The current situation underscores the danger of ignoring our interdependence and the critical importance of global cooperation. This shows us that all humanity is in the same boat. Since a virus can be defeated somewhere only when it is defeated everywhere, this shows that it is absurd to pretend that we can achieve security in isolation, within a particular country, nation, culture, religion or class, writes Valdai Club expert Djoomart Otorbaev.
The development of the latest coronavirus vaccines has generated unprecedented optimism around the world. The news revived the global economy, created millions of new jobs, and stock indices rose to record levels. Is the emergence of new vaccines a panacea for all problems? How justified is such optimism today?
Indeed, not one, but dozens of different drugs have been developed in a number of countries. The regulatory authorities approved many of them in an unprecedentedly short time. The implementation of some of them led to mixed results: for example, a number of countries imposed restrictions on their use. In general, however, the use of the vaccines already confirms their effectiveness. For example, it looks like Israel could become the first country in the world to achieve collective immunity. To date, 5.3 million people have already been vaccinated in that country, that is, more than half of its inhabitants, and about a million more people have acquired immunity after contracting the illness.
By early March, around 413 million doses of COVID-19 vaccine had been produced globally, according to Airfinity, an analytical firm. According to its forecasts, by the end of 2021 this figure will rise to 9.5 billion doses. However, many now agree that the emergence of effective drugs is only one element needed to combat the disease. Despite the huge funds allocated by many countries and companies, and the heroic efforts of scientists and doctors who developed vaccines in record time, the process of restoring pre-pandemic life will be very lengthy. Even with the most ambitious vaccination programme in human history, 2021 is likely to be the first year that a “new normal” will emerge in the world, in which humanity will remain for a long time, probably not just for months, but for years. There are several reasons for this.
First, the availability of vaccines and effective results in the vaccination of the population are not the same thing. Pharmaceutical companies need to produce a sufficient number of doses. The vaccines must then be distributed and transported to vaccination sites. They usually need to be stored in freezers, and some require storage at extremely low temperatures. Almost all companies are already experiencing difficulties with both the production and distribution of vaccines. Many customers are increasingly unhappy with delays in their delivery. Several European countries are planning to sue vaccine manufacturers for long delays. Tracking the supply, storage and distribution of vaccines will be even more difficult in countries that lack the necessary resources, infrastructure and expertise.
Second, healthcare providers must be thoroughly trained on how to prepare and administer each dose. This entails the unprecedented process of providing quality training to millions of doctors and nurses around the world. The most difficult vaccination programme in the history of mankind must be carefully planned and financed, following a year when medical professionals performed exhausting work while dealing with chronically underfunded infrastructure, which has left medical personnel, even in the most developed countries, at the limits of their physical capabilities.
Third, not all people agree to be vaccinated. For example, only 60 percent of Americans say they would receive a coronavirus vaccine if it were available today. However, 39 percent say they probably or definitely don’t want the vaccine. Only 23 percent of Russian citizens are ready to be vaccinated against the coronavirus, according to a study performed by the United Russia party. Meanwhile, 73 percent of respondents are not ready for vaccination, and the remaining 4 percent said that they had already had COVID-19 and did not need the vaccine. Immunologists estimate that 50 to 70 percent of the population in each region will need vaccinations to achieve herd immunity. Some researchers suspect that it could be even higher. Globally, this is from four to six billion people.
There are huge inequalities in the distribution of vaccines. According to researchers at Duke Global Health Innovation Center, high- and middle-income countries, which account for only a fifth of the world population, have already purchased about 6 billion doses. Low- and lower-middle income countries, representing four fifths of the world’s population, will receive only about 2.6 billion doses. This includes 1.1 billion doses from the COVAX project, as international sponsors have pledged to vaccinate a fifth of the world’s population.
Just as the virus has created a colourful kaleidoscope of infections, the irregular use of vaccines could soon lead to an even wider variety of “immunity islands”. It is also clear that rich countries will form these “islands” much earlier than poor ones. Even within a single country, the vaccination campaign will be distributed differently. As a result, acquired immunity will differ sufficiently among different age groups, and among different “priority” groups such as doctors and teachers, in large cities and small rural settlements.
Both healthy and infected people will move both within these clusters and between them. Such processes will take place even at the level of individual families. We will observe a kind of “Brownian movement” of viruses, which will significantly complicate the localisation and suppression of the disease. Practice has shown that the experience of complete isolation does not work well, with the rare exception of highly organised countries such as China or Vietnam. People will continue to move between “prosperous” and “disadvantaged” regions, adding additional uncertainty in the fight against the disease.
