The World Health Organization declared COVID a pandemic on March 11, 2020. In the two years since, countries have diverged on their containment strategies, introducing many different ways to mitigate the virus, with effects variables. Here, four health experts examine what worked well, where scientists and policymakers went wrong, and what needs to be done to protect human health from now on.
Andrew Lee, Professor of Public Health, University of Sheffield
Most governments have not responded well to the pandemic. The first answer needed to be decisive, fast, communicated transparently and delivered at scale. Often this was not the case.
Before the arrival of effective treatments or vaccines, brutal measures such as confinement were necessary to minimize the loss of life. Indeed, in places like New Zealand, Taiwan and South Korea, where the spread of infection was initially low, lockdowns have been effective and virus removal possible. Countries that have successfully pursued elimination strategies have seen a drop in the number of cases and deaths, buying time until vaccine protection arrives.
However, we are now in a different phase of the pandemic. Vaccines have significantly changed the risk. Elimination of the virus also appears unfeasible at present, with widespread transmission in virtually every country. The value of lockdowns and travel restrictions is now significantly reduced and their wider societal harms need to take into account.
To live safely with the virus, we must learn from the past two years. This includes getting away from presenteeismthat drives people to go to work or school when they are sick, as well as to appreciate the importance of ventilation and face masks to reduce the spread of airborne disease. The threat of new variants has not gone away, so genomic surveillance of the virus will still be needed on a global scale.
We must also learn from our mistakes. Narrow hospital-centric outlook meant that we did not sufficiently protect vulnerable and disadvantaged people, such as residents of nursing homes, people with disabilities learning disabilities, ethnic minorities and the poor. We also didn’t realize early enough that the pandemic was a “syndemic” – interact with and amplify many other illnesses, such as poor mental health, smoking and alcohol-related illnesses.
Sheena Cruickshank, Professor of Biomedical Sciences, University of Manchester
Immunological discoveries have been key in the fight against COVID. Overall, they would not have happened without the cooperation of scientists from all disciplines and all nations – and without the help of the public around the world. Scientific collaboration has been one of the main successes of the pandemic.
Early access to the genetic code of the coronavirus, combined with our knowledge of other members of the virus family (such as Mers and Sars), allowed work on vaccines to start quickly. Knowing that the virus was using its spike protein to enter our cells then gave us an initial target for vaccines.
Decades of experience in vaccine development, along with investments from governments and the pharmaceutical industry, as well as the participation of hundreds of thousands of volunteers in clinical trials, then accelerated the development of vaccines at an astonishing degree. When it comes to vaccine development, the world has got it right.
Understanding the immune response to COVID has helped us understand why certain groups (like the elderly) are much more vulnerable to severe infection. National studies have used their size and scope to identify biomarkers that correspond to the protection or serious illness in COVIDwhich can improve patient outcomes and inform new treatments.
However, lives continue to be lost due to the lack of equity in vaccines, with many countries still being deprived of vaccines and medicines that could help them. Lives have also been lost due to misinformation – fueling mistrust, vaccine hesitancy and the promotion of unsafe or inappropriate “cures” for COVID. Much remains to be done to ensure good access to vaccines and their use around the world.
KK Cheng, Professor of Public Health and Primary Care, University of Birmingham
Very few countries with strong public health traditions have avoided the disasters of the pandemic. Why?
One explanation is that most developed countries were completely untouched by the 2003 Sars epidemic and were only slightly affected by the 2009 swine flu pandemic. Complacency crept in and there was also a general lack of experience in managing a pandemic.
Additionally, at the start of 2020, there were two widely held beliefs: first that the coronavirus, like the flu virus, simply could not be contained, even for a few months; and second, extreme restrictive measures, which we now call “lockdowns,” would be impractical in liberal democracies. Both turned out to be wrong.
In the UK, failure to appreciate the importance of early action, such as in the case of wildfires, has also led to delays in introducing or strengthening control measures by fear of negative economic impacts. These high-level issues have culminated in disasters downstream, including inadequate testing capacity, lack of PPE in health and care facilities, inadequate infection control in care homes, testing systems and dysfunctional traceability and the failure of home isolation of cases.
The potential benefits of island states have also, in many cases, been squandered by loose border controls. Australia and New Zealand showed countries like the UK what was theoretically possible to contain the virus – at least in the early stages of the pandemic.
A persistent global failure is the inequitable distribution of vaccines. Always only 13.7% people in low-income countries have received at least one dose.
Trish Greenhalgh, Professor of Health Sciences in Primary Care, University of Oxford
We initially assumed that the pandemic would be solved by evidence-based medicine – a school of research dominated by the search for generalizable truths (“how large is the effect of intervention X on outcome Y in disease Z? “). Although this approach helped to find effective treatments for COVID, it confused us to assess non-pharmaceutical interventions such as masks.
While being obsessed with the need for controlled experiments (“masked” versus “masked”), we suppressed our scientific imagination. We have not questioned enough the novelty of COVID and the significance of its unique patterns of spread, such as superspreader events, asymptomatic transmission and the much higher chances of catching COVID inside versus outside. All these things should have raised hypotheses very early on about a airborne transmission mechanism and the potential value of masks.
We also viewed masks too simplistically, not understanding them as a complex procedure in a complex system. The masks vary in quality and efficiency and can be mounted good or bad. They protect other people as well as the wearer – therefore their population-level effects must be mathematically modeled rather than simply tested in one-off experiments. Moreover, hiding (or refusing to hide) is a social practice, linked to identity and values; many people refused to mask up, and clashes has become, unfortunately, part of the masking.
Two years ago, I wrote my first academic paper on COVID, advocating for the use of precautionary principle and the introduction of public masking “just in case”. It took another four months – and 40,000 deaths – before the UK did.
Covid vaccination for children in the 12-14 age group could start this week