Covid 19 has reinforced that life cannot be taken for granted, viruses cannot be taken lightly and unpredictability in the merging scenarios of health have to be respected and addressed.
Today, we are heading towards an Endemic for the vaccinated and a Pandemic for the unvaccinated. For those in the lesser privileged regions where vaccination penetration rates are still in single digits, the situation is certainly much worse.
We know that the transmission is going to continue, hopefully at a decreasing rate. The difference is that the danger of severe illness for the vaccinated is much less whereas life threatening for those who are not. There are countless more pathogens, fungal infections and viruses and we must be ready to face them. It is also essential to learn to adapt to the presence of the virus in all of its mutations rather than trying to battle it. We also have to mutate as a society to sustain and grow.
As many countries accelerate their booster programs, we need to ensure that these are not resources away from the global effort to deliver first doses to the billions of people still unvaccinated. We can end this global crisis, by equitable access to Covid 19 vaccines. However, we are a long way from that. We need scaled up manufacturing of vaccines, regulatory framework, infrastructure, logistics, data systems and monitoring, personnel, necessary compensation, liability and legal safety net. Without all this, the world’s largest and most complex global deployment of vaccines would not have been possible. This new paradigm of global cooperation doesn’t just apply to vaccines, we have seen incredible progress in the development of therapeutics for Covid and the contribution Genomics can play to global disease monitoring and control. Equity, governance and manufacturing serves as a foundation upon which we must build.
For future pandemic preparedness, it is critical that these kinds of programs get the long-term investments they need. Not just to prevent outbreaks but also because their work will help improve global disease surveillance. By helping to build stronger and more resilient primary healthcare in the least served communities, they help shine the spotlight at what essentially are global health security blind spots.
To transition from a pandemic to an endemic, the first rule has to be an acceptable level of disease burden that the healthcare system can endure and also what society is willing to bear. Secondly, we need to see how rapidly the technology has telescoped into allowing the white-collar workers to adapt to working from remote environments. Thirdly, this continues to be a fluid situation in the foreseeable future, therefore, countries need to develop active monitoring systems, closely watch hospitalizations and mortality rates along with regular genome sequencing for monitoring the situation.
Investments not only in healthcare but in the monitoring infrastructure is essential. If we have to learn to live with the virus in its various forms, we have to minimize its ability to be lethal and burden our healthcare system.
There have been 3 determinants of how the countries performed:
- How strong their governance systems are
- How strong their health systems are
- How much trust there is in the society where people are willing to do the right thing e.g., getting vaccinated.
The countries that performed best had all these three things namely Governance, public health systems and societal trust. Thus, we have a recipe as to how to deal with the next pandemic.
The world needs a new structure established, a global threat fund. Secondly, securing the procurement is necessary. Thirdly, the public and private partnership is extremely important e.g., the collaboration in India between the government, ICMR and the Serum institute. Fourthly, we need to learn from the mistakes that we have made in the past including not negotiating or not including access probations in the funding that was given to the manufacturers, technology transparency, renegotiating the platforms etc. Lastly, vision of manufacturing is very crucial. Manufacturing capacity needs to be ready to go into production and someone needs to pay for that, plus the impact of the global procurement mechanisms is critical to find the right balance between the global, regional & national platforms.
Absolute endorsement of science which has saved us and will save us in the future is science of the highest quality that we need to be investing in and challenging.