Valdai Club

It’s becoming obvious for a simple non-physician that the key task of the medical and pharmaceutical community around the world should now be the development of a new version of the vaccines that can protect against new strains of coronavirus that have appeared in recent months, with the fastest possible replacement of old vaccines with these new ones, writes Valdai Club Programme Director Oleg Barabanov.

From the very beginning of the coronavirus pandemic, there has been no shortage of predictions about when it will end. Most of them have been optimistic in nature and had a pronounced aim to calm society. Therefore, their socio-psychological and politically determined nature dominated over strictly medical ones, even if these predictions were made by expert epidemiologists. Doctors also failed to stand aside from the political agenda. In winter and early spring 2020, as soon as the virus began to spread from China around the world, as we remember, the bulk of the statements boiled down to the fact that the epidemic would end by summer, and that the virus, they said, would not be able to live at high temperatures. In religious circles, the dominant theme was that the epidemic would end by Easter.

None of this worked. Easter 2020 passed, and the epidemic only intensified (partly due to the accumulation of people at religious services). The summer of 2020 led to a surge in diseases in the tropical and equatorial zones: in Brazil and in Central America. Therefore, new forecasts have appeared. On the one hand, they focused on analogies with epidemics of the past — first of all, with the Spanish flu pandemic at the beginning of the 20^th century: like the Spanish flu, the coronavirus epidemic could last two years. With the growth of the second wave of diseases in Europe and North America in the autumn of 2020, this was supplemented by forecasts that in these two years (but no more!) the epidemic will be seasonal in nature. On the other hand, more and more people began to talk about herd immunity, which was defined in 60-70% of the population.

Since the first vaccines against coronavirus had just begun to be registered in the autumn of 2020, and there was no mass use of them yet, there was only one simple and cynical way to reach this magical herd immunity threshold: everyone, eventually, would get sick.

Naturally, there is no reason to say that some states have chosen to implement this particular strategy, at least there is no evidence that this is in the official public discourse. But the fact remains that during the autumn-winter wave of 2020, a fairly clear divergence can be traced in the approaches of states to the pandemic. If during the first wave, almost all countries throughout the world affected by the virus (except Sweden, Belarus and Tanzania) introduced lockdowns in one form or another or similar de facto restrictions, this time the situation was different. Some countries continued the lockdown strategy, which led to an increase in protests and civil discontent, while others this time abandoned stringent quarantine measures, despite the fact that the indicators of the second wave were often worse than those of the first one.

In this regard, the predictive discourse has also changed. Earlier, in the first wave, a dilemma arose: was the state to favour the economy or the health and life of the population? Policymakers, as a rule, decided in favor of the latter, and it was said that there was no alternative to lockdowns. But starting from the second wave, a sufficient number of forecasts appeared projecting that the economy would not withstand a second wave of lockdowns, and therefore, it was preferable to avoid implementing them. They were accompanied by medical statements that doctors have already learned how to effectively respond to the pandemic, that drugs and treatment methods have already been tested, and therefore there is no need to close the economy. In a number of countries the issue of lockdown has become the subject of a rather acute internal political struggle. Where a lockdown was introduced, the opposition opposed its ineffective use, and where there was no lockdown, the opposition, on the contrary, demanded that one be introduced, despite the perceived reluctance of society to once again be exposed to quarantine measures.

The apotheosis of this attitude towards collective immunity, at least regarding diseases, was the situation in the Brazilian city of Manaus. In the fall of 2020, scientifically reviewed articles were published, where it was stated that, according to an analysis of antibodies, the proportion of those who had recovered in this city had reached the 60-70% threshold of herd immunity. And therefore, the further spread of the epidemic was unlikely. And for some, alas, not a very long time, Manaus became the model for a recovered city, where the pandemic was no longer scary. But the situation changed quickly. The virus has mutated. By the end of 2020 — beginning of 2021, a new strain had appeared in Brazil, and the old accumulated antibodies in those who had recovered by that time either disappeared or did not provide adequate protection from it. Throughout the country, including in Manaus, the epidemic unfolded with renewed vigor. This collapse of the Manaus model in an unbiased view clearly showed that in conditions where the virus rapidly mutated, betting on achieving herd immunity is hardly justified.

But in the winter of 2020-21 the topic of herd immunity received a sharp new stimulus for predictions. This time it was vaccination. The emergence of several coronavirus vaccines in the world at once, which, according to research results, provided a high degree of protection against the original strains, led to a mass vaccination campaign, first in the vaccine-producing countries, and then on a global scale, in nearly every country at one rate or another. This was accompanied by new optimistic forecasts (both political and medical) that now the victory over the coronavirus is close, that human genius and the capabilities of the pharmaceutical industry are great, and that herd immunity is realistically achievable. The only challenge, it was said, is the vaccination rate.

