In conversation with…Dr Jason Kindrachuk

Last spring, Prairie Manufacturer’s editor, Jeff Baker, spoke with Dr. Jason Kindrachuk, Assistant Professor in the Department of Medical Microbiology & Infectious Diseases, at the University of Manitoba to learn more about COVID-19 and what lay ahead for us at that point.

Jeff recently reconnected with Dr Kindrachuk to chat about what we’ve learned over the past year about COVID-19, the difference that vaccines are making, how the end of the pandemic might look, and what individuals can do – separately and together – to bring the end closer for all.

This conversation took place on February 11, 2022 and has been edited for length and clarity. 

Jeff Baker (JB): Last time we chatted it was almost a year ago – almost to the day. We’ve had a lot of stuff happen. In your view, what is different, what’s the same? What have we learned that really stands out for you?

Jason Kindrachuk (JK): The biggest thing is, and I think there’s really no debate, is that vaccines work. We have not only one vaccine, but we have multiple vaccines that are available and have been widely distributed that are amazingly effective in being able to reduce the healthcare toll that we’ve all been concerned about. To me, that’s been one of the biggest lessons that I hope we learned. With these vaccines, we’re able to change the course infectious disease outbreaks and endemics very, very quickly – much more rapidly than we ever have previously, and that’s hugely important for us.

Now, we can’t be solely reliant on vaccines, though. We have to appreciate that whether it was luck, or the combined focus and expertise, it’s all contributed to how the vaccines have helped us, but we just don’t know whether this would bear out in the same timeframe or the same way with other infectious diseases.

The other thing that I think we need to appreciate is the challenge of vaccine-hesitant or vaccine-reluctant people; it’s something we certainly need to meet head-on. We can’t assume that everybody is on board and that the people who aren’t are just a very tiny minority that don’t wield any sort of authority or influence in the larger community.

We’re talking about fighting emerging infectious diseases. Now, it’s not only about battling the virus; it’s also about battling misinformation through good public messaging and science communication. Not many of us have been trained specifically in science communication and public outreach, but I think we’ve learned a lot and learned from so many people around us. It’s going to be a long-term process that we’re not going to solve in the next couple of weeks.

With all that said, there’s still some areas of concern that we need to address. While we’ve got many parts of Canada talking about removing restrictions and opening things up again, there is a large part of the global population that still doesn’t have regular and sustainable access to the vaccines.

This is about equity in terms of vaccination, and it’s about equity of health care access and supporting infrastructure and resources that give the ability to move vaccines into the communities that need them. We can’t forget that the pandemic isn’t going to be over until it’s over globally.

Discussions seem to be moving towards ‘learning to live with the virus’ and needing to ‘get comfortable with the virus,’ or that it’s becoming endemic. Well, part of living with the virus is continuing to learn about the virus. We also need to appreciate that living with the virus isn’t necessarily the most optimal move going forward.

A virus becoming endemic doesn’t mean it’s mild. Other endemic diseases, like malaria, still have a significant impact on the lives of a vast swath of our global community. We already face a lot of infectious diseases on an endemic basis, so are we comfortable with adding another one onto the pile? Let’s do everything we can to try and minimize the toll it will have.

JB: I know you’re not a historian or a political scientist, but you do know your stuff, Jason. Are there examples of other pandemics or viruses that have become so political? 

JK: We can look back at the pre-1900 smallpox vaccination campaigns in the United States and see that there were some groups pushing back against vaccination. In the 1918 Spanish influenza pandemic, we saw similar pushback against mask mandates, too.

I think part of the difference today is that we have social media and the ability for us to communicate globally instantaneously. We’re no longer talking about a situation where we have nations that are isolated and the ability to transfer information from one continent to another takes a long time. Those messages disseminate amazingly quickly, and, of course, there’s a co-ordination behind this which makes it much more challenging. This isn’t necessarily grassroots organizations that that are driving the campaigns.

While we didn’t want to see the situation come to this – which is the reality we’re living – there is an opportunity for us to learn. We need to look at things, acknowledge they are not perfect, and figure out what we need and want to change from a communication standpoint. I think that’s going to be the biggest question for us.

JB: We keep seeing new variants of SARS-CoV-2 popping up around the world. How do these variants keep happening? Can we prevent additional variants from appearing?

JK: Viruses have been in existence for eons. When we think about RNA viruses – SARS, influenza, etc. – they’re very good at what they do, but they’re also very good at not being efficient.

What happens is we get random mutations that often don’t amount to anything because they’re very random and they don’t change the virus’s behaviour. Occasionally, through chance events, you get the right combination of random mutations that can provide the virus with some sort of fitness advantage. It changes the behaviour enough that the new variant can out-compete other variants around it. 

