This is not even the end of the beginning – we need a completely new approach to Covid-19
It is now clear that what we are dealing with is not a crisis with a beginning and an end, but a new state of the world. This is no criticism of governments, which have been struggling with a challenge more profound than any faced in modern history. Yes, some governments have done better than others; but this challenge is unique in complexity and scale.
We should recognise that, so far, the virus has moved with greater agility and intelligence than humanity. The virus has mutated; the new strains are more transmissible yet not apparently less deadly. It will continue mutating. Vaccines will likely require adjustment to beat such mutations; and there is an outside, but not unfortunately negligible, risk that, at some point, unless we get ahead of the virus, there will be a mutation not susceptible to vaccine, in which case we will need a new range of antiviral and other biologics to counter it, as the world has learnt to do with HIV/Aids.
No country has been able to eradicate Covid-19 except by total isolation – a policy that is neither replicable for countries like Britain, nor sustainable over time. Even in China, South Korea, Australia and New Zealand, despite the most stringent curbs, the disease can’t be eradicated completely and in any event, at some point isolation must end for economic reasons. A country’s population expects its leadership first to look after them.
But there is something else becoming obvious if it wasn’t already: virus anywhere is virus everywhere. Taking global action therefore ceases to be only a matter of altruistic engagement and becomes one of enlightened self-interest. The world and every country in it has paid a heavy price for the failures of global cooperation in 2020.
The question which should be asked of policymakers in government is not what is possible, but what is necessary. It is true that extraordinary efforts have been made, and that systems have been under the most intense strain doing everything that is possible to combat Covid-19. But the blunt fact is: it hasn’t been enough.
This year was supposed to be the year we returned to some sort of normal. Right now, we can’t even be sure that this year won’t be worse than last year. That is a horrible thing to say, but the sooner we confront reality, the sooner we make that prospect much less likely.
Policy makers essentially believed in March 2020 that there would be three phases to Covid-19. In the first, we would lock down to get the disease under control. In the second, we would keep some restrictions in place combined with measures, such as test and trace, as we kept the disease under control and waited for the vaccines. Then there would be a third phase where we vaccinated over the course of 2021 and we would be ready for “normal”.
What has happened is that with mutation, phase two collapsed. The choice we have been left with is: mass vaccination or mass lockdown.
As a result, there has been a disorderly concertina-ing of the timeframe for vaccination. Last year, many countries were negotiating with the vaccine makers as if it was a buyer’s market. Now there is a mad scramble for vaccines, with vaccine nationalism more rampant than that of PPE in the early stages of the pandemic.
We need to learn the lessons of the past year in order to make this year different and better.
It is true that getting vaccines to distribution in 10 months is, by conventional standards, miraculous. But the miracle is insufficient measured against the nature of the pandemic. We need to make possible what at present is impossible: getting from analysis of any new strain to vaccine development to vaccine production in a matter of weeks. And to be able to manufacture such vaccines at enormous scale. And the same with antiviral and other biologics.
This requires a completely new approach, which recognises that the present national and global health infrastructure has failed and that the market cannot perform this task. The weaknesses nationally and internationally are manifest, and not correctable without a plan involving a partnership between public and private sector and between governments.
I believe every larger-population nation – certainly in the developed world and many in the developing world – will face a demand from their people that they have national capacity for vaccine production and associated bioscience capability.
And the world must come together to make sure that such capacity exists on every continent, with provision in place for the fair and equitable distribution of all that is necessary to combat the disease effectively.
The capability will contain at least the following elements:
1) Vaccine, antiviral and biologics development at speed
2) Research and development – including the rapid development of antiviral and vaccines platforms that are capable of adding multiple strains quickly
3) Comparable data – the lack of standards has made the surveillance and health management effort harder
4) Distribution mechanisms which are instantaneous
5) Tests for disease which are rapid at point of use and as accurate as traditional PCR
6) Data systems which capture all relevant data fast and in comprehensive form
7) Surveillance systems which allow early tracking and discovery of disease and mutation
In the short term, we must ensure the fast sequencing and clinical characterisation of any new strain; repurposing of bioreactor and other capacity for the manufacture of vaccine; development of better rapid tests; proper coordination between the main credible regulatory bodies for speedy clearance of new drugs; an overhaul of clinical trial procedures; and advice from a high-level group, including science, medicine, pharma industry, manufacturing, distribution and logistics, to guide governments in decision making.
At the same time, we should start to put in place the long-term global health infrastructure which will mean we are on top of future pandemics.
But it all starts with a recognition that up to now, the virus has been smarter and swifter than us; and this is what must change.
