German Virologist Christian Drosten on the Ongoing Battle Against COVID "In the Worst Case, It Could Take a Few More Winters"
In an interview, leading German virologist Christian Drosten discusses his concerns about a major new wave of COVID-19 this winter, his own mistakes in the pandemic and the reasons he distanced himself from a government committee convened to battle the disease.
DER SPIEGEL: Professor Drosten, the American medical historian Charles E. Rosenberg once wrote that "epidemics ordinarily end with a whimper, not a bang." You instilled us with hope in January that there might soon be an end to the whimpering. You said we would reach the endemic state by the end of the year, that we were practically at that goal. Do you still view the situation that way – or would you like to take this opportunity to correct yourself?
Drosten: Did I really say it like that? (laughs)
DER SPIEGEL: Yes.
Drosten: At the time, I assumed certain basic premises – that, for example, there would be a consistent political line on pandemic control and an effective update vaccine, and that the virus wouldn’t change much. Otherwise, of course it’s not like the endemic state is just suddenly there and we can celebrate something like World Endemic Day. The endemic state is a question of definition. It is reached when fewer and fewer people feel the pandemic in their everyday lives.
DER SPIEGEL: The development of an Omicron vaccine proved to be more difficult than anticipated.
Drosten: … and few expected such rapid changes in the virus. When the Alpha variant came along, it was very surprising for me. When Delta appeared, I was skeptical at first. Then, with Omicron, we had to reorient ourselves yet again, and since January, there have already been new Omicron sublineages. So, I actually would like to correct myself. I no longer believe that we will have the impression by the end of the year that the pandemic has come to an end. The part about the whimpering is true: It will take longer.
The article you are reading originally appeared in German in issue 26/2022 (June 25th, 2022) of DER SPIEGEL.
DER SPIEGEL: Case numbers are rising again. What is your latest forecast? Where do you expect things to go from here?
Drosten: We are actually seeing an exponential rise in the number of cases again – the BA.5 variant is just extremely transmissible, and people are losing the protection from their most recent vaccination at the same time. I am hoping that the school summer holidays will somewhat curb the increase, but from September onward, I am afraid we will have very high case numbers. You can see in other countries that hospitalization and death rates are again rising. Unfortunately, that will also be the case here. Overall, however, far fewer people will become seriously ill and die than in 2021. Still, there is no normalcy when so many people are sick. If decision-makers don’t do anything, there will be a great deal of illness-related absence in the workplace. This will become a real problem that will burden not only those affected, but also the already beleaguered economy. Not to mention long COVID, which should be taken very seriously.
DER SPIEGEL: The recommendation is currently making the rounds on Twitter that people should deliberately infect themselves now in summer to be immune in the winter. How do you feel about that?
Drosten: That is absolute nonsense. It isn’t possible for enough people to get infected in the summer to keep the corona numbers down in the winter. That was evident last year in Britain: The measures were relaxed there in the summer because of the European football championship, and there was a huge number of infections – but in the following autumn and winter, the number of severe cases and deaths was even higher than in Germany, and this despite better vaccination coverage among the population. The summer infections had no preparatory effect for the winter.
DER SPIEGEL: You said yourself last autumn that, sooner or later, everyone would have to get infected, and that this would be justifiable on the basis of vaccination. You said that infection would develop mucosal immunity, which would protect against further infections. Many people took that as encouragement to catch the disease. Did you really mean it that way?
Drosten: Under no circumstances should you infect yourself intentionally! You should continue to avoid it to the extent possible, also because of the risk of long COVID. Unfortunately, though, infection is inevitable in the longer term. And gradually, a mucosal-specific protection actually forms, which I assume will make the overall population immunity more resilient. On the other hand, as we are seeing right now, the virus is also evolving and getting better at escaping the immune response. I assume there will eventually be a new equilibrium: Population immunity through vaccination and infection will eventually be so strong that the virus will fade in significance. Then we will be in the endemic state.
DER SPIEGEL: When will that be?
Drosten: It’s hard to say. In the worst case, it could take a few more winters.
DER SPIEGEL: People don’t seem to be protected from reinfection for very long after an infection with the Omicron variant. Does mucosal immunity even work at all for Omicron?