At first it seemed that all this was really so. In a number of large and medium-sized countries in terms of population, the number of new daily cases decreased from the extremely high values of the end of 2020 to almost single-digit figures. The most striking examples here are Britain and Israel. But the virus, as it turned out, also did not stand still. Another new strain has appeared, which first spread in India in March-May 2021. Incidentally, this time of year is the hottest season in India, which was another answer to the initial medical predictions that the virus would be less dangerous as the temperature rises. As a result, the situation in India became close to catastrophic. More than three hundred thousand infections per day, according to official statistics, more than a thousand deaths per day, a lack of oxygen for patients, pleas for help from the world community, etc. A “softer”, “kinder” virus didn’t emerge, despite the forecasts.

The situation in India was also accompanied by controversy related to political correctness in the terminology used to speak about the coronavirus. The world media had been naming new strains according to their place of origin: “Brazilian”, “British”, “South African” and, as a rule, this did not meet with objections. When a new strain arose in India, and the world media began to call it “Indian” by analogy with the others, voices began to be heard in India that it was racism. It is difficult to say whether this was a politically-inspired or government campaign, or only the views of individual ultra-radicals, but one way or another, due to the political correctness of the WHO, it began to use the letters of the Greek alphabet to describe the strains. Whether there is racism towards the Greeks is a separate question.

This led to a sharp increase in disease in many countries in the summer of 2021 (which cancelled the predictions that the virus was seasonal typical for the fall and spring). And with the analogy about the Spanish flu, they began to say more and more often that the Spanish flu pandemic lasted not two, but actually three years. And beyond the predictions, it quickly became clear that virtually all vaccines offered far less protection against the new strain. The infection curve went up sharply again, including those countries that, thanks to the high percentage of vaccinated people, had been able to stop the pandemic earlier (including Israel and the UK). In this regard, it is interesting to follow the modification of medical forecasts in recent months. On the one hand, if earlier it was argued that vaccines provide protection for two years, or at least for a year, now they are increasingly talking about a period of six months, and many vaccine manufacturers and states recommend either a third booster dose or full revaccination. On the other hand, the main emphasis in medical forecasts began to be placed on the fact that the vaccine, despite not protecting against a new strain, reduces the severity of the disease. At first, everything looked exactly like this. In the UK, Israel and continental Europe, the death-to-case ratio was significantly lower than in previous waves. At the same time, statistics were different in other countries with high vaccination rates. For example, in the United States, where, against the background of other large countries in terms of population, there is a fairly high level of vaccination (more than 50%), the percentage of deaths in relation to cases is still high and by no means lower than during previous waves. On August 20 2021, a statistical study of Public Health England, quite an official structure, appeared, which indicates that 799 out of 73,372 infected patients had died among fully vaccinated patients, while among the unvaccinated group there were 133,390 deaths. These data show that although the total number of deaths is now really low, the percentage of deaths among vaccinated people is higher than among unvaccinated ones. Nobody, especially in the mainstream media around the world, promoted these figures, but they are also very typical.

The situation is becoming similar to that of influenza vaccines: the flu virus mutates rapidly, and therefore new vaccines have to be created almost every year. It is clear that for the pharmaceutical industry, which produces billions of doses of these vaccines and earns a lot of money from this, the need to write them off and start new production will bring financial losses. Understandably, public confidence in coronavirus vaccines could be harmed if people realise that they are only effective before a new strain emerges. But a competent and honest PR policy, which doesn’t resort to excessive optimism, will be able to fix this. Again, using a clear analogy with influenza vaccines.

As a result, against the background of all these unfulfilled optimistic medical predictions (as a political scientist, however, I quite understand their use as strategies to placate society), a simple non-physician is tempted to make his own prediction. If we draw an analogy between the mutations of the coronavirus and the mutations of the influenza virus, then from a purely logical point of view it will be necessary to say that the world is waiting for a chronic pandemic of the coronavirus, that this pandemic will always exist. It will erupt and fade, just like flu epidemics, but it will always be. At least until the moment when some new virus replaces Covid-19, as Covid itself has practically pushed the influenza virus out of the global population. And if there is always an epidemic, then it is clear that introducing lockdowns forever, with each new outbreak happening 2-3 times a year, is by no means an option. Therefore, humanity must learn to live with this chronic pandemic. And constantly (perhaps 2-3 times a year) to develop new vaccines and mass produce them.