RAZINA MUNSHI: The ‘prevention paradox’

Governments have grossly over-reacted to the pandemic, people have begun to declare. The smattering of initial voices pressing for an end to lockdowns has given way to a clamour. So governments are caving in and easing restrictions on movement and economic activity. But this only sends the Covid-19 infection rate higher – and one by one, countries are hit with a second wave of infections.

Christian Drosten, the director of the Institute of Virology at the Charité hospital in Berlin – and one of those who identified the Sars virus in 2003 – calls this the “prevention paradox”.

In Germany, says Drosten, people see that hospitals aren’t overwhelmed and that the spread of the virus wasn’t nearly as dire as initially feared. They can’t understand why their shops and factories have to shut. For many Germans, Drosten is the evil guy who is crippling the economy, he told The Guardian.

But those people refuse to look at the experience of Germany’s neighbours, or at some US cities. It has led Germany to discover that a competent, early handling of the crisis can become a burden later on.

The prevention paradox occurs when a policy is introduced – at a cost in terms of time and convenience – yet the potential benefit to individuals is relatively low. The World Health Organisation says the prevention paradox shows that interventions can achieve large health gains for populations, but might offer only small advantages to each individual.

Last week the rates of new infections increased in Germany. The numbers rose as well in China and South Korea, which have also recently eased lockdown restrictions. This includes a cluster of new infections this week in Wuhan after no new cases had been reported there for a month.

As US states, too, start to allow more economic activity, Anthony Fauci, the director of the country’s National Institute of Allergy & Infectious Diseases, says: “In my mind, it’s inevitable that we’ll have a return of the virus … when it does, how we handle it will determine our fate.”

Is the prevention paradox a useful reference to counter voices that suggest the prevention is more harmful than the disease itself?

Darrell Hudson, associate professor at the Institute for Public Health at Washington University’s Brown School, cites the examples of illnesses such as polio, smallpox and rubella. Most people have never met someone affected by these diseases, since vaccination efforts have been so productive. “When there are no new cases, people start to ask: ‘Why do we need vaccinations again?’”

The prevention strategy has worked so well, in fact, that there is no-one around with polio to demonstrate how debilitating that condition is.

Now, Covid-19 isn’t polio. And a lockdown as a prevention strategy will never be as successful as a vaccine. It is but one measure, along with social distancing and better hygiene, that can slow the spread. If nothing else, understanding the prevention paradox could help explain how the extreme efficacy of vaccines is actually the reason for recent resistance to vaccines.

Goodbye to a terrible custom

To bring it back to something we shouldn’t hold on to, The Atlantic says good riddance to the handshake. The article dwells on that 29-second handshake of Donald Trump and President Emmanuel Macron of France, and delves into the history of this Western norm. The gesture, Megan Garber writes, “no longer makes sense when the human hand itself can double as a bioweapon”.

On another matter, Kenya’s The Nation laments the reporting on Covid-19 in Africa. Archives are not neutral; they’re sites for contestation and projections of power, says writer Nanjala Nyabola. Her view is that flawed and partial accounts of pandemics that understate the agency of affected communities and overstate the contribution of foreign interventions can have consequences long after the emergency period.

And concerning the next US election, the New York Review of Books writes that with the coronavirus pandemic, Republicans may have discovered the ultimate voter-suppression tactic. Writer David Cole says the suppression tactics the party previously pursued pale in comparison to the fear of contracting a deadly disease, which is certain to deter many people from going to the polls. Cole argues that if citizens aren’t allowed to vote though the postal service they are effective being denied the right to vote at all.

* Munshi is News & Fox editor of the FM​

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