Gibraltar aims for community protection against Covid-19 in ‘weeks, not months’, Medical Director says

Gibraltar could be “very close” to achieving community protection against Covid-19 and is hoping for “a normal summer” thanks to the rollout of its vaccination programme, Dr Krish Rawal, the acting Medical Director of the Gibraltar Health Authority, said on Thursday.

Gibraltar hopes to be “days and weeks, not months and years” from achieving the critical mass of people vaccinated against the virus that health experts and officials believe could provide the key to a gradual easing of restrictions and a return to a semblance of normal life, Dr Rawal said.

But while Dr Rawal’s assessment was upbeat, the core message from the Gibraltar Government remains one of caution and the need to guard against complacency.

The vaccination programme will in the weeks ahead become a key element of the Rock’s strategy to emerge from the Covid-19 pandemic, but many questions remain as to the impact the vaccine will have on this community’s protection from the virus, not least because of the many new strains that have now been detected around the world.

Increasingly, scientific research points to the likely need for vaccines to be adjusted to tackle those news strains, much as is the case with the annual flu jab, and for boosters to ensure continued immunity.

Likewise, Gibraltar’s fluid interaction with both the UK and Spain means that any decisions about lifting restrictions here must also take into account what is happening in those countries.

For now though, the success of the UK-backed vaccination programme in Gibraltar gives at least some scope for optimism.

Dr Rawal was speaking during a webinar organised by Gibrael, the Gibraltar Israel Chamber of Commerce, during which he discussed the Rock’s vaccination drive alongside Professor Lior Zangi, a leading Israeli medical professor at the Icahn School of Medicine at Mount Sinai Hospital, in New York, who has been involved in the research and development of the Moderna Covid-19 vaccine.

Israel, which has rolled out a mass immunisation programme, tops the global vaccination table having administered 57 doses per 100 residents.

Although the data is still early, cases and hospital admissions in Israel are falling steeply among vaccinated age groups in the first clear sign worldwide that Covid-19 jabs are preventing illness following the mass inoculation campaign.

Gibraltar, which has received four shipments of vaccines delivered from the UK and has so far administered 21,999 doses, including 6,737 second doses, follows Israel in the global vaccination table.

But this is largely due to the fact that the Rock’s small size and population – which in this context includes cross-border workers, who are also being vaccinated - means vaccines can be swiftly administered without the logistical challenges faced by larger countries.

Dr Rawal said vaccine uptake in Gibraltar had so far been “very good” and well above the 70% that experts say is necessary in order to achieve so-called “herd immunity” from the main strains detected so far.

In the groups vaccinated to date, only 3.5% have declined the vaccine, an important fact given that around two thirds of the population have received their jabs in the month or so since the start of the programme.

“We’re very close to achieving that herd immunity level already and I think we will achieve that with the most recent delivery [of vaccines],” Dr Rawal said.

“In terms of vaccinating the entire population, you have to bear in mind that people are entirely within their rights to decline the vaccine if they don't want it.”

“We’re reluctant to set an absolute date [for all the community to be vaccinated] because we’re dependent on our next delivery, but we're aiming for a normal summer and I think that's a realistic target.”

“I think if we give people something to aim for, I don't think that would be unreasonable.”

“We are measuring the timescale of our vaccinations for herd immunity and beyond in days and weeks, not months and years.”

BEYOND VACCINATION

What happens once that critical mass of vaccinated people is achieved is still unclear, however, and will be a political decision driven by science.

Israel plans to open up some hotels, gyms and other leisure facilities in two weeks to those documented as being immune to Covid-19, the country’s Health Minister, Yuli Edelstein, said on Wednesday, in a possible harbinger of a wider emergence from the pandemic.

Having administered Pfizer/BioNTech vaccines to almost 40% of its 9 million population, Israel saw first signs of managing to outpace highly contagious virus variants, he added.

Israel has said it would issue an official app allowing users to link up to their Health Ministry files and show if they have been vaccinated against or recovered from Covid-19, with presumed immunity, in order to gain entry to leisure facilities.

Those to whom neither applies would be able to get a Covid-19 test and, if the result is negative, display it on the app for up to 72 hours of similar access, officials have said.

Initially dubbed ‘Green Passport’, Israel’s system has been renamed ‘Green Pass’ in an apparent bid to head off speculation that it would also enable unfettered travel abroad.

Gibraltar has also introduced a card for people who have received their second dose of the Pfizer/BioNTech vaccine, but its value outside Gibraltar remains unclear.