Drosten: One reason for the frequent reinfection is probably that Omicron doesn’t multiply in the lungs as much as earlier variants – it remains mostly in the upper respiratory tract. Infections in the lungs lead to a stronger immune response and later to a more pronounced immunity. It appears that this is not the case with Omicron, at least not for the BA.1 and BA.2 sublineages. Even with the seasonal coronaviruses that circulate endemically in the population, we still see regular reinfections in the upper respiratory tract. For the Omicron subvariant BA.5, which has recently become dominant in Germany, there are indications that it does affect the deeper respiratory tract more strongly again – so immunity could also possibly be more pronounced again after infection. But we still lack more precise knowledge about this.
DER SPIEGEL: If BA.5 affects the lungs more severely, should we expect more severe disease again from this point on?
Drosten: I don’t think we are going to see crowded ICUs again, but the tide is turning more in the direction of disease again. It is not true that a virus automatically becomes increasingly harmless in the course of evolution as some claim. This makes me even more worried about the autumn. Moreover, influenza will be a further factor, as can be seen at the moment in the Australian winter.
DER SPIEGEL: You have said that it is not feasible to vaccinate a large portion of the population against COVID every six months in the long run. Why not?
Drosten: Besides the financial and logistical issues, the main scientific concern here is the problem of what is known as original antigenic sin. That’s why the time interval between vaccinations may need to be greater.
DER SPIEGEL: Can you please explain?
Drosten: Original antigenic sin is a phenomenon that is known from influenza. Applied to SARS-CoV-2, it would mean that vaccines against the new virus variants might not work or will work poorly against these new variants because antibodies are still being developed primarily against the original strain of SARS-CoV-2 – that is, if the immune system has been trained for this type through the initial immunizations. This is currently being discussed in theory – and, unfortunately, it is often used as an argument against vaccination. On the other hand, the question is whether the original antigenic sin really plays a relevant role in SARS-CoV-2 if the interval between vaccinations is long enough. I tend to think it does not. At the same time, it is not yet known how long the interval between vaccinations should actually be.
DER SPIEGEL: So, should people get immunized with the Omicron combination vaccine in the autumn or not?
Drosten: I would do it. This vaccination is only foreseen for people over 70, and I'm not that old yet. But even at 50 and older, you can still experience severe disease.
DER SPIEGEL: Would you recommend the combination vaccine even if a person has already been vaccinated four times with the wild-type vaccine?
Drosten: The combination vaccination will also benefit people who have been vaccinated four times. A weighting of immunity toward Omicron is expected with it, and I suspect the effect will get better the greater the interval from the previous vaccination. However, those who are concerned should also learn about the new medications for early treatment – they are available now.
DER SPIEGEL: And when are the better vaccines coming?
Drosten: There are very promising approaches to mucosal vaccination, such as nasal sprays, which could build up mucosal immunity and protect against infection, but they will not be ready this winter. All in all, though, I still think our current situation is not so bad. The important thing is to make much better use of what we already have. Foremost, of course, classic vaccination. It goes without saying that elderly people should ideally be vaccinated four times. We should also make full use of the possibilities that exist in Germany for childhood vaccinations; this has not happened by a long shot. Everyone else should at least be triple vaccinated and quadruple vaccinated if desired, and I think the employer associations and the Economy Ministry should also call for company coronavirus vaccinations once again before the autumn for this reason.
DER SPIEGEL: How is that going to work?
Drosten: Quite simply with the announcement: "Dear employers, this is in your own interest. Please help to ensure that a large part of your workforce doesn’t have to stay home sick in the fall. Now, once again, call on your people to get vaccinated." We should be able to immunize or provide a booster shot to as many as 40 million people before winter. That would really make a difference. Also, there is still far too little known about the possibility as a high-risk patient of taking an antiviral drug in case of infection.
DER SPIEGEL: If the vaccination campaigns fail, do you really think people will go along with coronavirus containment measures, which would then be necessary again in the worst-case scenario, for a third year in a row?
Drosten: When the going gets tough, I still believe in the good in society. Most people are reasonable. They will all pull it together again, put on a mask and do what's necessary. I am quite sure of that.
