COVID-19: the next phase and beyond
After living for over 2 years with COVID-19 – with over 6.2 million confirmed deaths (but likely many more, with an estimated 20 million more deaths) and over 510 million confirmed cases – the world is at a critical point. The omicron wave, with its high transmissibility and smoother course than previous variants, especially for fully vaccinated people with no comorbidities, is declining in many countries. Restrictions are being eased 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 has diminished and travel is largely resuming. People are naturally exhausted and want to forget about the pandemic. It would be a big mistake.
First, the pandemic situation is not the same all over the world. China, for example, continues to employ its so-called dynamic zero COVID strategy of mass testing, quarantining those who test positive, and locking down neighborhoods or even entire cities (most recently Shanghai). The Chinese authorities have implemented these measures harshly and ruthlessly, with little regard for the human costs. The aim is, according to the Chinese authorities, to prevent further spread, protect the health system and avoid deaths. The problem is that the elderly and vulnerable are often not fully immunized and the effectiveness of licensed vaccines is suboptimal. For China, the top priority must be to accelerate an effective vaccination strategy. The current approach is not a long-term solution for the Chinese.
Second, the global immunization strategy is off track. Unacceptable inequities in vaccines persist. The WHO target of fully immunizing at least 70% of the population in every country by June 2022 is out of reach. Although 59.7% of people worldwide have received two doses of the vaccine, in more than 40 countries less than 20% are fully vaccinated. Even in high-income countries, a significant proportion of the population continues to refuse vaccination. The emergence of a new variant of SARS-CoV-2 is almost inevitable with continuously high transmission rates. The BA.4 and BA.5 omicron sub-variants first seen in South Africa are being watched closely. Constant vigilance is required everywhere.
Third, vaccine inequality is reflected in slow and delayed access to one of the few effective oral treatments for COVID-19, paxlovid. When taken early, paxlovid reduces the risk of hospitalization and death by 89%. Although high-income countries are ordering millions of doses from the manufacturer, Pfizer, the mechanisms to make paxlovid available in low- and middle-income countries through the Medicines Patent Pool are slow. A deal has been struck with 35 generic manufacturers in 12 countries, but is not expected to deliver the drug until 2023.
Finally, now is the time to plan, learn from mistakes, and build strong and resilient health systems and national and international preparedness strategies with sustainable financing. The capacities of health systems need to be strengthened, not only to be ready to deal with future pandemics, but also to immediately deal with delays in treatment, diagnosis and management of other diseases after the disruption of the 2 last years. Catch-up vaccination campaigns against diseases such as measles are urgently needed. Preparedness plans, both nationally and internationally, should place a strong emphasis on early data sharing and transparent monitoring. One Health should be the underlying principle, with simultaneous consideration of human and animal health. At the 75th World Health Assembly (May 22-29, 2022), we will have the opportunity to review progress on the revision of the International Health Regulations and further discuss a pandemic treaty – the treaty-making process has been far too slow. The progress report of the intergovernmental negotiating body is not expected before 2023.
At the national level, countries need independent surveys of their responses to COVID-19. Learning from mistakes is never easy and governments may be reluctant to even accept that they have been made. When the UK’s High Court ruled last week that it was illegal to send hospital patients back to care homes without a COVID-19 test, the UK government said it acted on the best evidence available to it. ‘era. This is a blatant lie. Evidence of asymptomatic transmission was clearly available at the end of January 2020.
Now is not the time to turn away from COVID-19 or rewrite history. It is time to make a strong commitment, to redouble our efforts to end the acute phase of the pandemic in 2022 for all, and to lay a solid and lasting foundation for a better future with clear responsibilities and an honest acceptance of the uncomfortable truths.
© 2022 Published by Elsevier Ltd.
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