Elimination strategy optimal pandemic response – new research

Professor Michael Baker.

A goal of eliminating community transmission of the pandemic virus causing COVID‑19 is achievable and sustainable as a response strategy for COVID‑19 and other emerging pandemic diseases, new research suggests.

An analysis published today in the high impact British Medical Journal (BMJ) by University of Otago, Wellington, Professors of Public Health, Michael Baker and Nick Wilson, together with Professor Tony Blakely, at the University of Melbourne, shows the goal of eliminating COVID‑19 using an elimination strategy can be successful.

They are now calling on the World Health Organization to provide more support for countries pursuing elimination as a response to the pandemic, including improved ways of reporting data from countries using this approach.

Professor Baker explains the goal of elimination is a major departure from pandemic influenza mitigation. The typical approach of high-income nations such as those in North America and Europe has been a controlled transmission strategy using mitigation or suppression.

“Elimination may now provide the preferred approach to managing emerging pandemics, which is a major revolution in thinking in this area,” Professor Baker explains.

“Experience indicates that elimination of COVID‑19 has been successful in several jurisdictions, albeit with occasional outbreaks from border control failures that need to be managed rapidly and effectively,” he says.

“Obvious benefits of rapid elimination are greatly reduced case numbers, a lower risk of health sector overload and fewer overall deaths from COVID‑19. There is also an opportunity to avoid serious health inequities, such as the catastrophic effect of previous pandemics on Māori.

Professor Baker says the main reason for writing this paper was to summarise what has been learned in New Zealand and Australia with COVID‑19 elimination and to share these lessons with countries struggling with the pandemic.

“Over the course of this year, we have been in regular contact with overseas colleagues, particularly in the UK, who are advocating for their governments to take an elimination or 'zero covid' approach. The emergence of an apparently more infectious virus variant is just another reason to eliminate this infection.”
Conditions favouring successful elimination include informed input from scientists, political commitment, sufficient public health infrastructure, public engagement and trust, and a safety net to support vulnerable populations.

Professor Nick Wilson.

Professor Wilson says one of the perceived barriers to applying a vigorous response, such as elimination, to the COVID‑19 pandemic, is the belief that this might sacrifice the economy and ultimately result in more hardship and negative health effects.

“Our preliminary analysis suggests that the opposite is true. Countries following an elimination strategy – notably China, Taiwan, Australia and New Zealand – have suffered less economically than countries with suppression goals. Our analysis was based on gross domestic product (GDP) projections for all of 2020 from the International Monetary Fund.”

International tourism, for example, is substantially reduced, regardless of individual countries having border control restrictions, Professor Wilson says.

“Iceland reopened to tourism, but the demand remained low, imported cases of COVID‑19 increased and the net effect was a larger decline in GDP than was seen in New Zealand.”

The introduction of effective COVID‑19 vaccines is also likely to further facilitate elimination, the researchers say.

Reference: Baker M, Wilson N, Blakely T. 2020. Elimination may be the optimal response strategy for covid‑19 and other emerging pandemic diseases. BMJ. 371:m4907. doi: 4910.1136/bmj.m4907

Link to paper: https://www.bmj.com/content/371/bmj.m4907

For further information, contact

Professor Michael Baker
Professor of Public Health
University of Otago, Wellington
Email michael.baker@otago.ac.nz

Professor Nick Wilson
Professor of Public Health
University of Otago, Wellington
Email nick.wilson@otago.ac.nz

Liane Topham-Kindley
Manager, Media Engagement
University of Otago
Mob +64 21 279 9065
Email liane.topham-kindley@otago.ac.nz