Thread by @SGriffin_Lab

It's important to remember what's needed as a long-term solution to #COVID and future pandemics.
#VaccinesPlus requires population-scale mitigations, built around a core of broad vax coverage.
Suppression of prevalence is key to reduce exposure, risk to #CEV, and SARS2 evolution.

Continued development and access to antivirals, ideally as drug combinations, will blunt the impact whilst we strive for this, increasing pandemic preparedness.
However, prevention always beats cure.
There MUST be Govt recognition and appropriate measures vs aerosol transmission.

We need to think long-term re vax programmes.
We've stopped, basically, meaning a longer, more damaging journey to a (possible) predictable relationship with SARS2 that can (possibly) be dealt with via targeted approaches.
To pretend to do this successfully now is just ludicrous.

We did ~70% of the emergency cover, then just hung up our gloves and let rip🤦‍♂️
Kids' 1st experience of SARS2 will be infection, not vaccines...utterly bonkers.
We need preschool triple jabs with paediatric dose mRNA followed by 6 month/1 yr boosters, dep on prevalence & variants.

This is neither measles, nor influenza. It is SARS2.
We r fortunate to have excellent paediatric vaccines that protect vs severe COVID. This is important as u5s, especially 6m-1yr are at ⏫️risk of acute COVID.
By contrast, we have this 🤦‍♂️
👏@sheenacr

theguardian.com/commentisfree/…

Boosters and future vax in development may include mucosal strategies, ideally targeting invariant epitopes, but they require the systemic immunity of current mRNA vax as a foundation, IMHO.
If we stop immunising, inevitably population immunity will deteriorate. Harm will ensue.

But, ANY immunity, regardless of its nature, faces continued challenge by high levels of exposure to infection. Studies agree that resistance to infection in populations is eroded by high prevalence.
So not only are we diminishing protection, we're also testing it to the limit.

There is always a pyramid of severity for any disease - broader at the bottom 4 less severe, sharper at the top for nasty.
How tall and broad that pyramid is depends on virulence and Immunity, and it's overall size on prevalence.
So, two of these variables CAN be influenced.

The threshold for severity drops for immunosuppressed/deficient people, or those with comorbidity.

For SARS2, there's also a separate pyramid for longer term problems, including "classical" #LongCovid and other sequelae.

So, at the moment, #CEV face a VERY large, sharp pyramid.

But, even though the pyramid is broader for many of us, its size, due to prevalence, still means that the summit exceeds the threshold of protection in acute disease.

The threshold is far lower when it comes to #LongCovid...current policy COMPLETELY ignores an entire pyramid!

Of course, other factors can alter the shape of the pyramid and the threshold of severity, for example, age, therapeutics, vaccines, prior infection, reducing individual exposure/inoculum, other medicines, malnutrition etc.
So, shrink/change the pyramid, or raise the threshold.

We also need to be aware of where we and/or our threshold might place on the pyramid, which is made difficult by reduced surveillance, and is near impossible for #CEV.
The shape of the #LongCovid pyramid is also uncertain for many of us, even now, although we know vax changes it.

So, THIS is why #cleanair is important, why (improved) vaccines are essential, and why testing should continue whilst prevalence remains high.
If we leave things as they are, I can see it taking years to achieve the degree of cross-protection and slower variation seen 4 flu.

This has to happen on a population scale, or the #CEV will continue to suffer, be forced to live restricted lives, and be directly affected by the actions of others.

Difficulties arise from this issue, plus the #LongCovid pyramid affects more people than some may havevus think.

The ideal is that we can ALL understand our pyramids, thresholds, or, even better, have risks mitigated by public health measures so we can all live lives according to weighted decisions balanced by individual risk, and impact upon others.
Sadly, the UK direction is not aligned.

We MUST remember this, especially as many people ARE able to judge their pyramids.
This isn't fair, of course, but it's reality (that needs to change). "MOST" isn't good enough, but at the same time blaming individuals just serves to further divide what should be united opinions.

It is the job of government to ensure that mitigations allow people to genuinely "live" with COVID.
Some folks are aware of their pyramid, some don't care, some are hyper aware, some choose to risk certain scenarios on balance of risk. The injustice isn't their fault, it's govt.

Many of us have complex reasons for actions we undertake during these difficult times.
We need to draw together and reestablish public health, pressure government to act for the vulnerable.
It's understandable that #CEV and #LongCovid feel cornered, justifiably, this must change.

Let's keep our eyes on the prize. #vaccinesplus, #cleanair, shrink those pyramids, and get ready for the next one...
Oh, and asking people to pay for essential medicines sucks, big time! 🤬