As we investigate the patient populations, we’re learning more every day. We’re getting more information now that suggests chronic infections are related to the mutations, because you have this continual turnover of basically the same virus in a specific individual, and over an extended period it provides more time for mutations to occur. It gives the virus a bigger playing field to create and ‘try out’ these mutations.

Another thing to appreciate is that SARS-CoV-2 is no longer restricted to only humans. That’s important when we look at things through a global ‘one health’ lens that accounts for human health, animal health, the environment, and how it’s all interlinked. 

We know that cats and mink (among numerous other species) have tested positive for the virus, and now we’re seeing deer not only infected, but there seems to be ongoing transmission within the deer population. So, now the question becomes ‘when the virus is in those other animal species, what is it doing?’ What are the mutations that are occurring? Could they jump back at humans? Could they be making the virus worse for humans when it does jump back?

Testing every animal species for the virus isn’t necessarily feasible, so how do we apply what we’ve learned in the field, through computer modelling, and through machine learning to go forward? How does this inform the long-range plan for the virus? 

Talk of pandemics and viruses tends to gravitate towards the thought of eradication. However, we’ve only eradicated one human virus in all of history – smallpox – and it was unique to the human population. With SARS-CoV-2, I don’t see eradication as feasible. Even if we get transmission down to essentially zero in the human population, we just don’t know how far and wide its distribution is in the animal population.

The discussion then moves to controlling the virus, minimizing transmission generally, and continuing to adapt to what the virus is telling us about itself. If we want to reduce the emergence of variants, including variants of concern, we’ve got to think beyond our borders. This is a global issue.

JB: So, if the key is getting transmission down, what can individuals do to play a part in ending the global pandemic, regardless of what our local or regional politicians are trying to tell us?

JK: Yes, this is a global issue, but we can have control over this, and what we can do as individuals is help reduce the potential for ongoing spread. The vaccines aren’t going to end the pandemic on their own. We do this by getting vaccinated and by shifting our behaviours. 

We all need to get our third doses – and further doses, too, if that’s what this requires. We also need to shift our behaviours in the community so that if you’re sick or have symptoms, you don’t go out in public or you use a mask and be more conscious of your behaviours that could be contributing to the spread.

We need the public advocating to our governments, and certainly to international organizations, about the importance of getting the rest of the world vaccinated. And as we move out of the pandemic, we need to make sure we don’t make the same mistakes we made following SARS, Ebola, or the 2009 influenza, mostly in cutting sustainable funding for research and surveillance. 

We often see funding ramped up for a few years, then when people and governments lose interest, they tend to reduce the funding. We need to keep up the pressure on governments to make long-term investments, and not just when a new virus or disease emerges, but prior to those events occurring. 

JB: There are variations on the theme around the world, even within our own country, about what living in the pandemic looks like. But what does the end of this pandemic look like?

JK: Looking back to history – I was three years old at this point – to 1980 with the eradication of smallpox, there was massive media coverage of the announcements. The fact that we were able to eradicate this virus was ground-breaking. It’d never happened before. It’s probably not going to be the same situation with COVID-19 though.

We’ll see a move away from the toll the disease had on our health care systems, and we’ll start to see the scientific community move away from a sole focus on COVID-19. Most researchers I know, independent of their backgrounds in different viruses, they shifted their research to focus on COVID, but we need to get back to that other research too. 

Truly, COVID-19 has been a galvanizing event for the scientific community; we’ve been working so closely together and collaborating in so many ways, but those other research areas have unfortunately been neglected for the last couple years. 

I would say the true end to this pandemic is based on when we stop seeing high transmission rates in low- and middle-income countries. Yes, we’re seeing a light at the end of the tunnel in higher-income countries, and it’s very bright, but we need to make sure that light shines for everyone in every country. 

Look at influenza, for example. We talk about it being ‘just the flu,’ but the virus still kills 500,000 people a year across the globe. And influenza is a vaccine-preventable disease that still has disproportionate effects on the most vulnerable areas of the world. 

How many more diseases do we look at as being ‘just another flu;’ how many more do we want to add to that list? We don’t want to add anymore, so let’s do everything we can so we keep that list down to a minimum.

JB: Five hundred thousand deaths from influenza each year? That’s horrible. It’s like the cities of Regina AND Saskatoon disappearing each year, every year. 

JK: One hundred percent.

Again, I go back to this idea that with what it is now a vaccine-preventable disease, there are still individuals and populations that will have high risk of severe disease, even with vaccinations, but we have the tools and knowledge that can reduce the toll. 

If we’ve got this virus and let it continue to transmit widely, we know what’s going to happen. We’ve watched Alpha, Beta, Gamma, Delta, Omicron, among others, so we need to, at some point, say ‘let’s not keep letting the same thing happen.’

I work in virology. It’s a world of doom and gloom because emerging infectious diseases are not fun things to work on, but there is some reason for optimism. We just can’t let that optimism hide or minimize the situation that is still at hand in some parts of our world.