José Vicente Tuells Hernandez: Preventive Medicine Specialist and Director of Asisa Chair of Balmis Vaccinology at the University of Alicante Discusses Pandemics, Vaccines and Epidemiological Surveillance

Jose Vicente Tuells Hernandez, He has a degree in Medicine and Surgery from the University of Valencia, a doctor in Health Sciences and an Extraordinary Doctorate Award from the University of Alicante (UA). Specialist in Preventive Medicine and Public Health, he has been linked to the UA since 1984 as a professor and professor (Vaccines and Social Vaccinology) and is director of the Asisa Chair of Balmis Vaccinology at the UA and a member of the Royal National Academy of Medicine.

Last week the meditative doctor Cavadas warned about the dangers of another pandemic, worse than covid-19.

Well, predicting that there will be a new pandemic is playing it safe. Every 10 or 11 years in the world there is a risk of a pandemic, which are global epidemics. In 2009-2010 we had influenza-A. There have been other flus before. It is a phenomenon that occurs cyclically in the world. What happens is that in the world there are also local epidemics that we pay little attention to, outbreaks of Ebola, cholera, centered in some African or South American countries. There are continuously epidemics in the world and from time to time the risk becomes more global and becomes a pandemic.

But worse?

Pandemics have to do with diseases that are transmitted either by air, by water, or by person-to-person contact. Say that it will be worse? Well, it depends on the type of virus it is. You can’t know. If it’s a new virus, the risk is always a little higher. In the case of SARS-CoV-2, it was not new, it was a mutation of a previous coronavirus. With all due respect to Dr. Cavadas, the prediction of a pandemic has not been made by him alone, it has been made by other gurus including Bill Gates for example, and it is easy to do thinking that at any moment the multiplication of a virus can be triggered.

“There is still no approved vaccine, there are vaccines approved for pandemic use, but they have not passed the phase 3 trial phase and are still being studied for their adverse or secondary effects”

And how does Epidemiology deal with it?

The important thing about this is not so much when but how we are going to be prepared to face it. And it is evident that the covid-19 pandemic has taught us some very important lessons. First, the isolation and detection of the virus. Second, epidemiological surveillance of cases and contacts. And thirdly, find a remedy such as the vaccine. But that has not been unique in history. What has been unique in history is finding it in so few months. It has been the largest launch of a vaccine campaign in history, the largest number of vaccines launched in the world and also achieved in less time. That vaccine is not yet finalized. There is still no approved vaccine, there are vaccines approved for pandemic use, but they have not passed the phase 3 trial phase and are still being studied for their adverse or secondary effects.

[Repaso pandémico: dos años del primer caso oficial de coronavirus en la Comunidad Valenciana]

The general opinion is that it has been managed well.

In Spain there has been talk of the creation of a Public Health or Health Surveillance Agency that has not come to fruition. Epidemiological surveillance, instead of being strengthened, has been weakened because right now there is no follow-up on cases or contacts. And some cases are not even declared because many family doctors have ordered that those who do not need hospitalization be declared as trivial disease or not declared. Something in which I disagree because I believe that the cases must be reflected in the patient histories, even if it was a banal covid-19 and the person had it like a cold. If good epidemiological surveillance is not carried out, we will never know the size of the disease or the beneficial effect that the vaccine is producing, nor when it is time to give a new dose or to schedule or lengthen the time between doses.

Why are there epidemics like influenza-A declared global pandemics, which remained diluted in certain areas of the world?

This has been global because the virus had more virulence, worth the redundancy, like those of the coronavirus saga. Due to the mechanism of transmission of the disease and above all because in acute respiratory conditions it produced disastrous consequences that made it a more lethal disease. When you currently suffer from the flu, it is possible that throughout your life you have already had some previous flus, with which your body has a vague memory of what the flu virus is. This did not happen with SARS-CoV-2.

How would you rate the performance of governments in general around the world, because for there to have been this vaccine there had to be a lot of economic investment?

From a scientific point of view, it has been a great success to have more than half a dozen respectable vaccines available in such a short time. That is incontrovertible, just like the global launch of those vaccines. It has been spectacular. This has been due to the fact that when it comes to taking out a vaccine in clinical trials, the deadlines have been shortened and a surveillance system for clinical trials has been introduced that has allowed them to be overlapped in phases 1, 2 and 3. However There has been a phenomenon that has been called “vaccine nationalism.” That is, that many states or groups of states decided to provide themselves with vaccines for their inhabitants and the market collapsed because they compromised with this or that industry for so many millions of vaccines. Spain has had vaccines available from the first moment and they have had the possibility of getting a dose, a memory, another memory and more. Paradoxically in Africa that has not happened, which is an example of inequality.

It is surprising that in some European countries we have their inhabitants with three or four or five doses of vaccines and that only in 20% of African countries, it does not arrive, their inhabitants have two doses. That brings mutations so I think we should be smarter. But even if it were only for the issue of inequality, that management has not been good. Then, on the other hand, an initiative called COVAX was launched to help the poorest countries. But not all that are needed have been sent. In this sense, the European Union shows hypocritical streaks. On the one hand, with the industry I guarantee enough vaccine doses for all my inhabitants, and on the other hand I give a little charity to low-income countries.

