Infectologist Saulius Caplinskas: "I do not want to be a bad harbinger, but it is obvious we are entering an era of viruses"

When after 30 years I finally met Professor Saulius Caplinskas, now already the ex-director of Lithuania’s Center for Infectious Diseases and AIDS (ULAC), a prominent infectologist and, certainly, one of the very most recognizable TV faces during the COVID-19 pandemic, face to face, I felt as though I was meeting a good old friend. Together we reviewed the magazine “Saugok sveikata” (“Protect your health") published by the Centre and edited by me in the early 1990s. We also remembered the club "Journalists against AIDS" of which I was president at the time in a twist of the most stunning circumstances. In 1992, when I, a sophomore student, went to Miami to work for a cruise company, each of its future employees had to take a mandatory blood test. Due to reasons unknown to me, a higher-than-normal amount of antibodies was found in my test, so what the Americans did was send me back home for a thorough health check. Extremely anxious, I rushed to Caplinskas, the-then director of the AIDS center in Vilnius. "Do not worry, you really don't have AIDS – antibodies in the blood can increase for various reasons, and the Americans simply saved on you by not carrying out a more thorough blood test," he cheered me up.

I don't know anything about viruses, but, in terms of communication, the information campaigns against AIDS (HIV) and against the coronavirus seemed similar to me due to their wide reach. How much were both campaigns similar to you?

There are definitely similarities. In both cases, especially in the case of AIDS, when there were no social networks like the ones today, it was necessary to "break through" the walls of silence and indifference. There was especially a lot of fear – sometimes justified, often not – of social stigma in the case of the AIDS pandemic. From the beginning, I told everyone: "You can't stigmatize people. AIDS is not a disease of separate groups of people."

At the AIDS center, we had to educate journalists, advise them on what information to publish. You remember that we had the newspaper "AIDS kronika" (“AIDS chronicle”), the magazine “Saugok savo sveikata” (“Protect your health"), etc. The main goal was to educate and motivate people, especially from high-risk groups, to change their behavior.

In addition, during the AIDS era, the-then Ministry of Health had given us, the AIDS Center, a free hand. "Do whatever it takes to keep the virus from spreading and giving us headaches," said the ministry heads to me.

In the case of the corona virus pandemic, on the contrary, there was a lot of mistrust in everyone, including private health care institutions, laboratories, and the institution of family doctors (physicians). The entire response was overly politicized, focused on directives and prohibitions, and concentrated only in the hands of the Health Ministry.

Over the two years of the corona virus pandemic, I counted I gave around 1200 interviews, including publications authored by me. This also shows how much public attention has been paid to the corona virus.

Like no one else, you knew well the “backstage” of the COVID decisions of the governments, first of that led by Saulius Skvernelis and, now, Ingrida Simonyte. Do you believe there have been mistakes in the COVID handling?

There were quite big mistakes (made). Instead of making efforts to prevent COVID – to vaccinate those groups of society where its spread was the greatest and the consequences were the most severe, the Governments simply closed the country. And for so long!

With the onset of the COVID-19 pandemic, it was clear to me that statistically one in three people who contract it will experience no symptoms, most will be mildly ill, and the most vulnerable will be those with weakened immune systems, including those 65 and older.

So, it was necessary to go to those groups – to vaccinate and educate all of them– not to scare and "lock up" the entire country, especially children, for whom the virus is much less dangerous.

With the introduction of mandatory vaccinations for individual professions and activities, another red line has been crossed. And then we have those decisions to close or delay planned health services, not to mention the forced 14-day isolation for doctors who have been in contact with a COVID patient but who did not get sick.

The price of the mistakes in Lithuania is one of the highest excess mortality rates in the world in 2021 and 2020.

Of course, I am in no way denying the danger of the corona virus – it is necessary for everyone to protect themselves, and especially their elderly relatives, to comply with hygiene requirements.

In all countries at all times there have been, there are and, I have no doubt, there will be anti-vaxxers, hence the World Health Organization (hereinafter WHO) has recommended paying attention only to those who understand the importance of vaccinations and to those who doubt their benefits.

Frankly, I regret that many of my expert insights were not taken into account. Or it was done too late. I did not take part in the decision making.

