After living for more than two years with COVID-19 – with over 6.2 million confirmed deaths (but probably many more, with approximately 20 million more deaths) and over 510 million confirmed deaths – the world is at a critical juncture. Omicron wave, with its high transmissibility and softer gait than previous versions, especially for people who are fully vaccinated and without 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 abolished in many countries. Testing and surveillance have dwindled and travel has begun. People are understandably exhausted and want to forget about the pandemic. That would be a serious mistake.
First, the pandemic situation is not the same everywhere in the world. China, for example, continues to use its so-called dynamic zero strategy of COVID for mass testing, quarantining those with a positive sample and blocking neighborhoods or even entire cities (most likely Shanghai). The Chinese authorities are strictly and ruthlessly implementing these measures, without taking into account human costs. The goal, according to Chinese officials, is to avoid further spread, protect the health care system and prevent deaths. The problem is that the elderly and vulnerable are often not fully vaccinated, and the efficacy of licensed vaccines is suboptimal. For China, the main priority must be to accelerate an effective vaccination strategy. The current approach is not a long-term solution for the Chinese.
Second, the global vaccination strategy is far from over. The unacceptable injustice to vaccines continues. The WHO’s goal of fully vaccinating at least 70% of people in each country by June 2022 is very unattainable. Although 59.7% of people worldwide have received two doses of vaccine, in more than 40 countries less than 20% have been 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 at continuous high transmission speeds. The omicron subvariants BA.4 and BA.5, first observed in South Africa, are closely observed. Constant vigilance is needed everywhere.
Third, the unfairness of vaccines is reflected in slow and slow 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 order millions of doses from Pfizer, the mechanisms for delivering paxlovid to low- and middle-income countries through the Patent Pool for Medicines are slow. An agreement has been reached with 35 generic drug manufacturers in 12 countries, but they are not expected to deliver the drug before 2023.
Finally, now is the time to plan, learn from mistakes and build strong sustainable health systems, as well as national and international long-term preparedness strategies. The capacity of health systems needs to be strengthened, not only to be prepared for future pandemics, but also to deal immediately with delays in the treatment, diagnosis and care of other diseases after a break in the last 2 years. Vaccines are urgently needed to catch vaccines for diseases such as measles. Preparedness plans, both at national and international level, must have a strong emphasis on early data sharing and transparent monitoring. One health must be the basic principle, taking into account the health of both humans and animals. The 75th World Health Assembly (22-29 May 2022) has the opportunity to examine progress in the revision of the International Health Regulations and to discuss a further pandemic agreement – the treaty process is too slow. The progress report on the Intergovernmental Negotiating Body is not expected until 2023.
At the national level, countries need independent studies for 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 Supreme Court ruled last week that it was illegal to discharge hospital patients into nursing homes without testing for COVID-19, the UK government said it was acting on the best available evidence to date. This is an outright lie. Evidence of asymptomatic transmission was clearly available by the end of January 2020.
Now is not the time to give up COVID-19 or rewrite history. It is time to commit vigorously, redouble our efforts to end the acute phase of the 2022 pandemic for all, and lay a strong, solid foundation for a better future with clear responsibilities and honest acceptance of uncomfortable truths.
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DOI: https://doi.org/10.1016/S0140-6736(22)00817-0
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© 2022 Posted by Elsevier Ltd.
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