COVID-19: how can we get it under control in 2021?

Towards the end of last year a host of articles and podcasts appeared wishing good riddance to 2020: a  ‘lost year’ dominated by the COVID-19 pandemic and all its associated costs in terms of deaths, human misery and economic damage.

With the vaccines arriving on the scene like the 7th Cavalry just before the year’s end, many of us hoped that 2021 would be different: a year when we could put the virus behind us, get our lives and economies back to normal and see our governments and media emerge from the ‘pandemic crisis management mode’ to focus on all the other problems besetting our planet, not least of which is the growing impact and urgency of climate change.

Certainly, the vaccines are being rolled out, certified for use and distributed in Europe and North America. We now have three of them: the Pfizer/BioNTech, Moderna and Oxford/AstraZeneca vaccines, which have demonstrated a high degree of effectiveness in trials and can be scaled up quickly for mass production. The vaccination campaigns are already underway.

Yet the first two weeks of 2021 have also made it depressingly clear that there is no early end in sight and the pandemic is unfortunately likely to get worse before it gets better. New variants of COVID-19 found in the UK and South Africa have rapidly spread across the globe, increasing the transmission rate of the virus by around 50%. The more people are infected and the pandemic continues, the more it is likely that further variants of COVID-19 will emerge, some of which could be even more infectious or potentially deadly. This could make the existing vaccines less protective, requiring new vaccines to be developed. It also means that more people will need to be vaccinated to achieve ‘herd immunity’.

At the same time the new vaccines are being rolled out at a leisurely pace in some countries. Only Israel so far has been able to inoculate 20% of its population. France has enacted a rule making it necessary for vaccine recipients to give their formal consent before they can be treated. Elsewhere, administrative rules regarding priority categories (such as people in care homes, medical staff and people with pre-existing medical conditions) may make sense in terms of treating the most vulnerable first.

Yet if all people in these categories have to be dealt with before we can move on to the next category, there is the risk of wastage due to no-shows, and the bulk of the population will have to wait until the summer or autumn before it can emerge from lockdown and resume normal life and economic activity.

Meanwhile, the virus shows no signs of slowing down. Over 200,000 Americans and 60,000 Brits are being infected every day and daily death tolls are higher than ever. Health systems are close to breaking point.

Countries which seemed to be doing better in coping with the first wave than many others are now finding the going much tougher. Germany is recording more than 20,000 new infections and over 1,000 deaths each day. As about 1 in 10 COVID-19 patients develop lasting effects in their lungs and muscles – known as ‘long COVID’ – the greater the number of overall infections, the greater the long-term burden on health systems to treat these patients.

Thus, we are very much in a race between the virus and the vaccine.

There is a triple challenge of vaccine supply, vaccine roll-out and vaccine acceptance. In the US, up to 25% of health workers have refused to take a vaccine because they are wary of its effects. In some countries such as France, opinion polls show a high degree of suspicion of vaccines, fuelled by anti-vaxxer disinformation on social media.

At the same time, governments face the challenge of securing uninterrupted access to vaccine supplies, transporting and storing the vaccines at very low temperatures and making sure that they can carry out the vaccinations before the vaccines expire. This is proving to be a problem. Currently some EU countries have only been able to inject 25% of the vaccine doses they have received into people’s arms.

Yet the longer it takes the global community to get COVID-19 under control in 2021, the graver the consequences will be for our common security and prosperity.

There is the economic impact of millions of job losses, company bankruptcies, spiralling deficits and falling tax revenues. There is also the long-term strain on health services from millions of postponed operations for cancer or heart disease as hospitals prioritise COVID-19 treatment, not to mention the increase in cases of anxiety and depression. There is the educational impact of millions of school and university students whose courses have suffered severe and prolonged disruption and who have not been able to take the exams or develop the skills which will qualify them for future careers. And there is the lack of attention by democratic governments to conflicts in Africa and the Middle East, or China’s clampdown on Hong Kong, or the plight of the opposition in Belarus, to name but a few examples, as the pandemic takes up the entire political bandwidth.

It is clear that we cannot afford for 2021 to be a repeat of 2020. It is absolutely vital that governments get on top of the pandemic quickly and durably before it wreaks even more havoc. How can this be achieved?  Five things strike me as critical in this respect.

First, we need to maintain tight lockdowns and rigorous social discipline until at least the late spring or early summer to break the current momentum of the virus transmission and to take the pressure off our health systems. The vaccine may be our best, maybe our only exit strategy. But it will take months to have a mass impact and it will work faster as a supplement to, rather than a replacement for, the basic precautions such as working from home, mask-wearing and social distancing.

Moreover, we still do not know if the vaccines will stop transmission as well as illness, if they will stay effective for a long time and if they will be effective across all age groups and health conditions. So governments will need to persuade their tired, frustrated populations to continue to respect the rules and be patient. Fines and warnings may help, but we know that lockdowns on this scale only work if the citizenry willingly cooperates and shows a sense of individual responsibility. As Thanksgiving travel in the US or Christmas and New Year rave parties in Europe have demonstrated, this civic compliance is becoming harder for governments to achieve.

Governments will have to do a better job of consistent and persuasive messaging, free of hypocrisy when it comes to tolerance of rules violations, avoiding the constant U-turns which have undermined public trust.  Rather than chasing the virus they will need to convincingly demonstrate that they have a strategy to get ahead of it.

