COVID-19: the next stage and beyond

Having lived with COVID-19 for more than 2 years - with over 6.2 million confirmed deaths (but likely many more, with an estimated 20 million additional deaths) and over 510 million confirmed cases - the world is at a critical juncture. The Omicron wave, with its high transmissibility and milder course than previous variants, especially in fully vaccinated people without comorbidities, is ebbing away in many countries. Restrictions are being eased and people are slowly returning to pre-pandemic activities, including gatherings, office work and cultural events. Mask requirements are being lifted in many countries. Testing and surveillance have decreased and travel is resuming on a large scale. People are understandably tired and want to forget about the pandemic. This would be a serious mistake.

First, the pandemic situation is not the same all over the world. China, for example, continues to implement its so-called dynamic zero-COVID strategy with mass testing, quarantine of people who test positive and lockdown of districts or even entire cities (most recently Shanghai). The Chinese authorities have implemented these measures harshly and ruthlessly, with little regard for the human cost. According to Chinese officials, the aim is to prevent further spread, protect the health system and avert deaths. The problem is that elderly and vulnerable people are often not fully vaccinated and the effectiveness of approved vaccines is suboptimal. Accelerating an effective vaccination strategy must be a top priority for China. The current approach is not a long-term solution for the Chinese. Second, the global vaccination strategy is far from on track. Unacceptable vaccination bias persists. The WHO goal of fully vaccinating at least 70% of people in every country by June 2022 is far out of reach. Although 59.7% of people worldwide have received two doses of vaccine, less than 20% are fully vaccinated in more than 40 countries. Even in high-income countries, a sizeable proportion of the population remains opposed to vaccination. The emergence of a new SARS-CoV-2 variant is almost inevitable with sustained high transmission rates. Omicron subvariants BA.4 and BA.5, first observed in South Africa, are closely monitored. Constant vigilance is required everywhere.

Third, vaccine inequity is revealed in the 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%. Despite high-income countries ordering millions of doses from manufacturer Pfizer, mechanisms to make Paxlovid available through the Medicines Patent Pool in low- and middle-income countries have been slow. An agreement has been reached with 35 generic drug manufacturers in 12 countries, but the drug is not expected to ship until 2023.

Finally, now is the time to plan, learn from mistakes, and create strong, resilient health systems and national and international preparedness strategies with sustained funding. Health systems' capacities need to be strengthened, not only to be prepared for future pandemics, but to deal promptly with the delays in treatment, diagnosis and care of other diseases following the disruptions of the past two years. Catch-up vaccination campaigns against diseases such as measles are urgently needed. Preparedness plans, both national and international, must have a strong focus on early data sharing and transparent monitoring. One Health should be the underlying principle while considering human and animal health. The 75th World Health Assembly (22-29 May 2022) is an opportunity to review progress on the revision of the International Health Regulations and to further discuss a pandemic agreement - the process for an agreement has been far too slow. The intergovernmental negotiating body's progress report is not expected before 2023.

At the national level, countries need independent research into their responses to COVID-19. Learning from mistakes is never easy, and governments can be reluctant to even accept that they were made. When the UK High Court ruled last week that it was unlawful to discharge hospital patients into care homes without COVID-19 testing, the UK government professed it acted on the best evidence available at the time. This is not true. Evidence of asymptomatic transmission was apparently available at the end of January 2020.

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

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