“The European Union shows hypocritical streaks. On the one hand, I guarantee with the industry enough vaccine doses for all my inhabitants, and on the other hand I give a little charity to low-income countries”

Are airborne epidemics the most dangerous?

They will always be the most difficult to control, or the water ones too. We breathe many times per minute. In a waterborne disease you can close the source or for sexual intercourse you can stop maintaining them. The air does not distinguish and the proof is that the covid has affected the most vulnerable, but it has affected both young people and older people, rich and poor.

Other scientists warn that with climate change many glaciers are melting and prehistoric viruses that we do not know about could be released.

There are thousands of theories because we are in a populist age for everything. In the last three years we have discovered hundreds of epidemiologists, hundreds of volcanologists, hundreds of climatologists. Populism and social media means that there are people who are walking encyclopedias or Wikipedias. They talk about everything and know everything.

You have to leave your space and time to science.

Clear. What do we do with the protocols, what do we do with the people who were needed in public health? This is not being worked on and it is unfortunate. At first there were military and backup people at the checkpoint. But it’s been a year or so since they were removed. Yes, the cases have decreased dramatically, but there is still covid-19. And they don’t want to know anything. They had to staff Epidemiology and now it has returned to the previous figures. When it is necessary to hire ten epidemiologists again, wouldn’t it be better to already have three prepared?

“They had to staff Epidemiology and now it has returned to the previous figures. When it is necessary to hire ten virologists again, wouldn’t it be better to already have three prepared?”

What have you tried to explain in the exhibition ‘The smallpox vaccine. Its dissemination in Spain and America’ which ends on July 10 at the College of Physicians of Alicante?

It is a walk through the history of smallpox and how it spread throughout the world and how it was fought. First of all, with invocations to gods and goddesses, saints or saints. Later, when it was observed that people suffering from smallpox remained immune to the virus, a technique called inoculation or variolation was introduced, which consisted of taking pustules from a person who had already passed it and transmitting it to a healthy person.

[Operación Balmis: 218 años desde que un alicantino capitaneó la primera expedición sanitaria internacional]

The vaccine, how is the vaccine for smallpox discovered?

Approximately 220 years ago, Edward Jenner discovered that cowpox could immunize man against human smallpox. He invents vaccination, a word that comes from cow. He observed that some female farmers or cowgirls who worked as milkmaids did not get smallpox. The exhibition vindicates the figure of Jenner and that of two Spaniards, Ignacio María Ruiz de Luzuriaga and Francisco Javier Balmis, the disseminator or preparer of the vaccine in Spain, on the peninsula, and the one who took it to all the Spanish overseas territories.

With vaccinating children. Could it be done today?

Now ethically it would be difficult, but it must be recognized that it was free, a philanthropic expedition with the aim of eliminating the spread of smallpox in the world. Vaccination is, in perspective, the beginning of the pillars of the Welfare State. Some children died, but the mortality of the vaccinated children was very low compared to the risk they had throughout the trip and all the vicissitudes they suffered.

“We know more about Balmis’s feat because it retains a more adventurous spirit and is made looking abroad. In fact, Balmis’s feat was admired by Jenner himself because the British government was not capable of organizing an equal expedition”

The figure of Balmis is well known, but not so much that of Ruiz de Luzuriaga.

And that was academically superior. An enlightened doctor of the few Spanish doctors who studied the career outside of Spain and received a doctorate outside of Spain. He received his doctorate in Edinburgh and Spain was already the secretary of the Royal Academy of Medicine for 30 years. We know more about Balmis’ feat because she retains a more adventurous spirit and is made looking outside. In fact, Balmis’ feat was admired by Jenner himself because the British government was not capable of organizing an expedition like it. And also with the part of philanthropy, the gratuity so that the vaccine would remain in the places where it arrived. With the Vaccine Boards, which was something very new, the first vaccination centers.

In fact, smallpox has disappeared from the world.

Two strains remain for research at two sites, in a Russian laboratory in Siberia and at the CDC in Atlanta in the United States.

What are the star pieces that Alicante can see in the College of Physicians?

We have the famous original lithograph that was made of the Balmis expedition of which there are only two in Spain. The other is in the National Library. We have the engraving of the Jennerian Society where all the people who have done things for vaccination appear, including Balmis and Luzuriaga. We have an original book by Jenner from 1798. Documents such as letters requesting vaccinations from the Countess of Montijo.

And a very special section for the people of Alicante, the history of the sculpture promised to the city and which was never carried out. A work by Pepe Gutiérrez, a sculptor who made bonfires in Alicante and to whom the piece was commissioned, with all the journalistic journey on the matter that began in 1978 with the mayor Ambrosio Lucíañez, the different sketches of him.