An international group of scientists and social scientists, convened by the Wellcome Trust, recently developed four pandemic scenarios. Key variables included what we can learn about the biology of SARS-CoV-2 (the virus that causes COVID-19) – such as the rate of mutation and the extent to which an infection triggers antibodies – and how quickly we effectively develop and deploy vaccines, antivirals and other treatments.
The study then examined how each of these four scenarios would play out in five general contexts: high, middle and low income countries, as well as conflict zones and vulnerable environments like refugee camps and prisons. Even in the most optimistic of the four scenarios – characterized by a relatively stable virus, effective vaccines, and improved antiviral therapies – SARS-CoV-2 will not be eradicated in all five settings within five years, although community transmission can be eliminated within certain limits. And as long as one setting is under an outbreak of COVID-19, all settings are vulnerable.
As the study shows, eradicating the virus and ending the medical emergency will require not only a vaccine that reduces transmission, but also effective treatments and rapid, accurate testing. Such a medical toolkit should be available and affordable for each country, and be deployed in a way that draws on global experience and mobilizes local communities.
Yet, for now, only one of the nine main vaccine candidates is stopping the spread of the virus; the others are simply aimed at limiting the severity of covid-19. Moreover, while the treatment of moderate and severe cases has improved considerably, they remain unsatisfactory. And the tests are imperfect, expensive, and prone to supply chain weaknesses.
With such a flawed medical toolkit, non-pharmaceutical interventions (NPIs), such as social distancing and mask wear, are vital. Fortunately, most countries have recognized the critical importance of early action, imposing strict rules to protect public health fairly quickly. Many have also provided strong economic support, to protect lives and livelihoods amid lockdowns. But short-term emergency measures like global lockdowns are not a lasting solution. Few countries – especially in emerging and developing countries – can afford to lock down their economies, let alone keep recommended policies in place until an effective vaccine is widely available.
These measures are simply meant to slow transmission and save time for decision makers and health professionals to identify vulnerabilities and, guided by contributions from the social sciences, design innovative medium and long term strategies adapted to local conditions. Unfortunately, this time has not been used particularly judiciously so far, with policymakers preferring to emulate the solutions of others, rather than applying the lessons creatively in ways that take into account local conditions.
NIPs are not universal. The process of pushing them back isn’t either. As a group of researchers recently suggested, epidemiology – ideally complemented by behavioral science – must guide this process.
In practice, this means that countries should only ease restrictions when they have strong systems in place to monitor changes in the public health situation and to track and trace those infected. And they are expected to maintain other transmission reduction measures, such as face mask requirements, for a period of time. These measures must be supported by sustained investments in public health and the capacity of the health system.
The political dimension of relevant decisions – for example, whether to open schools or allow large gatherings – should also be taken into account. Leaders need to identify tradeoffs between their policy options, recognizing that they can be very different depending on the economic, social and political context.
The way in which political choices are made and implemented is very important. An effective response must emphasize both individual and collective action, with people taking responsibility for themselves and their communities. Meanwhile, as countries like Norway and Finland have shown, funding temporary “circuit breakers” – as rich countries should all be able to do – can help make progress in reducing community spread.
Weak political leaders like US President Donald Trump who think they can avoid the pain and discontent that the restrictions bring end up imposing higher costs on their populations. Likewise, those who focus on doing the best or the worst miss the point: everyone is better if others are doing well. Competition for medical supplies and vaccine doses yet to be produced is counterproductive.
So, while individual countries must tailor solutions to local conditions, the response to covid-19 must ultimately be global. Resources must be channeled to the most vulnerable countries and population groups. They must also continue to be assigned to other public health imperatives, such as the fight against malaria.
Already, the pandemic is fueling inequalities both between countries and within countries. Wealth is the most effective protection against covid-19 because it facilitates social distancing and virtually guarantees quality health care. But such inequalities weaken the resilience of the global community. The most effective interventions are those that protect the most vulnerable.
One day, the world will be able to have the full toolkit it needs to eradicate the virus and will need to focus on building the infrastructure and implementing the logistics capacity to deploy it. In the meantime, we should stop placing our hopes in a quick return to “normal” and start developing comprehensive, creative and cooperative strategies for living with covid-19. © 2020 / Project Syndicate (www.project-syndicate.org)
Erik Berglöf is the Chief Economist of the Asian Infrastructure Investment Bank