Additionally, the Gibraltar Government has not yet outlined its plans for how the card might be used inside Gibraltar in the coming weeks and months either.

For now, its position on the need for community-wide caution remains unchanged given the impact of the virus to date.

“Our aspiration is to continue to keep pace with UK on vaccinations and to protect as many of our population as possible in time for the warmer months,” a spokesman for the Gibraltar Government told the Chronicle.

“We still need to be very, very cautious though.”

“We cannot yet reliably plan for a normal spring or summer, however much we might want to.”

“If we let down our guard now, we will be falling at the last hurdle.”

EARLY EVIDENCE

Professor Zangi said there was growing scientific evidence from Israel that people who had been vaccinated would not transmit the disease to others, although he cautioned research on this was still at an early stage.

But he said that early research pointed to a route out of the pandemic restrictions. The more people got vaccinated swiftly, he said, the less room the vaccine would have to mutate.

“The science behind it says - and we have now more and more evidence - that the people who are vaccinated, their body cannot hold the virus,” he said.

“So the chances that you will transfer it to someone who is not vaccinated is reduced significantly.”

“So it makes a lot of sense that if you cannot be sick and you cannot transmit the disease, or you can severely reduce the transmission of that disease, why can’t you go back to your life?"

“Scientifically, I can tell you that we don’t know of any virus that if you are vaccinated against, you can transmit it.”

“The data that we have now which is emerging from the work in Israel is not compelling yet, but we would be very surprised if someone that's vaccinated would be able to transmit the disease.”

Gibraltar is taking a more apprehensive approach and will maintain restrictions including social distance, mask use and close monitoring of community infections.

That stance stems not just from the devastating cost in human life over the past two months, but from the wider economic and social impact the virus has had on community life for the past year.

It means that frontline healthcare staff, for example, will continue to be swabbed weekly at least for the next 12 weeks even if they have had their two doses of the vaccine.

But officials and their public health advisors are already looking beyond the current situation, hence the early introduction of the vaccination card.

“The card was [introduced] on the basis that there was nothing else available at the time, certainly nothing internationally recognised,” Dr Rawal said.

“So we've introduced something to show people that they've had the two doses of the vaccine.”

“In terms of how that translates now to whether it is recognisable at the border with Spain or on flights to the UK, for example, we don’t know as yet.”

“But we at least have something.”

Even so, despite the uplifting assessment after months of bleak news, Dr Rawal stressed that there was no rush to remove restrictions until there was firm evidence to back the initial assumptions on the impact of the vaccination programme.

“In terms of relaxing the restrictions, I recognise entirely what [Professor Zangi] is saying about the research that is emerging, that once you've been vaccinated, you can't transmit it - but this is clearly early research,” he said.

“We’ve taken a slightly more conservative, cautious approach.”

“So we're maintaining a lot [of restrictions] when it comes to social distancing and masks and swabbing.”

But he added: “Given this global vaccination programme, research is moving so quickly that I anticipate things will change within those 12 weeks.”

VACCINE RELUCTANCE

Professor Zangi reflected too on the reluctance among many people around the world to take the vaccine over concerns about its safety or efficacy.

As a researcher whose work was fundamental to the development of the Moderna vaccine, he said he could not understand those objections.

The Moderna vaccine, like the Pfizer/BioNTech jab, works by introducing into the body genetic material, called mRNA, that contains the instructions to make the so-called “spike” protein of the coronavirus.

In response to these proteins, the body’s immune pathways are activated – a response that offers protection to the virus itself.

“There are people who don't want to be vaccinated [and] I have to face a lot of these fake news about the vaccination,” Professor Zangi said.

“This vaccine is one of the biggest achievements that's ever been done by humankind and people are behaving like we want to give them toxins or whatever other things they have in their minds.”

“I don’t really get it.”

“These vaccines work extremely well and hopefully more people will want to take it.”

“The reasons people get the vaccine and want other people to get vaccinated is because the chances for mutation reduce dramatically.”

“So we have an interest that everyone gets vaccinated.”

Professor Zangi said no one should be forced to take the vaccine if they did not want it.

But he hoped that as governments eased restrictions based on the critical mass of vaccinated people, those reluctant to be jabbed would start to change their mind.

“This can be a 'carrot and stick' kind of thing, but more using the carrot,” he said.

In parallel, he added, scientists had a duty to talk to the public and explain and answer all their questions.

“Our job is really to reduce those alarming news [about the vaccine] that are actually false,” he said.

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