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In this installment of the Thinkers series, a renowned biotechnology scientist and entrepreneur and infectious disease expert, coordinator and president of the Access Health International Center for Global Public Health Studies, and the Reasons It All Depends of coordinated global action.
In 2020, COVID-19 took the planet by storm; first it attacked Asia, and then it traversed Europe and the Americas in what seemed like an endless tide of suffering. Each new milestone reached (the first hundred deaths in January, then the first thousand in February, 10,000 in March, 100,000 in April, and a million until September) always raises the same question: when will it end?
Despite the virulence of the disease, many assume that the end of the pandemic will come sometime in 2021. But these are unfounded hopes. The control of an epidemic involves four fundamental components: leadership, governance, social solidarity and a medical instrument. Most countries failed in the first three, which practically ensures that COVID-19 will remain with us throughout the coming year.
Most likely, winter in the northern hemisphere will bring a rapid increase in infections and deaths, especially in Europe and North America, where daily infection rates began to rise in mid-autumn. And when the temperatures begin to rise in the north, in South America it will begin to be cold and another wave of epidemics will descend on us.
As for the fourth component of epidemic control, many take it for granted that a vaccine or effective treatment is imminent. It is true that the pandemic mobilized the cream of science and medicine. Researchers around the world acted swiftly and took collaboration to levels never seen before: they identified the virus, drew its genetic map, made strides toward potential vaccines and treatments. But even with these incredible successes, the likelihood that we will have a safe, universally available vaccine or treatment effective enough to stop the pandemic before the end of 2021 is still slim.
As of this writing in late 2020, there are still no published results for any of the candidate vaccines that are in the advanced stage of clinical trials. Pharmaceuticals are very hopeful, but their press releases do not present comprehensive data. From what is known so far, it is possible to say with certainty that none of the vaccines in development will be able to prevent infection or confer immunity for life. At best, they will limit the symptoms of those infected and minimize the number of severe COVID-19 cases. In addition, vaccines that are in development may require the application of several doses, with a delay of up to two months until the onset of effects.
Nor will there be an effective treatment in a short time. Therapies that initially generated great expectations (remdesivir, convalescent plasma, and dexamethasone) have been shown to have little or no effect on overall morbidity and mortality rates. And to obtain treatments with more therapeutic potential, for example monoclonal antibodies, are still many months away, and they may end up being too expensive for widespread application.
The absence of a quick medical solution will increase the need for leadership, governance and social solidarity. The political leadership must take full responsibility for the lives that are lost. Less than three weeks after the scientific identification of the virus, and when the first official death had already been registered in Wuhan, Chinese President Xi Jinping confined 57 million Chinese citizens in Hubei province, with a ban on traveling to other regions and to leave home unnecessarily.
China showed that infections could be halved in just two weeks with standard measures such as mandatory mask use, physical distancing, quarantine and isolation. In contrast, in countries like Brazil, the United Kingdom, and the United States, the national political leadership dismissed the threat and hesitated in organizing an adequate response.
Many commentators have attributed China’s success to totalitarianism, but the system of government is not the deciding factor. It is much more important that the political leadership is willing to accept economic suffering and loss of daily comforts in the short term in exchange for protecting citizens. In New Zealand and Australia (two vibrant democracies), bold leadership and strong governance brought the infection rate to near zero, and politicians like New Zealand Prime Minister Jacinda Ardern have been rewarded at the polls.
The first year of fighting COVID-19 taught us that an inconsistent response will only exacerbate the pandemic. National and global crises demand coordinated national and global action. The United States, the United Kingdom, Brazil, and other underperforming countries failed on both counts. In fact, some countries insist on the silly idea of herd immunity, despite the fact that there is scientific evidence that for this disease there is no such protection. There are four frequent coronaviruses that are little talked about, which return year after year and infect up to 15% of the world’s population (including many people who have already been infected). Assuming that SARS-CoV-2 is no exception, any country pinning its hopes on a herd immunity strategy will put the rest of the world in jeopardy year after year.
The Chinese government made some crucial mistakes at first, but one thing it did well was to warn the rest of the world that the virus was transmittable by air and that the only way to control it was by using immediate and drastic measures. The countries that ignored the warning fared the worst afterward, both in economic and human terms. Meanwhile, the countries that demonstrated social solidarity in controlling the outbreaks have been able to reopen their economies, although not necessarily their borders.
But ultimately, a collective response is just a sum of individual actions. There are many people around the world who consider that accepting the use of protective equipment is a renunciation of personal freedoms. But in times of war when the danger is evident, people have shown time and again that they are willing to make great sacrifices for their fellow citizens.
The need for a message change is evident. We are at war with a virus. No one denies that personal freedom is important, but we are at a time when we all have to give up certain comforts for the benefit of those around us.
With each new earthquake, tsunami, or emerging disease, we have a reminder of the dangers of nature. The reason many Asian countries reacted faster and more effectively to COVID-19 is that they still had memories of SARS, H1N1, and bird flu. The experience of these countries in recent years shows that a strict application of sanitary measures within a solid framework of leadership, governance and social solidarity makes it possible to control a pandemic in a short time and limit the number of deaths.
That is the biggest lesson of 2020. If it is not incorporated into national policies in 2021, the pandemic can last not only all of the coming year but many more.
* Translation: Esteban Flamini. Copyright: Project Syndicate, 2020. www.project-syndicate.org.
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