"As we approach the new year, we must all learn the painful lessons this year has taught us. 2022 must be the end of the COVID-19 pandemic."
- Tedros Adhanom Ghebreyesus, Director General, World Health Organization
“The future depends much, much more on what humans do than what the virus does.”
- Jonathan Quick, MD, MPH, Duke Global Health Institute
We’ve survived two years of the COVID-19 pandemic. Sadly, 2022 is off to a shaky start due to what the World Health Organization (WHO) describes as a “tsunami of new COVID-19 cases” propelled by the SARS-CoV-2 Omicron variant. Nonetheless, I think there are three things that have a chance of changing the trajectory of COVID-19 and of the world’s responses to future pandemics. They are the basis of this Germ Gem post.
1. COVID-19 isn’t going away. Early in the COVID-19 pandemic I mistakenly predicted that SARS-CoV-2 could be eliminated in the U.S., just as had happened years ago with measles virus. It’s now clear that this won’t happen with SARS-CoV-2 because as good as COVID-19 vaccines are, they’re not nearly as effective as the measles vaccine. Also, unlike measles virus, SARS-CoV-2 has found a home in a number of potential animal reservoirs (see my November 24 Germ Gems post, “SARS-CoV-2 Reservoirs Are Filling Fast: Spillovers and Spillbacks”).
As we’ve all witnessed, SARS-CoV-2 is an incredibly wily virus that mutates more quickly than was initially hoped. Therefore, don’t be too surprised if new SARS-CoV-2 variants continue this virus’s journey from Omicron, the 15th letter in the 24-letter classical Greek alphabet, to the last letter Omega.
Most coronavirus experts predict that the current COVID-19 pandemic is likely to evolve (settle down) and become an endemic. This scenario is literally one that we can live with (there already are four endemic coronaviruses that cause seasonal bouts of the common cold). Last week National Institute of Allergy and Infectious Diseases (NIAID) director, Dr. Anthony Fauci, concluded, “we’re going to have to adjust to some controlled spread of the virus, being more sensitive to economic and societal concerns.”
2. New COVID-19 vaccines and vaccine strategies are coming. When the COVID-19 pandemic erupted in Wuhan, China in December 2019 no one could have predicted the numerous accomplishments made by scientists, the vaccine industry, governments, and public health officials in battling this virus in such a short period of time. Although it seems like a long time ago, on December 8, 2020 worldwide mass vaccination against COVID-19 began when 90-year-old Margaret Kenan received a shot of Pfizer/BioNTech vaccine in the U.K. This was a watershed event. In the past year, there’s been a torrent of water over the vaccine dam, and the progress that has been made in fighting COVID-19 has become a blur.
In the U.S., we currently have three safe and effective vaccines to fight COVID-19 that were developed in record time. In addition, there are currently 113 other vaccines in clinical trials, and 44 have reached the final stages of testing. As New York Times science journalist Carl Zimmer wrote: “But as the virus mutates, it’s raising big questions about how effective [vaccines] will be in the future, and whether new vaccines can be quickly created and manufactured to keep up with the changing virus. One thing I’ll be looking at is how vaccine makers cope with Omicron and future variants. We will need a universal booster that protects against all possible variants.”
Based on the pivotal contributions of the National Institutes of Health (NIH) in the development of the current COVID-19 vaccines, I predict we’ll again see the NIH assume a leadership role in development of a universal coronavirus vaccine in 2022. I recommend reading the “Perspective” in the December 15, 2021 issue of the New England Journal of Medicine, “Universal Coronavirus Vaccines—An Urgent Need.” by three NIH experts who could spearhead such a spectacular development in 2022: epidemiologist David Morens, virologist Jeffrey Tauenberger, and NIAID director, Anthony Fauci.
3. Fewer mistakes will be made in responding to future pandemics. The COVID-19 pandemic caught everyone off guard. Before the pandemic, most public health experts were predicting that it would be a devastating influenza pandemic, similar to the 1918-1919 catastrophic flu pandemic caused by influenza A virus that circulates in birds. Instead of influenza, the third coronavirus pandemic of the 21st century emerged in China where bats carry many SARS-CoV-2-like coronaviruses.
While it can be discouraging to recall the mistakes made in the handling of the COVID-19 pandemic over the past two years (by the WHO, U.S. Food and Drug Administration, and Center for Disease Control and Prevention, among others), it’s not all that surprising. As epidemiologists who study pandemics like to say, “If you’ve seen one pandemic, you’ve seen … one pandemic.” Many of the aspects of the COVID-19 pandemic are unique to this virus.
The good news is that there’s no shortage of talented scientists, public health, and policy experts who are working on COVID-19, and they’re providing valuable guidance. (For example, see former FDA commissioner, Dr. Scott Gottlieb’s new book Uncontrolled Spread; Caroline Nyce’s article in the December 31, 2021 issue of The Atlantic “What Covid Could Look Like One Year From Now;” and journalist Ed Yong’s article in The Atlantic in September, 2021, “We’re Already Barreling Toward the Next Pandemic.”)
Even though the current COVID-19 pandemic demands the rapt attention and cooperation of researchers in many disciplines, it’s encouraging to see that some experts are focused on the future. In the spirit of cooperation, an “International Agreement on Pandemic Prevention and Preparedness” was forged in 2021. In an article in Nature in early December 2021, “World commits to a pandemic-response pact: what’s next.” the author points out that “After failing to rein in COVID, world leaders begin to shape an accord to prevent future disasters — one that holds them accountable.” One thing the COVID-19 pandemic has taught us is that the costs of not working together are astronomical. Let’s hope in 2022 that we pull together globally.