February 8, 2023
JAKARTA – As we enter the fourth year of the COVID-19 pandemic some quarters are of the view that the pandemic is over. In a recent report, the Indonesian government indicated that it would declare the end of the pandemic after consultation with the World Health Organization (WHO).
Such sentiments are understandable as many countries have suffered from “pandemic fatigue” caused by severe lockdowns and draconian restrictions, and are hankering for life and economic activity to return to normal, pre-pandemic levels.
But is the pandemic truly over? While the worst is probably behind us, the pandemic is far from over and we adopt such a view at our peril. We need to continue our vigilance and preparedness and there are five important issues that we need to keep in mind moving forward.
First, we need to ensure continued and robust surveillance and monitoring capabilities. As the “pandemic is over” mindset gains widespread acceptance, complacency has set in and surveillance of both the virus and of infected cases have been relaxed in many parts of the world.
This is dangerous.
Accurate data on virus spread, hospitalizations, deaths, vaccine coverage and circulating virus variants through genomic sequencing are absolutely crucial for preparedness and response efforts should a new wave of severe COVID-19 infections emerge in the future. While there is always a possibility of a more virulent new variant appearing, present indications are that dominant variants, while able to spread rapidly, cause relatively mild illness.
But without clear, credible, timely and reliable data from robust surveillance systems, ongoing efforts to manage the pandemic becomes a scientific guessing game with limited value to policymaking.
Second, we need to continue and strengthen efforts to provide more widespread and equitable vaccine coverage, especially in developing countries and among the vulnerable segments of the population.
As the old adage states, “No one is safe until everyone is safe.”
Despite the efforts of the multilateral initiative Covax to provide equitable access to COVID-19 vaccines in developing countries, and the fact that more than two-dozen different vaccines have been used worldwide, Africa, for example, has the lowest vaccination rate of any continent, with just 35.2 percent of the population receiving at least one dose of a vaccine, compared to 82.2 percent in Latin America. Worryingly, vaccination rates around the world have stagnated in recent months, with public demand dropping even as vaccine supply has become more abundant.
At the same time, we also need to continue to support research and development of newer vaccines. For example, there are promising innovations of vaccines delivered through nasal sprays and all-variant vaccines which can provide protection against any SARS-CoV-2 strains that may appear in the future.
Third, we need to continue to combat the spread of misinformation, fake news and bad science, which continue to undermine efforts to mitigate the pandemic and prepare for future crises.
Fake news continues to spread around vaccine safety and efficacy, as well as disease severity caused by newer variants of the virus.
Two recent examples suffice. A hoax circulated recently in Indonesian social media that the CEO of multinational pharmaceutical company Pfizer has been arrested for falsifying and lying about data from the company’s COVID-19 vaccine development trials.
In the second example, the Singapore health ministry had to issue a public statement refuting fake news circulating on social media that the latest SARS-CoV-2 variant, XBB1.5, is causing a rapid and large increase in cases with severe illness and deaths in the country. The Singapore government is initiating POFMA (Protection from Online Falsehoods and Manipulation Act) action against such falsehoods.
Fourth, we must continue to strive for rational policies, which safeguard both lives and livelihoods. China’s recent abandonment of its “zero-COVID” policy led to a confusing spectrum of travel restrictions with some countries requiring testing of travelers from China while others imposed no restrictions.
Most experts question the value of preflight testing, and singling out travelers from China seems discriminatory when the virus has spread globally, and can potentially be carried by any traveler from any country. Referring to a previous point, it is broadly thought that better surveillance, not travel restrictions, is the best way to deal with potentially dangerous variants of SARS-CoV-2.
Therefore, more rational policies, which are based primarily on a country’s readiness to deal with future threats, are needed in the future. These policies should take into account the extent of vaccination coverage, healthcare capacity, medicines supply, surveillance systems and, importantly, being able to draw on learnings and experience from the past three years in terms of the best practices to mitigate the public health effects of the pandemic.
Finally, we must trust the value of local knowledge in dealing with pandemics. Local knowledge has been enriched and strengthened over the last three years of the pandemic and should be kept in mind for dealing with future disasters.
A recent report from the organization Resolve to Save Lives highlighted the fact that local knowledge actually prevented at least six pandemics from breaking out in the past in developing-country settings. While cutting-edge technologies like new mRNA vaccines and genomic sequencing were critical to controlling the COVID-19 pandemic, the interventions that help prevent these six pandemics in the past were largely unglamorous and included trust in the local health system, training local workers in rapidly detecting and reporting suspected cases and rapid deployment of contact tracers, vaccinators and laboratory workers to remote areas.
The value and importance of local knowledge is well captured by Gunael Rodier, a former WHO director of Communicable Diseases, who stated that “the best way to prevent the global spread of diseases is to detect and contain them while they are still local”.
In conclusion, and in case some of us still think that the pandemic is over, recall what US epidemiologist Mark Lipsitch said in March 2022: “With COVID-19, we’ve made it to the life raft. Dry land is far away.”
By overcoming complacency and hubris through good surveillance, equitable vaccine access, combating misinformation, rational policies and valuing local knowledge perhaps we can ultimately reach dry land together.
— The writer is a visiting professor at Yong Loo Lin School of Medicine, National University of Singapore.