Second, we need a much faster and consistent roll-out of the vaccinations. The UK, which aims to vaccinate 2 million people a week by February, has called out the army to help build dozens of mass vaccination centres in sports stadiums and gyms, and to organise a mass registration and call up system. Like the US, it is appealing to retired nurses and doctors or medical students and pharmacists to carry out the vaccinations. This may feel like a wartime mobilisation of the home front but it is needed; other countries need to rapidly scale up their effort after a very slow and experimental start. It has recently opened the governments of the Netherlands, Belgium, France and Germany, in particular, to criticism.

At the same time governments need to decide if they will vaccinate initially with only one dose, to give as many people as possible some form of protection quickly. Otherwise, they may follow the advice of regulators and the WHO to apply the two recommended doses per person for full protection.  This may help to foster public trust in the vaccine but it will come at the cost of quick universal coverage, unless vaccine production can be rapidly increased, which – given limited production capacity – seems unlikely.

Third, we need to look at the non-Western vaccines, such as Sputnik V produced by Russia or the Sinovac and Sinopharm-produced Coronavax vaccines from China. Western media and some government officials have been sceptical regarding the quality of these vaccines given that they have not undergone the same time-extensive trials and rigorous certification processes that are the hallmark of the Western vaccines. As such, caution is justified. Yet at the same time the Russian and Chinese vaccines have now been administered to millions of people. The UAE and Bahrain have been using them extensively and the trials continue, especially in Brazil.

So as the evidence regarding the safety and effectiveness of these non-Western vaccines mounts up, it should be easier for health authorities in Europe, North America and elsewhere to evaluate their suitability and make use of them to increase overall vaccine supply. Already AstraZeneca has announced a project with the Russian Sputnik V laboratory to produce a combined vaccine as the two products are based on the same technology. Similar fusion or hybrid products could be attempted with the Chinese vaccine on the basis of an exchange of reliable, transparent data.

Fourth is the issue of developing countries. As the advanced industrial economies have monopolised 90% of the early global supply of all the available vaccines, little has been left over for the rest of the world. China is already rushing to fill this gap and reap the diplomatic rewards from being seen as the saviour of developing countries. It has already signed bilateral vaccine distribution agreements with 15 countries while the West risks being seen as selfish and indifferent.

Yet we can only be safe from COVID-19, given its rapid transmission and resurgence rate, when everyone is safe. So helping the developing countries get adequate supplies of the vaccine is not an exercise in charity but rational self-interest. The WHO, with major support from the EU, has established the COVAX programme to distribute vaccines to developing countries at low or no cost. COVAX should soon reach its initial capitalisation of $5bn and there are good prospects that the incoming Biden administration will not only re-join the WHO but commit resources to COVAX as well.

Patent and intellectual property sharing would help poorer countries produce generic versions of the vaccines locally. Moreover, it makes sense for the richer countries, which have the necessary low-temperature refrigeration equipment, to use as much as possible the Pfizer and Moderna vaccines, which are difficult to transport and store, so that the lower cost, easier to store and distribute Oxford/AstraZeneca vaccine can be diverted to the developing countries. A country like Canada, which has placed orders for five times as much vaccine as its population requires, could redirect its surplus supplies to poorer countries as soon as it achieves a comprehensive level of domestic coverage. This is a key challenge for the G7 and G20, which the UK and Italy respectively will chair in 2021, and for the new Atlanticism and multilateral engagement which the Biden and the EU have pledged to work towards after the 20 January inauguration.

Fifth, and finally, there is being better prepared for next time. COVID-19 did not come out of nowhere. In recent years SARS, MERS, Avian bird flu, Zika and Ebola have all been harbingers of our vulnerability to rapidly spreading viruses in the age of globalisation and greater contact between humans and nature. Because these earlier viruses did not go global in the way that COVID-19 has, we did not heed the warning signs and prepare ourselves for the ‘big one’.

Countries that were previously impacted and built functioning test and trace systems, robust health systems and good public information based on social solidarity have developed greater trust and social compliance with restrictions, as we have seen in South East Asia.  They are not perfect and have not emerged unscathed; we may well recoil at some of the authoritarian practices and suppression of information that China has used. Yet their infection and death rates are starkly lower than in the West.  By contrast, the creativity of the more individualistic Western societies may well be an asset too, particularly when it comes to scientific research and innovation. We need to take the best and discard the worst from both the Asian and Western models.

When it comes to preparedness, much has already been written about the need to stockpile medicines, respirators and protective clothing. Yet we also need to look at the deeper issues and be prepared to have mature and open political debates. Why do so many people refuse to wear masks and ignore the science?  How do social and wealth inequalities translate into health inequalities?  How does our immediate decision-making help or hinder epidemic control?  What is the best division of responsibility between the national and the local level in generating policy, leadership and resources?

Humanity has always been dependent on scientific advancements. COVID-19 underscores that this will be even more imperative in the future. Scientific research shows that of newly discovered pathogens, two-thirds are viruses. There will be more COVID-19-type pandemics and even the present one is likely to linger and mutate. We will need scientists to spot the most dangerous mutations and warn us in good time. So investing in science education and research must be a high priority for all our countries. Scientific discovery is becoming harder and if we do not promote science, or if we allow it to be cheaply denigrated by deniers and conspiracy theorists, we may not be able to miraculously develop a vaccine within a year next time round. So, while we try to recover from the COVID-19 trauma, learning the right lessons and being ready for its return one day will be a test of responsible government.

None of this will be easy but it offers us a way out of the quagmire of endless lockdown, frustration and anxiety in 2021 and the prospect that the return to normal will last somewhat longer than last year’s two-week summer vacation. These actions will probably need to drag on for longer in 2021 than we had hoped, but if governments pursue them vigorously there is a least a chance that I will not need to write the same New Year’s commentary this time next January.