DER SPIEGEL: You belong to the minority of those who have never had a SARS-CoV-2 infection. How have you managed to avoid it?
Drosten: It is difficult to say. So far, I guess I have just been lucky. I rarely put myself in risky situations, but I’m not overly cautious either. I am taking business trips and going to restaurants again, and if I’m in a larger group where no one is wearing a mask, I don’t put one on either. I don’t want to be Dr. Strange. But I always try to be considerate: If for example, a customer in a bakery wears a mask, I put one on because that person could be a risk patient.
DER SPIEGEL: You’ve been attacked and insulted for your public engagement and you have received death threats. Do you regret stepping forward?
Drosten: In terms of research, this pandemic was certainly the opportunity of a lifetime for me. But I let it pass. At the beginning of the pandemic, I made the very conscious decision to get involved publicly because I felt that this was the way I could do the most for society as a scientist. But if I had known how much negative feedback would come from a very vocal minority, how certain circles would systematically try to steer public and political opinion in a certain direction, I would not have done it. That really shocked me.
Virologist Drosten: "I sometimes have the feeling that the people in the vocal minority who reinterpret and twist everything simply have greater endurance."Foto: Julia Steinigeweg / DER SPIEGEL
DER SPIEGEL: Corona truthers and vaccine opponents often rely on simplistic purported truths, such as COVID is "like the flu." Some even use your term "mucosal immunity" when calling for people to deliberately infect themselves. Despite your award-winning podcast, did you ultimately wind up failing as a communicator of science?
Drosten: I don't see it that way. I do not, at least, question the impact of the podcast. At the beginning, especially, it was essential to explain the scientific background in detail. This also ultimately helped opinion leaders to quickly get up to date on their level of expertise. And in the more than 1,500 pages of the transcript, you can still read everything and get an idea of the growing body of research. What really perplexes me, though, is that I sometimes have the feeling that the people in the vocal minority who reinterpret and twist everything simply have greater endurance – perhaps also because they seem to be preoccupied with nothing but this all day long and have nothing better to do. Whereas I and many other scientists who have done a lot of good communications work are now in a position where we slowly can’t do it anymore and urgently need to get back to our normal work, these people just don’t stop – they keep getting a stage. I find that very concerning.
DER SPIEGEL: You resigned from your post on the expert committee set up by the German government and the federal parliament to examine, among other things, the success of certain coronavirus containment measures. Was that a mistake?
Drosten: Yes, it was wrong.
DER SPIEGEL: Why?
Drosten: One of the main reasons I left was that the job could not be done with the group of people in place. If you want to approach things seriously in a scientific manner, you need people who are willing to search through the literature, assist with writing and who bring in additional scientific expertise. Epidemiology, for example, wasn’t represented at all. The commission was assembled according to political criteria and not scientific criteria.
DER SPIEGEL: You weren’t provided with any external help.
Drosten: I was told that it wasn’t possible because only people who had been appointed personally could participate in the work. Later, I read in the Süddeutsche Zeitung newspaper that my colleague Hendrik Streeck had confirmed that external experts not cited by name had contributed to the text that was produced after my resignation. That made me feel a bit like I was taken for a ride. On top of that: There was also supposed to be transparency specifically about the experts who were taken on board here.
DER SPIEGEL: Some members of the (business friendly) Free Democratic Party (FDP), a junior partner in the government coalition, didn’t want you on the commission because they felt that you, as a supporter of containment measures, were biased.
Drosten: This myth, which was subsequently exaggerated in the media, is preposterous: Drosten initiated the measures then, and now he wants to prevent them from being evaluated. Both are patently false. I am a scientist, not a decision-maker. I never initiated any measure. And I wanted to push forward with the evaluation.
DER SPIEGEL: What can the commission's findings, which will be presented next week, still contribute?
Drosten: My criticisms of the composition of the commission, its resources and its working methods, with which I am not alone, are well known. The fact that it is only now being revealed, after inquiry, that ghost writers who are not known by name were involved in the genesis is unacceptable to me personally. And that, I have to say, leaves the work of this commission open to question from me as a citizen and as a scientist.
