Interview with Peter Piot, Director of the London School of Hygiene and Tropical Medicine and Special Advisor to the President of the European Commission on the response to the coronavirus and COVID-19: how science has been feeding into policy-making?
What does your role as EU special advisor on COVID-19 entail?
Peter Piot: I am part of the advisory panel on COVID-19 that regularly meets with Ursula Von der Leyen. We are continuously reviewing the situation and advising on issues around testing, border crossing, vaccination strategy…As special advisor, my focus is on R&D and working on the Access to COVID-19 Tools (ACT)-Accelerator and COVAX initiatives to ensure equitable access to affordable COVID-19 vaccines in Europe and beyond.
Ursula Von der Leyen has demonstrated great leadership in dealing with both the economic and health impact of the pandemic. She has stepped up, even though healthcare is not a competency of the European Union, given visibility to the issues, and ensured that vaccines will be available in Europe and for low-income countries.
How has science and medical evidence been feeding into policy during the pandemic?
Peter Piot: The pandemic has catapulted science to the forefront of policy-making.
No one in our lifetime has been confronted with this situation and level of uncertainty. There is far more certainty now, if only because all EU countries have proven that it is possible to reduce the spread of this virus by adopting different strategies decided at the national level.
Scientists can provide advice, but it is the politicians who have to make the decisions in the end, sometimes in the absence of evidence because there isn’t any available on what works. They are the ones having to consider the trade-offs between public health and the economy.
What are some of the problems when politicians say they are “following the science”?
Peter Piot: It sounds like they are abdicating responsibility. Science should inform policies aimed at reducing the spread of the virus and mortality rates, but science is only one element of the decision-making process.
I have never seen so much intense collaboration and sharing of knowledge. It is a challenge to keep up with (and make sense of) all the information that is coming out. However, this is a good ‘problem’ to have. When we had the SARS epidemic in 2003 or the Ebola one in 2014 there wasn’t that much information sharing. Scientists were keeping their findings to themselves until they were properly published. I think we have made real progress on this front.
Are current measures getting the balance right between protecting health and keeping the economy going?
Peter Piot: In theory, there is no dichotomy, if we can’t keep the virus under control we can forget about re-launching the economy. It is more about the nuances of the ‘how’. Most countries, except Sweden, went for a total lockdown that did slow down the spread, but this is not something we can repeat or maintain for long. Thanks to more refined epidemiological surveillance we identify outbreaks better and faster, predict where they are more likely to occur and take appropriate action. This is how we can find a compromise between controlling outbreaks and not bringing the economy to a complete standstill.
In practice, this requires pretty sophisticated test and trace systems and while some countries, such as Germany and Denmark, are doing quite a good job at controlling the spread of the virus, others like the UK and Spain aren’t.
It is an extremely difficult time for politicians trying to implement measures that infringe on people’s freedom in societies that are characterized by individualism. In general, South East Asian countries, where there is a much stronger sense of community, have been far more successful in controlling the virus. If everybody respected the rules and recommendations we wouldn’t have these outbreaks or have far fewer.
How would you rate the EU’s response to COVID-19 so far?
Peter Piot: In terms of supporting research and the procurement of vaccines, I think the European Commission has done a really good job. In terms of actually controlling of the epidemic, which comes down to the measures implemented by each member state, the situation is very variable and still evolving. Some central European countries that acted promptly and had very limited spread initially, are now also seeing a rise in cases. Germany has probably had the best response, they started early with testing, have a strong central leadership and are also able to implement local measures effectively.
I am a strong believer that the response has to be locally driven. You need a strong interaction and synergy between central policy making and local authorities that have to take responsibility and accountability for what is going on in different parts of the country.
What should the role of the EU be in epidemics?
Peter Piot: Viruses don’t respect borders. Although each member state has its own healthcare system, COVID-19 has forced us to think about how to manage health crises at the EU level.
Border crossing restrictions and travel quarantines are a total mess at the moment. Agreement and coherence within Europe are urgently needed. To address this, the Commission is working on a proposal that encourages every member state to use the same criteria to assess risk and agree on quarantine periods.
In addition to securing an economic recovery package that will help re-build better, the EU is playing an important role in strengthening Europe’s capacity for biomedical research and ensuring that poorer countries in the world have access to treatments and vaccines. We urgently need to establish a European instrument such as the American BARDA (Biomedical Advanced Research and Development Authority) to directly support the development of tools to fight epidemic threats.
When dealing with epidemics, if countries/people only think about themselves, we all lose.
You have recently stated that a vaccine is the only way out of the pandemic. Might effective treatments be found before a vaccine is widely available?
Peter Piot: We are likely to see incremental progress with treatments. In the next few months I expect we will see better treatments not just with small molecules but also with antibodies. These are also being tested as prophylactic treatments. The EU’s clinical trial network is helping to speed up these studies by facilitating collaborations between pharmaceutical companies, scientists and clinicians across various European countries.
What lessons have we learnt regarding science and policy making during the pandemic? Will we be better prepared for future ones?
Peter Piot: I hope so! We must document what is going on very well for the future so that when COVID-19 stops being headline news the EU will continue to invest in preparedness and public health systems, not just for preventing infectious diseases, but also other chronic diseases such as obesity and diabetes that place a huge burden on healthcare systems.
This interview was conducted on October 6, 2020.
• Joint statement on scientific advice to European policy makers in the fight against the COVID-19 pandemic
• COVID-19, future pandemics and other crises in the global context. Scientific advice on the management of the COVID-19 pandemic, better preparedness to future pandemics and resilience to crises in general