To tell the truth, I had to go through many experiences (during the pandemic) – even institutional mobbing.  I was fired from the position of director of the ULAC after the accusations against me were fabricated, but the court reinstated me and awarded me compensation. By the way, the former Minister of Health (Aurelijus Veryga) also signed the decision to close the Center of Infectious Diseases and AIDS and the current minister left the decision intact.

Have the statistics of sexually transmitted diseases changed significantly over the last 30 years?

 It depends on which region of the world and which diseases we are talking about. In Lithuania, during the period you mentioned, the incidence of registered bacterial sexually transmitted infections (STIs) decreased, and a particularly large change in the incidence of gonorrhea was observed. The number of such diseases decreased significantly already at the very beginning of the AIDS pandemic – people began to be more careful; their sexual behavior became more responsible. Thus, on the one hand, the trends in the decrease in the incidence of STIs are determined by changed sexual behavior; on the other hand, the availability of tests is also changing, people prefer anonymous health care, and doctors are no longer afraid not to register cases, so some of them may not be included in the statistics. And such a, let's say, softer approach to STIs can do a disservice, because without ensuring high-quality examination and treatment, all of which constitute effective infection management, in the future we can expect leaps in the growth of such cases and challenges – how to cure a person in general, we may see drug-resistant gonorrhoea, much higher infertility rates and other complications.

To me, the lower numbers of STI cases in Lithuania testify that Lithuanians are more restrained and change sexual partners less often than many Westerners. 

The highest incidence of STIs is registered among young people. It is estimated that 5 to 7 percent of sexually active individuals by the age of 19 have chlamydia, which, if not properly treated, can account for up to a third of all infertility cases.

When it comes to human papilloma virus (HPV), as many as 75 percent of people have encountered it at some point in their lives.

It is important to mention that since 2016 September 1, executing the National Immunoprophylaxis Program, 11-year-old girls are being vaccinated against HPV infection in Lithuania. The vaccination protects against types 16 and 18 of the human papilloma virus, which accounts for about 70 percent of cases. In five years, HPV vaccination coverage in Lithuania has increased fivefold.

In Lithuania, only girls are vaccinated against HPV, while 13 EU/EEA countries already recommend vaccinating both girls and boys with the much more effective nine-valent vaccine, which protects against a wider range of HPV types, including those that cause genital warts.

Will there be pandemics of other viral diseases after the COVID-19 pandemic is finally over?

I think so. We just don't know when, where and what kind of virus it will be. Infectious viral diseases have made a resurgence. Not only the WHO warned about this, but also the disease control centers in America and Europe did so. I myself have talked a lot about this. Unfortunately, they pose a threat both to public health and to each of us. 

I believe that we haven't really “run away” from COVID, either. SARS-CoV-2 is a mutating, adaptive virus. Its stronger Alpha and Delta variants were outcompeted by the much faster-spreading Omicron, which thankfully causes a milder disease.

It is likely that there will not be more severe variants of the virus that will land people in the intensive care unit. But one thing is clear: there is a large niche for the virus to spread and, probably, it will never be completely eliminated, and will gradually turn into just another wave of the corona virus.

I have no doubt that we will see more cases of influenza and acute upper respiratory infections in the future. Tuberculosis has not disappeared, nor have HIV, hepatitis, also sexually transmitted infections.

Unfortunately, more and more microorganisms are becoming resistant to antibiotics due to the irrational use of antimicrobial drugs (usually antibiotics). Consequently, infections will be more difficult to overcome, and often with social media promoting mistrust of vaccines, the number of non-vaccinators will certainly not decrease.

I think it's only a matter of time before we see outbreaks of already forgotten diseases such as measles, diphtheria, whooping cough, which are already being registered in other European countries.

Generally speaking, I am against mandatory vaccinations, but it is necessary to systematically and responsibly educate people, expand and improve the vaccination schedule for other infectious diseases, for example, including free vaccinations for chickenpox and tick-borne encephalitis, HPV vaccination for boys and men.

Let me remind everyone that the COVID-19 pandemic was caused by the virus jumping over the species barrier. HIV also arose because the virus jumped the species barrier – from monkeys to the human population, as in the case of monkey pox, by the way.

Nowadays, especially before the COVID pandemic, we travel a lot and quickly – across several continents in a day, which means that the spread of various infectious diseases is also accelerating. If we make it possible for viruses and bacteria to spread, they will definitely take advantage of it, evolve and spread because they need to survive.

I don't want to be a bad harbinger, but we may be entering an age of viruses.