The latest analysis by the International Council of Nurses shows that out of four million healthcare workers worldwide, more than 20,000 could have died from COVID-19. Everywhere in the world, healthcare workers are exhausted. For more than a year and almost continuously, they have been fighting the disease, and often without moral or material support. Even in the most advanced countries, medical personnel are working at the limits of their physical capabilities. Despite this, mass layoffs have begun. According to the latest estimates, even in the United States, a fifth of all rural hospitals were closed in the past year. Today, American hospitals are already short more than 150,000 nurses.
If the coronavirus becomes a chronic infection, it will present an extremely serious problem for all of humanity. Many patients infected with SARS-CoV-2 continue to struggle with so-called “long-term COVID-19” for many weeks or even month; symptoms include constant fatigue, psychological illnesses, memory problems, and sudden loss of energy. Several studies have estimated that between a quarter and half of all infected people have at least one symptom that persists for a month or longer.
Although the influence of the SARS-CoV-2 virus should be weakened after large-scale vaccinations, it seems to remain with us for a long time. For example, polio vaccines were first created in the 1950s, but polio, although very close to being eradicated, still exists. Unfortunately, a similar process occurs with many other vaccine-preventable diseases, including measles, tuberculosis, or cervical cancer. A relatively recent example: more than 1.7 million people worldwide were infected with HIV in 2019, although drugs that block the infection have been around for many years.
What happens next with SARS-CoV-2 also depends on how our immune system responds to vaccines. Since the response of the immune system is still unknown and unpredictable, it is currently impossible to tell how the virus will develop. How individuals develop immunity is still a big mystery for scientists.
For example, with some viral diseases, such as chickenpox and measles, immunity can last for life. With other diseases, it disappears much earlier. For example, we all know that the immune system forgets how to fight the flu viruses after less than a year. An intermediate example is immunity against deadly coronaviruses like MERS and SARS, which can last for several years.
Some immunologists speculate that immunity to the current virus can range in duration from one year to several years. It is already clear that the current virus triggers immune memory that lasts at least six months, although a number of people have been re-infected earlier than this. If immunity is gradually weakening, then re-vaccination may be required after a few months or years.
It is also a matter of serious concern how the new virus will behave when large numbers of people are vaccinated. It has already been proven that the virus can mutate, that is, it changes its genetic code. Such new variants, which commonly turn out to be even more contagious, have already been found in a number of countries, for example, in the UK, South Africa, Brazil, etc. For example, the South African strain is trying to bypass the “attack” of new vaccines and infect already-immunised people. If the virus behaves this way, it can become similar to the influenza virus, that is, an ever-changing adversary that forces humanity to catch up on a regular basis.
COVID-19 will not be the last pandemic, nor the worst. In an interview with the Süddeutsche Zeitung, Microsoft founder Bill Gates said the next pandemic could be ten times worse than the pandemic caused by the SARS-CoV-2 virus. Humanity needs to start preparing for a new pandemic just now. It is necessary to develop real and multilateral criteria for human preparedness for a pandemic.
The current situation underscores the danger of ignoring our interdependence and the critical importance of global cooperation. This shows us that all humanity is in the same boat.
History has taught us that humanity quickly forgets the past, especially if it causes unpleasant feelings. The Spanish flu pandemic, which began in March 1918 and lasted until the spring of 1920, remains the most devastating in modern history. It infected 500 million people, roughly a third of the world’s population at the time, in four successive waves. The death toll is usually estimated at between 17 and 100 million. Not only was the overall mortality rate recorded at the time frightening, but also its dynamics. During the transition from the first wave of the epidemic to the second one, the proportion of deaths increased 25-fold. Scientists still cannot come to a consensus on what the reason was: whether the virus mutated, or the tragedy was the result of the behaviour of people who neglected safety rules.
Despite its scale, even this catastrophic epidemic has practically disappeared from the public consciousness and history textbooks. World War I, a series of national revolutions and the Great Depression eclipsed it in human memory. Political and economic upheavals and the global reformatting of the world map have displaced one of the most catastrophic pages of mankind’s history from its collective memory. People only remembered that pandemic last year.
History will likely remember the COVID-19 pandemic as a once-in-a-century disaster. But this pandemic must act as a catalyst for the transformation of national and global health systems. The pandemic has exposed serious deficiencies in these systems, stemming from their organisational and financial principles that reflect individualism rather than solidarity. These flaws are tragically personalised in a story told by a New York City anaesthesiologist who remembered the dying words of one of his COVID-19 patients when he was placed on a ventilator: “Who will pay for this?”