This is due to technological development and improved patient care and research capacity. This won’t be the last pandemic, but it better prepares us for the next ones.
PERSONAL CARD
From September, Dr. Óscar H. Franco Durán will return to the Netherlands, where his family resides, as Director of the Department of Global Public Health and Full Professor of Public Health at Utrecht University. He will also continue as an assistant professor at Harvard University and scientific adviser to the French television channel France24. Until the middle of this year, Dr. Franco was Director of the Institute for Social and Preventive Medicine and Full Professor of Public Health and Epidemiology at the University of Bern in Switzerland.
As a researcher, Professor Franco has over 800 scientific articles published in high-impact journals and an H-index of 104 (web of science) and 132 (Google Scholar).
In his native Colombia, he obtained a bachelor’s degree from Colegio San Pedro Claver in 1992 and a doctorate from Universidad Javeriana de Bogotá in 1998. He then obtained a master’s degree in clinical epidemiology, a doctorate in public health and a postdoctoral degree in epidemiology and public health at Erasmus University Bogotá, Rotterdam, The Netherlands. He then obtained a clinical specialization in public health at the University of Cambridge, England, where he also served as assistant professor and director of the master’s degree in public health.
From 2012 to 2018 he worked as Full Professor of Preventive Medicine at Erasmus University Rotterdam, where he led the research group on cardiovascular diseases and the research group on aging.
Óscar Franco is a Fellow of the European Society of Cardiology, at St Edmunds College, University of Cambridge, he was awarded the Netherlands National Public Health Prize in 2005, the Life Sciences Prize for Epidemiologist of the Year in Europe 2020 and was appointed Honorary Professor at Javeriana University in Bogotá, Colombia, in 2021.