Lessons learned in containing a borderless pandemic
As we mark the one-year anniversary of the start of COVID-19 pandemic, it's worth taking stock. Much of Asia either has the virus under control, or at least strongly suppressed, even if it's an increasingly difficult battle. Most of Europe and the Americas have been through multiple waves, and the virus continues to take many lives and crush economies.
We can already draw a few lessons from this situation:
- Rapid action early on saves lives and reduces economic disruption – so in the future we must act faster.
- The science of viral spread cannot be counteracted by ideological contortion or denial. Governments must understand the unique characteristics of a virus and develop appropriate responses.
We still don't know how the coronavirus will evolve. Concerns center around it becoming like a seasonal flu virus, requiring regular, maybe annual, vaccine updates. But the virus is a coronavirus: we have several coronaviruses that cause the common cold, and it is possible that COVID-19 could become just like them. Either outcome requires government action based on science – and global vaccination.
Government strategies upended by science
Our biggest problems in 2020 were denial and conspiracy theories, which created roadblocks to action. Leaders in the US, UK and Brazil in particular impeded progress in containing the spread of the virus. They didn’t always follow the scientists’ advice and, in some cases, acted to undermine it, placing ideology above facts. It taught us that good leadership and willingness to act based on science, such as Taiwan, Vietnam or New Zealand, can control the pandemic with less harm.
Western countries have been through a roller-coaster ride of lockdowns. This is avoidable by simply doing more when there are fewer infections going around. Incredibly effective methods include consistent mask wearing combined with social distancing, enhanced hygiene, staying home if infection is suspected, and an effective testing and tracing system (see diagram).
However, instead of sticking to these less intrusive measures when COVID-19 cases were down, the US and Europe waited for real crises to develop and only then reacted. If these simple measures were followed widely and consistently, lockdowns could be less frequent and shorter. But that requires a sense of responsibility by people and public spiritedness. Perhaps we need to relearn that with freedom comes responsibility?
I believe we saw a sign of that in the UK when the B.1.1.7 variant emerged in November 2020. Mobility data shows that most people quickly adhered to severe restrictions that were almost as harsh as those in the first lockdown, despite growing COVID-19 fatigue.
Differences between Asia and the West
Perhaps the winter lockdowns benefited from our training in the spring last year. But had we looked to Asia and learned from its containment measures, we may have done far better throughout the pandemic. Some East Asian countries had a practice run in 2003 with SARS. As a result, they understood that the responses needed were different to those when dealing with the flu. Many Westerners misguidedly dismissed the measures adopted in Asia, citing authoritarianism. A few actions were incompatible with Western democracy, but enough were acceptable to have succeeded. Asian democracies like Taiwan, South Korea and Malaysia showed us this. The seeming inability of Europe and the US to acknowledge their success and learn from countries in the East is our great loss.
However, China benefited somewhat from an earlier, less infectious version of the COVID-19 virus. The mutation D614G was present in almost all western epidemics from April 2020 onwards. It overtook the original version that spread in China, so, in retrospect, was likely faster moving and harder to contain. How big or small that shift was is hard to calculate, but it likely made a difference.
Few seemed to have foreseen the ferocious return to large-scale spread in the early winter. A wave was expected, but the scale and speed were astonishing, even in countries that had controlled the virus quite well last spring. Mutations may have assisted the spread. Perhaps superspreading happened in a chain-like manner, through large infectious doses, with several superspreading events happening simultaneously, as was seen in the UK? Or was it the dry air indoors (humidity seems to matter more than temperature in spreading COVID-19) generated by central heating systems which kicked in at the start of winter? There are still many unknowns.
Vaccination needs to be global with an unknown evolution of COVID-19
Despite the variants, the news for 2021 is still good at this point since we have adaptable vaccines. But why do we have multiple mutations when the coronavirus mutates slowly? It comes down to the numbers. Mutations are rarely beneficial to the virus, unless the virus has millions of opportunities like with COVID-19 infections. Then a rare occurrence results in outcomes of consequence.
Low levels of infection will mean fewer new variants. While infection levels are high, we may need to adapt vaccines to these mutations. The question is whether we will need further vaccines in the years that follow. Immunity to COVID-19 appears to fade eventually. But if the human-virus interaction follows a pattern similar to colds, vaccinations may not be needed after a few years – that's still an open question. If ongoing vaccinations are needed, it’s a cost and an inconvenience, but manageable.
One of the inspiring things to observe at this stage in the pandemic is that countries that fared very differently – Asia, Europe and the US – have all developed efficacious vaccines. There are exceptional scientists everywhere collaborating, working to push the boundaries of knowledge, sharing their insights generously –all for the benefit of humanity. The scientists have made their contribution and continue to do so.
Now it’s the turn of the rest of us: we need to ensure these vaccines are not only the preserve of rich nations. The COVAX project seeks to distribute 2 billion vaccines by the end of 2021 to poorer countries to give everyone equitable access. This approach limits the spread of pockets of ongoing intense infection and decreases the likelihood of variants arising.
It is ambitious and costly to vaccinate the entire planet, but we must do it to make us all more resilient. Science has given us the know-how, but now we need to provide the resources and funding to distribute the vaccines globally. I believe this is not a time to cut development aid, but rather a time to enhance it. Only if we all tackle this together, can we fight borderless pandemics.