Cambridge, England – COVID-19 stormed across the planet in 2020, striking first in Asia and then surging throughout Europe and the Americas in what seemed like an endless tidal wave of grief. With each passing milestone — the first 100 deaths in January, followed by the first 1,000 in February, 10,000 in March, 100,000 in April, and one million as of September — the question always has been: When will it end?
Despite its virulence, many simply assume that the pandemic will end sometime in 2021. But such hopes are misplaced. Controlling an epidemic involves four fundamental components: leadership, governance, social solidarity and a medical toolkit. Most countries today have failed on the first three, all but ensuring that COVID-19 will remain with us over the next year.
Most likely, winter in the northern hemisphere will bring a sharp rise in infections and deaths. The losses will be particularly pronounced in Europe and North America, where daily infection rates were already spiking in mid-autumn. And just as the weather starts to warm in the north, South America will cool and another epidemic wave will crash over us.
As for the fourth component of epidemic control, many assume that a vaccine or a lifesaving treatment is imminent. True, the pandemic has brought out the very best in science and medicine. Researchers around the world have moved faster and collaborated more closely than ever before, identifying the virus, mapping its genetic makeup and working toward potential vaccines and treatments. But even with these incredible successes, there is still only a slim chance that we will have a vaccine or treatment that is safe, universally available, and effective enough to stop the pandemic before the end of 2021.
Based on what we know today, we can be sure that none of the vaccines under development will prevent infection or provide lifelong, lasting immunity. At best, they will limit the symptoms of those infected and minimize the number of COVID-19 cases that progress to severe illness. Moreover, the vaccines currently under development may require multiple doses, with a delay of up to two months before the benefits kick in.
Likewise, lifesaving treatments for those with COVID-19 will not come quickly. Treatments that initially met with great fanfare — remdesivir, convalescent plasma and dexamethasone — have since proven to have little to no effect on overall morbidity or mortality. And treatments with greater therapeutic potential, like monoclonal antibodies, are still many months away, and may ultimately prove too costly to be made widely available.
The absence of a medical quick fix will increase the need for leadership, governance, and social solidarity. Political leaders must accept full responsibility for the lives that are lost. Less than three weeks after scientists identified the virus, and after the first reported death in Wuhan, Chinese President Xi Jinping locked down 57 million Chinese citizens in Hubei province, preventing them from traveling to other regions or leaving their homes for anything other than necessities.
China showed that new infections could be halved in just two weeks through standard measures such as enforced mask-wearing, social distancing and mandatory quarantine and isolation. By contrast, in countries like Brazil, the United Kingdom, and the United States, national political leaders dismissed the threat and dithered in marshaling the appropriate response.
Many commentators have attributed China’s success to totalitarianism, but a country’s system of government is not really the deciding factor. Far more important is whether political leaders are willing to trade short-term economic pain and quotidian conveniences for the safety of their citizens. In New Zealand and Australia — both vibrant democracies — bold leadership and strong governance brought new infections down almost to zero, and political leaders such as New Zealand Prime Minister Jacinda Ardern were rewarded accordingly at the ballot box.
The first year of dealing with COVID-19 has taught us that piecemeal measures will only feed the pandemic. National and global crises call for national and global coordinated action. The U.S., the U.K., Brazil and other laggards have failed on both counts. Indeed, some countries are still pursuing the foolish notion of herd immunity, despite scientific evidence suggesting that no such protection exists for this disease. There are four common (though rarely remarked upon) coronaviruses that infect up to 15% of the world’s population each year, and that come back year after year, often re-infecting the same people. Assuming that SARS-CoV-2 is no exception, any country that places its hopes on a herd-immunity strategy will be endangering the rest of us year after year.
Although the Chinese government made some critical misjudgments early on, one thing it did right was to warn the rest of the world that the virus was transmissible, airborne, and controllable only through drastic and immediate measures. The countries that ignored the warning have since suffered the most, both economically and in human terms. Meanwhile, the countries that demonstrated social solidarity in controlling their outbreaks have been able to reopen their economies, though not necessarily their borders.
In the end, though, a collective response merely reflects the sum of individual actions. In too many countries, individuals fear that acceding to protective measures amounts to giving up one’s personal freedoms. Yet in times of war, when the dangers are apparent, people have shown time and again how much they are willing to sacrifice for their fellow citizens.
Clearly, a change in messaging is in order. We are at war with a virus. Few doubt the importance of personal liberty, but this is a time when we all need to forego certain conveniences for the sake of those around us.
Each new earthquake, tsunami, or emerging disease reminds us that nature is a dangerous force. If there was a reason why many Asian countries reacted more quickly and effectively to COVID-19, it was because they still harbored memories of SARS, H1N1 and the avian flu. Their experience in recent years shows that public-health measures that are stringently applied through strong leadership, governance, and social solidarity can quickly bring a pandemic under control and limit the death toll.
That is the biggest lesson of 2020. If it is not incorporated into national policies in 2021, the pandemic may well last not just through the next year but for many more years to come.
William A. Haseltine, a scientist, biotech entrepreneur, and infectious disease expert, is Chair and President of the global health think tank ACCESS Health International. © Project Syndicate, 2020.
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