An international group of scientists and social scientists, convened by the Wellcome Trust, recently built four pandemic scenarios. Key variables included what we could 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 causes antibodies – and how quickly we actually develop and implement vaccines, antivirals, and other treatments.
The study then considered how each of these four scenarios will unfold in five general frameworks: high-, middle- and low-income countries, as well as vulnerable and conflict-affected areas such as 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 situations within five years, although community transmission would could be eliminated within certain limits. And as long as one setting faces a COVID-19 outbreak, all settings are vulnerable.
According to the study, eradicating the virus and ending the medical emergency will require not only a vaccine to reduce transmission, but also effective treatments and fast and accurate tests. Such a set of medical instruments should be made available and affordable for each country and conducted in a way that leverages global experience and engages local communities.
However, at this time, only one of the top nine vaccine candidates stops the spread of the virus; the others only aim to limit the severity of covid-19. Moreover, while treatments for moderate and severe cases have significantly improved, they remain unsatisfactory. And testing is flawed, expensive and subject to supply chain deficiencies.
With such an imperfect set of medical tools, non-pharmaceutical interventions (NPIs), such as social distancing and wearing a mask, are vital. Fortunately, most countries have recognized the critical importance of early action, imposing strict rules to protect public health fairly quickly. Many also provided strong economic support to protect lives and livelihoods against the backdrop of the blockade. But short-term emergency measures, such as the closure of the blanket, are not a sustainable solution. Few countries – especially in emerging and developing countries – can afford to freeze their economies, let alone maintain the recommended policies until an effective vaccine is widely available.
Such measures should only slow down transmission and save time for policy makers and health professionals to identify vulnerabilities and, guided by the contribution of the social sciences, develop innovative medium- and long-term strategies tailored to local conditions. Unfortunately, this time has not been used wisely so far, with policy makers preferring to imitate mutual solutions rather than apply lessons creatively in ways that take into account local conditions.
NPIs are not unique. Nor is the process of rewinding. As a group of researchers recently suggested, epidemiology – ideally complemented by behavioral sciences – should guide this process.
In practice, this means that countries should only ease restrictions when they have robust systems in place to monitor developments in the public health situation and to track and monitor infected people. And it should maintain other measures to reduce transmission, such as face mask requirements, for a period of time. These measures must be supported by sustained investment in public health and the capacity of the health system.
The political dimension of relevant decisions must also be taken into account – for example, whether to open schools or allow large gatherings. Leaders need to identify the trade-offs of their policy options, recognizing that they may look very different depending on the economic, social and political context.
How policy choices are made and implemented matters a lot. An effective response must emphasize both individual and collective action, with people taking responsibility for themselves and their communities. In the meantime, as countries such as Norway and Finland have shown, funding for temporary “switches” – as all rich countries should be able to do – can make progress in reducing the spread of the community.
Weak political leaders, such as US President Donald Trump, who believe they can avoid the pain and discontent that restrictions bring, impose higher costs on their people. Likewise, those who focus on who is doing better or worse miss the idea: everyone is better off if others are doing well. Competition for medical supplies and vaccine doses not yet produced is counterproductive.
So while individual countries need to adapt solutions to local conditions, the covid-19 response must ultimately be global. Resources must be channeled to the most vulnerable countries and population groups. They must also continue to be allocated to other public health imperatives, such as the fight against malaria.
Already, the pandemic is fueling inequalities both within and within countries. Wealth has risen to the strongest protection against covid-19, as it facilitates social distancing and yet 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 may have the complete set of tools it needs to eradicate the virus and will have to focus on building the infrastructure and implementing the logistics capacity to implement it. In the meantime, we should stop hoping for a quick return to “normal” and start developing comprehensive, creative and cooperative strategies to live with covid-19. © 2020 / Project Syndicate (www.project-syndicate.org)
Erik Berglöf is chief economist at the Asian Infrastructure Investment Bank