DER SPIEGEL: Did you react too sensitively with your departure?
Drosten: I certainly have to face such criticism. Perhaps I got too carried away with this media fable about my alleged bias. Perhaps I should have been tougher and said: I know that I’m not biased, so it doesn’t matter what some newspapers write – let them write it. Things might have been different if I had stayed on board. But given the composition of the commission, it would have been difficult to do so even with the greatest perseverance. I also found it completely unacceptable that inside information from the consultations was repeatedly leaked.
Drosten during his interview with DER SPIEGEL: Of his resignation from an expert government commission on the pandemic, he says: "It was wrong."Foto: Julia Steinigeweg / DER SPIEGEL
DER SPIEGEL: Was the committee's composition a fatal flaw from the very beginning?
Drosten: The fact that parliament, the ministries and select scientific institutions – the Leopoldina (Germany’s academy of sciences), for example – initially convened this body is laid down in the Infection Protection Act. I don’t think that is up for criticism. But it is essential to criticize the fact that this was then set in stone. They should have said: We’ll create the nucleus and the scientists should then say what and who they need in addition for valid scientific evaluation.
DER SPIEGEL: Much of the criticism of the coronavirus containment measures also came from segments of the evidence-based medical community, which complained that they were imposed blindly, without evidence of their effectiveness.
Drosten: Here, I would just like to remind people: A pandemic is a state of emergency! People who are only willing to accept studies if there is a proper control group will have to acknowledge that they are wishing for too much in a pandemic. I am not going to be able to convince the district administrator to do a lockdown in village A and not in village B, and then see how things go in B with my control group – in the end, all the old people there will be dead.
DER SPIEGEL: There is nothing wrong with insisting on the best possible studies.
Drosten: Nobody is questioning that. However, it is simply out of touch with reality and unethical, also in view of the health risks posed by a pandemic, to demand a control study during such an emergency situation.
DER SPIEGEL: What measures do you think are working so well now that we should be looking at them again this winter?
Drosten: Wearing masks indoors is the least painful, and the more people you have together and the longer, the more important that becomes. The basic principle should always be the consideration: With more and more people in a room, the risk increases exponentially.
DER SPIEGEL: The debate about the course of the pandemic continues to rage, but the one about its origins has grown quieter: laboratory or animal reservoir? Where does SARS-CoV-2 come from?
Drosten: There are new assessments that suggest even more strongly that the virus originated from the Wuhan wildlife market. For the laboratory origin, on the other hand, no further arguments have been added, and those that do exist are weak in my opinion.
DER SPIEGEL: You signed a controversial statement in The Lancet very early on, vehemently opposing the laboratory theory when the evidence was still thin. Was that a mistake?
Drosten: This was not a scientific paper. In early 2020, at the last physical meeting at WHO in Geneva, I was personally asked if I would sign a statement of solidarity with Chinese scientists who were being pilloried; they had something prepared. It later emerged that it had been co-written by American scientists who had a conflict of interest and whose names did not appear as authors. If I had known that beforehand, I probably would not have participated or I would have at least asked about the background of the conflicts of interest.
DER SPIEGEL: You're a member of a new WHO team tasked specifically with investigating the laboratory theory. Will you be provided with access to the Chinese laboratories?
Drosten: I don’t think that will be possible. WHO may be able to provide contacts, but it will not be able to say: "We're now going to pound on the table and get to the bottom of this!" That's not the mandate of the mission.
DER SPIEGEL: The dramas and difficulties aside, do you also find the pandemic inspiring?
Drosten: Oh, there are so many nice little things – just getting feedback from people next door and leading politicians is good. And as a little added bonus, you get to meet people you otherwise would never get to know – as a scientist at virology congresses, you tend to move in a completely different, isolated world.
DER SPIEGEL: What are you most looking forward to now that the pandemic no longer dominates everything?
Drosten: That I can move freely again, that I can go on a camping holiday, for example.
DER SPIEGEL: That's your plan for your summer holidays?
Drosten: (laughs) Yeah, sure. I do all sorts of normal things.
DER SPIEGEL: Professor Drosten, thank you for this interview.