THREAD: Lancet comment on elimination

So, ICYMI there's a Lancet comment piece doing the rounds, shared by several prominent proponents of Zero Covid, comparing countries that opted for elimination, to those which didn't

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00978-8/fulltext

Let's consider a few points:

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1. The piece lists Australia, Iceland, Japan, New Zealand, & South Korea as countries that went down the elimination route.

a) Japan *didn't* go for elimination, but mitigation. See this article from the BMJ: https://www.bmj.com/content/372/bmj.n294 The case numbers also reflect this:

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b) South Korea might have aimed for elimination, but it is unclear as to whether it can be classified as an elimination country currently. Furthermore, SK was far more prepared for a pandemic- having already faced MERS. And even they struggled:

https://www.bma.org.uk/news-and-opinion/prepared-for-the-worst-how-south-korea-fought-off-covid-19

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c) Moreover it can be argued that Iceland's situation was not comparable with many other western countries H/T @ScienceShared

https://twitter.com/ScienceShared/status/1387701260841848843?s=20

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There's a lot to unpack here, the discussion with regard to vaccination rumbles ever on & it's not something I'm going to rehash now, suffice to say that there are many signs from countries with a high level of vaccination eg Israel, that SARS-CoV-2 can be well controlled.

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"History shows that vaccination alone can neither single-handedly nor rapidly control a virus and that a combination of public health measures are needed for containment." This is an un referenced statement, but as a counterpoint:

https://vk.ovg.ox.ac.uk/vk/measles 

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The statement of the Biden health department is also included as an argument for elimination.

Worth noting that:

a) The US is not pursuing an elimination strategy, with many states dropping restrictions in favour of a mass vaccination approach

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b) The US is hardly doing its part for vaccine equity:

https://twitter.com/DaveKeating/status/1385535841058140164?s=20

c) Politicians often say one thing, & do another (no I don't have a reference for this, other than 30+ years of being alive). Including them to justify an argument seems.... questionable

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Next:

a) It has taken 11 months to create the Trans Tasman bubble, & those 11 months have not entirely been straightforward- & remember- this is a travel bubble between 2 pretty geographically isolated countries, probably the easiest "bubble" to make

https://7news.com.au/travel/new-zealand-locks-in-trans-tasman-travel-bubble-commencement-date-c-2523236

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b) Worth also noting that closing borders has not been without consequence for many Australians

https://www.theguardian.com/australia-news/2021/apr/16/un-urges-australia-to-act-quickly-to-bring-stranded-australians-home

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Ultimately, I think the most important question, is whether it's actually helpful to compare approaches like this- whilst clearly we can look to other countries for ideas & strategies, nobody has a time machine- we cannot go back to March 2020 & pursue an elimination attempt

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There are many reasons why a strategy in one country may not suit another. This is not a "one size fits all" situation, & every approach comes with benefits & trade offs.

I agree with the sentiments in this thread https://twitter.com/VictimOfMaths/status/1387721386857222154?s=20

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Analyses like this are, by their nature, reductive. Covid (& the response to it) is country specific, & dependent upon a host of factors, eg: spread, existing capacity & technology, tolerance for surveillance & privacy, geography, the time interventions are implemented etc

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It is not simply a case of copying & pasting one country's response to another.

Sure, we can learn something, but direct comparisons are bound to be flawed

Anyone proposing coopting another country's response as a panacea, or without caveats is being overly simplistic

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