Thinking the Next Phase of the Pandemic
Updated: Mar 6
With the arrival of the first doses of COVID-19 vaccines to our shores after a long wait, moments of jubilation to celebrate this milestone in our pandemic control efforts should be replaced soon with hours, even days of introspection.
After all, much of our desired future (in the post-COVID world) is hinged upon the next steps we will have to take in the succeeding months and years to come. With lessons learned, if not wisdom gained, from our protracted experience with the pandemic and hopefully devoid of hubris and hypocrisy (the kind of which arguably befell most countries), we have no other recourse but to do it right and better this time around.
The consequences of our actions and decisions henceforth will have public health, societal, and even moral implications for generations to come. This makes futures thinking a pragmatic approach that we should embrace now as we do our best to turn a corner in the pandemic.
A recent Lancet article intimated that the road ahead is still long, unwinding, and uncertain. In 3-5 years, the authors pronounced, a whole gamut of different COVID-19 scenarios will pan out. Some will lead to the end states that we want—that is, achieving herd immunity, controlling vial transmission, restoring normalcy--but realistically and unfortunately, most will relate to situations that we don’t want to happen in this phase of our response.
The best- case scenario is that the next-generation vaccines will be effective against all known COVID-19 variants and all countries will stamp out the pandemic because of effective control measures—much of this because of global cooperation.
The worst- case scenario on the extreme end is that new variants will emerge with the vaccines available but not affording protection, and that only high-income countries will put up a good fight. The majority of countries will be on their own, strapped of their resources and unable to get the vaccines and other countermeasures because of intense nationalism.
Straddling these extreme ends of the spectrum are scenarios in which the glaring problem will be that of continuing infections or repeated outbreaks. In any case, wherever we look, the economy will be difficult to reset and normalcy in the real sense of the word can’t be attained.
Because of this plausible reality, we need to acknowledge that even when all the vaccines have been given to the target groups in our population to attain a sufficient level of herd immunity, the pandemic will not be over anytime soon.
All the rage now about vaccines will be for naught if our framework of response is not holistic--if we are not cognizant of the following five (5) elements of successful pandemic control:
First, viral evolution and distribution. We know how new SARS-CoV-2 variants can make our control efforts very challenging. Increasing transmissibility and potentially increasing the severity of cases and affecting the effectiveness of current vaccines, more variants can emerge as a result of natural mutations of the virus. This can impact on natural immunity from COVID-19 making annual booster shots a requirement. Also, SARS-CoV-2 has a high likelihood of being endemic because of its distribution not only in humans but also in common animals like dogs and cats.
Second, citizen behavior. Non-pharmaceutical interventions (use of masks, face shields, distancing, avoiding the crowds, sanitation) have been proven to be effective measures to curb transmission. Sustained efforts to religiously practice the minimum public health standards should be the rule despite the relaxation of quarantine measures as economic and social activities resume.
Third, government response. With health system capacities significantly improved and whole-of-society efforts put forward to decrease cases and deaths, countries have to build on and sustain their gains in responding to the pandemic. From mobilizing resources, shifting tactics to rallying the support of everyone, the leadership should be strategic in being able to withstand the journey up to the last mile.
Fourth, scientific progress. This is the real-world miracle that is the reason why we have survived this far. The unprecedented speed of scientific breakthroughs gave us effective diagnostics and vaccines, promising therapeutics, and validated the importance of simple measures (non-pharmaceutical interventions) that really save lives. Politics may have arguably spelled out the difference in terms of response outcomes of different countries but policies founded on science are the only ones that can guide us out of this crisis.
Lastly, global cooperation. As the pandemic will not be over everywhere if it’s not over anywhere, diplomacy for global solidarity in terms of access to vaccines and treatment should be of paramount concern. Low-income countries must not be left behind in this protracted journey. It should not be a race for countries to reach the destination first before others but as it is turning out, it is more like a solidarity walk down the long, winding, and uncertain road that is COVID-19 where at the end of the line, every nation should be a winner.
True enough, to date, there are still some unknowns as far as the following are concerned: immunologic response to vaccines, e.g. extent of immunity, reinfection; symptomatology, course and sequelae of COVID-19 illness in different groups; other health and non-health repercussions of COVID-19 in our social milieu; geopolitical ramifications and future state of world order as an offshoot of this crisis. In the horizon, there can be more unknowns that are still to be unraveled.
But let’s embrace what we know now: We need to watch how the virus evolves; we need to sustain our healthy and protective behaviors as citizens; we need to enable our government to do its job well and even better; we need to promote and support science to counter COVID-19 (and fake news); and we need to echo calls for concrete global cooperation so countries really work together to provide equitable access to vaccines, treatment and other needed logistics to make sure those who are bereft of resources, more vulnerable, and disadvantaged among us are given more.
As a concluding thought, as we roll out our vaccination program and move forward with actions related to the aforementioned elements, it is imperative to cultivate a scientific and futures-oriented mindset to help us successfully navigate our way to our ultimate destination as effectively and as fast as we should.
The author is a physician, public health emergency practitioner and academic examining the COVID-19 pandemic from a global health security perspective. The views expressed here are independent of the positions of the organizations he is affiliated with.