COVID-19: next stage and beyond

After more than 2 years of living with COVID-19 – with more than 6 · 2 million confirmed deaths (but perhaps even more, with approximately 20 million extra deaths) and more than 510 million confirmed cases – the world is in a very difficult situation. The omicron wave, with its high throughput and softer course than previous options, is declining in many countries, especially for those who have been fully vaccinated and have no additional disease. Restrictions have been eased and people are gradually returning to pre-pandemic activities, including meetings, office work and cultural events. In many countries, mask mandates are being removed. Testing and control are declining, and travel is becoming more widespread. People are obviously tired and want to forget about the pandemic. That would be a serious mistake.

First, the pandemic situation is not the same all over the world. For example, China continues to use the so-called dynamic zero COVID strategy, quarantining those who pass positive testing and closing districts or entire cities (soon Shanghai). The Chinese authorities have implemented these measures harshly and ruthlessly, without regard to human costs. According to Chinese officials, the goal is to prevent further spread, protect the health care system and prevent deaths. The problem is that older and vulnerable people are often not fully vaccinated and the effectiveness of licensed vaccines is low. The main priority for China should be to accelerate an effective immunization strategy. The current approach is not a long-term solution for the Chinese people.

Second, the global immunization strategy is wrong. The injustice of unacceptable vaccines continues. The goal of the WHO to vaccinate at least 70% of the population in each country by June 2022 will not be achieved. Although 59 · 7% of people worldwide have received two doses of the vaccine, less than 20% have been fully vaccinated in more than 40 countries. Even in high-income countries, a significant portion of the population refuses to be vaccinated. The emergence of a new version of SARS-CoV-2 will be almost inevitable with a consistently high transmission rate. BA.4 and BA.5 omicron subvariants, first seen in South Africa, are being closely monitored. We need constant monitoring everywhere.

Third, vaccine inequality is reflected in one of the few effective oral treatments for COVID-19 – slow and delayed access to paxlovid. Early administration of paxlovid reduces the risk of hospitalization and death by 89%. Despite the fact that high-income countries order millions of doses from the manufacturer Pfizer, the mechanisms for making paxlovid available in low- and middle-income countries through the patent pool of drugs are slow. Contracts have been signed with 35 generic manufacturers in 12 countries, but the drug is expected to be delivered by 2023.

Finally, now is the time to plan, learn from mistakes, and build national and international preparedness strategies with strong sustainable health systems as well as sustainable funding. It is necessary to strengthen the capacity of health care systems not only to prepare for a future pandemic, but also to immediately address the delays in the treatment, diagnosis and care of other diseases that have been interrupted for the past 2 years. A vaccination campaign against diseases such as measles is urgently needed. Preparatory plans, both national and international, should focus on early information sharing and transparent oversight. The same principle should apply to the health of both human and animal health. The 75th World Health Assembly (May 22-29, 2022) has the opportunity to review progress on international health regulations and discuss an anti-pandemic treaty – the treaty process has been very slow. The progress report of the intergovernmental negotiating body is not expected until 2023.

At the national level, countries need to independently investigate their responses to COVID-19. It is never easy to learn from mistakes, and governments may be reluctant to accept them. When the UK Supreme Court ruled last week that it was illegal to discharge hospitalized patients without a COVID-19 test, the UK government had acted on the best evidence available at the time. This is a blatant lie. Evidence of asymptomatic infection was available in late January 2020.

Now is not the time to give up COVID-19 or rewrite history. It is time for all to make an effort to end the acute phase of the pandemic in 2022, to redouble our efforts, and to lay a solid foundation for a better future with clear responsibility and honest acceptance of uncomfortable facts.

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