Saturday, December 10, 2022

COVID-19: The next stage and beyond

After living with COVID-19 for more than 2 years – with more than 6 2 million confirmed deaths (but probably many more, with an estimated 20 million more deaths) and more than 510 million confirmed cases – the world is at an important point. The omicron wave, with its higher transmittance and milder course than the previous forms, is being eliminated in many countries, especially for those who have been fully vaccinated and without comorbidities. Restrictions are being eased, and people are slowly returning to pre-pandemic activities, including gatherings, office-based work and cultural events. Mask mandates are being removed in many countries. Testing and surveillance have come down and the journey is beginning to be widespread. People are very tired and want to forget about the pandemic. This would be a grave mistake.

Firstly, the pandemic situation is not the same everywhere in the world. For example, China continues to implement its so-called dynamic zero COVID strategy of large-scale testing, excluding those who test positive, and expanding to districts or even entire cities (most recently Shanghai). shuts down. The Chinese authorities are harshly and ruthlessly implementing these measures without much consideration of the human costs. The goal, according to Chinese officials, is to avoid further spread, to protect the health system, and to prevent deaths. The problem is that older and vulnerable people are often not fully vaccinated, and the efficacy of licensed vaccines is sub-optimal. For China, accelerating an effective vaccination strategy should be a top priority. The current approach is not a long-term solution for the Chinese people.

Second, the global vaccination strategy is far off track. Unacceptable vaccine disparity persists. WHO’s goal of full immunization of at least 70% of people in every country by June 2022 is out of reach. Although 59·7% of people globally have received the two vaccines, in more than 40 countries less than 20% have been fully vaccinated. Even in high-income countries, a large proportion of the population is refusing vaccination. The emergence of a new SARS-CoV-2 variant with continued high transmission rates is almost inevitable. The BA.4 and BA.5 omicron subvariants, first observed in South Africa, are being closely monitored. There is a need for constant vigilance everywhere.

Third, vaccine disparity is reflected in slow and delayed access to one of the few effective oral treatments for COVID-19—paxclovid. 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, the mechanism is slow to make Paxlovid available to low-income and middle-income countries through the Pfizer, Medicines patent pool. An agreement has been reached with 35 generic manufacturers in 12 countries, but the drug is not expected to be delivered before 2023.

Finally, now is the time to plan, learn from mistakes, and build strong resilient health systems, as well as national and international preparedness strategies with sustainable funding. There is a need to strengthen the capabilities of health systems to not only be prepared for future pandemics, but also to deal with delays in treatment, diagnosis and care of other diseases after the disruption of the past 2 years. There is an urgent need for a catch-up vaccine campaign for diseases like measles. Preliminary data sharing and transparent monitoring should be emphasized in preparation plans at national and international level. There must be a health underlying principle with simultaneous consideration of both human and animal health. At the 75th World Health Assembly (May 22-29, 2022), there is an opportunity to examine progress in revising international health regulations and further discuss an epidemic treaty—the process of a treaty has been too slow. The progress report of the intergovernmental negotiating body is not expected until 2023.

At the national level, countries need to have independent investigations into their responses to COVID-19. It is never easy to learn from mistakes and governments may be hesitant to even admit that they have been made. When Britain’s High Court ruled last week that it was illegal to home-discharge hospital patients without a COVID-19 test, the UK government claimed to be acting on the best evidence available at the time. This is a plain lie. Evidence of asymptomatic transmission was clearly available by the end of January, 2020.

Now is not the time to turn our backs on COVID-19 or rewrite history. 2022 is a time for all to resolutely engage, try again to end the acute phase of the pandemic, and lay a strong lasting foundation for a better future with clear accountability and honest acceptance of inconvenient truths.

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