COVID-19: The next stage and beyond


After living for more than two years with COVID-19 — with more than 6.2 million confirmed deaths (but possibly many more, with an estimated 20 million excess deaths) and more than 510 million confirmed cases — the world is at a critical point. The omicron wave, with its higher transmissibility and moderate course of the previous variants, especially for fully vaccinated people without comorbidities, is declining in many countries. Restrictions are being relaxed, and people are slowly returning to pre-pandemic activities, including gatherings, office work and cultural events. Mask mandates are being lifted in many countries. Testing and surveillance declined and again began to travel on a large scale. People are understandably tired and want to forget about the pandemic. This would be a huge mistake.

First, the epidemic situation is not the same everywhere in the world. China, for example, continues to use its so-called dynamic zero COVID strategy for mass testing, quarantining those who test positive, and locking down regions or even entire cities (most recently Shanghai). The Chinese authorities were implementing these measures ruthlessly and ruthlessly, without much regard for the human costs. The goal, according to Chinese officials, is to avoid further spread, protect the health system, and avoid deaths. The problem is that the elderly and the frail are often not fully vaccinated, and the efficacy of licensed vaccines is suboptimal. For China, the top priority should be to accelerate an effective vaccination strategy. The current approach is not a long-term solution for the Chinese people.

Second, the global vaccination strategy is far from the right track. Persistent inequality in unacceptable vaccines. The World Health Organization’s goal of fully vaccinating at least 70% of people in every country by June 2022 is out of reach. Although 59 7% of people globally have received two doses of the vaccine, in more than 40 countries less than 20% are fully vaccinated. Even in high-income countries, a large percentage of the population continues to refuse vaccination. The emergence of a new variant of SARS-CoV-2 is almost inevitable as high transmission rates persist. The BA.4 and BA.5 sub variants that were first seen in South Africa are closely monitored. Constant vigilance is needed everywhere.

Third, the inequality in vaccines is reflected by slow and delayed access to one of the few effective oral treatments for COVID-19 – Baxiloid. When taken early, paxlovid reduces the risk of hospitalization and death by 89%. Although high-income countries require millions of doses from the manufacturer, Pfizer, the mechanisms for making paxlovid available in low- and middle-income countries via the drug patent pool are slow. An agreement has been reached with 35 generic drug manufacturers in 12 countries, but the drug is not expected to be delivered before 2023.

Finally, it is time to plan, learn from mistakes, and create robust and resilient health systems, as well as national and international preparedness strategies with sustainable funding. The capabilities of health systems must be strengthened, not only to be ready for future pandemics, but immediately to deal with delays in treatment, diagnosis, and care for other diseases after the disruption of the past two years. Vaccine campaigns are urgently needed to catch up on diseases such as measles. Preparedness plans, at the national and international levels, should place a strong emphasis on early data sharing and transparent monitoring. “One Health” should be the basic principle, taking into account human and animal health at the same time. At the Seventy-fifth Session of the World Health Assembly (May 22-29, 2022), there is an opportunity to examine progress in the revision of the International Health Regulations and discuss the Pandemic Treaty further – the treaty process has been very slow. The Intergovernmental Negotiating Body’s progress report is not expected until 2023.

Nationally, countries need independent inquiries about their responses to COVID-19. Learning from mistakes is never easy, and governments can even hesitate to accept that they were made. When the UK High Court ruled last week that it was illegal to take hospital patients into care homes without testing for COVID-19, the UK government claimed it acted on the best evidence available at the time. This is a blatant lie. Evidence of asymptomatic transmission was clearly available by late January 2020.

Now is not the time to turn away from COVID-19 or rewrite history. It is time to engage vigorously and redouble efforts to end the acute phase of the pandemic in 2022 for all, and to lay strong sustainable foundations for a better future with clear responsibilities and sincere acceptance of uncomfortable realities.

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