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8 December 2021

How the battle against Covid became a forever war

Many predicted the virus would become a mild illness akin to a common cold. But as the Omicron variant spreads, scientists say there may be worse to come.

By Anjana Ahuja

It has been two years since Covid-19 started spreading out of the industrial city of Wuhan in China, but the pandemic has not yet run out of steam. Just as some dared to hope that – thanks to speedy vaccines and medicines such as dexamethasone – the world was settling into an uneasy truce with its contagious foe, another variant of the Sars-CoV-2 virus arrived to shatter our complacency.

The Omicron variant, now present in 57 countries including the UK, has prompted the British government to extend mask mandates; introduce vaccine passports for some venues; and advise working from home. “Plan B” is an attempt to limit a looming wave of infections that, according to projections, could lead to 1,000 to 2,000 hospitalisations a day at its peak. Omicron infections are thought to be roughly doubling in the UK every three days. Ministers, who are urging people to get their boosters, have not ruled out making vaccinations compulsory.

That would allow Omicron to slip past the body’s immune system to a greater degree than existing variants, including Delta. Scientists are still trying to work out whether the new variant spreads faster than others; whether it is breaching the immune systems of the vaccinated or previously infected; and whether this translates to a higher risk of severe illness and death. A milder illness that is highly transmissible can still be deadly if healthcare systems are overwhelmed.

[See also: It’s not your doctor’s fault you can’t get an appointment]

The Omicron variant, originally known as B.1.1.529 and now officially designated a “variant of concern” by the World Health Organisation (WHO), is an unhappy reminder that the world remains mired in a pandemic. As of 30 November 2021, the WHO recorded more than 260 million cases and 5.2 million deaths due to “coronavirus disease 2019”, or Covid-19, the disease caused by the Sars-CoV-2 virus. Both numbers are likely to be gross undercounts, kept artificially low through a lack of testing and diagnostic capacity, as well as varied reporting criteria between countries.

The mythical future that so many confidently predicted, in which Covid-19 becomes a mild, endemic (constantly circulating) illness akin to a common cold, seems as remote in December 2021 as it did in December 2020. “In my view, we remain closer to the start of this pandemic than the end,” says Jeremy Farrar, until recently an adviser to the UK government on the Scientific Advisory Group for Emergencies (Sage), and director of the Wellcome Trust, a wealthy charitable foundation focused on global health. Uncertainty remains his watchword, given different strains of the virus are ricocheting around the globe infecting billions of people who show enormous differences in ethnicity, age, material wealth, nutritional status, and natural and vaccine-induced immunity to Covid-19.

That diversity, Farrar tells me, offers a rich playground for a novel pathogen: “In modern history, we have not seen a pathogen evolve and be in so many people all around the world. Continued transmission means continued evolution, and there is enormous evolutionary pressure on the virus to continue to evolve and exploit niches. The idea that pathogens become less virulent over time is, I think, overstated – we just don’t know if that will happen, or even if that were to happen how long it would take. We forget that, with obvious exceptions like HIV, Sars-1 and Nipah virus, most pathogens have been circulating in humans for centuries or millennia.” Hippocrates wrote of a flu-like illness in 412BC; seasonal influenza, so named because the illness was once thought to be influenced by the stars, still kills about 400,000 annually.

In many ways, the arrival of Omicron vindicates those, including Farrar and the former prime minister Gordon Brown, who have long argued that the pandemic will only end once the world is vaccinated. In a time of contagion, nobody is safe until everyone is safe. For WHO director-general Tedros Adhanom Ghebreyesus, who has repeatedly begged rich countries to share their vaccine spoils, the new variant symbolises “prolonged vaccine injustice”, in which rich countries triple-jab their citizens and hoard the surplus until doses expire, while health workers in poor countries perish for want of a first dose.

Of the 3.3 billion people around the world now fully immunised, only 6 per cent are in Africa, where Omicron was first identified. “The longer we take to deliver vaccine equity,” Dr Tedros tweeted recently, “the more we allow the virus to circulate, mutate and potentially become more dangerous.”

This was also the deeply felt message of every person interviewed for this report. It was no surprise to find vaccine equity the top concern of Richard Hatchett, head of the non-profit Coalition for Epidemic Preparedness and Innovations (CEPI). Hatchett’s organisation seed-funded the Moderna and Oxford/AstraZeneca vaccines in January 2020, something of which he is “very proud”.

When I ask Hatchett to describe his lowest point in the pandemic, he responds: “I’m inclined to interpret that emotionally – and I would say that has been watching the equity gap emerge and widen to such a profound extent.” Though the Covax scheme, a centralised source of vaccines supplied at minimal prices, has helped low- and middle-income countries, Hatchett says, “we haven’t prevented that gap from emerging – and that is tragic and unnecessary. The world could have done better.”

It was less expected to hear Professor Chee Yew Wong, professor of supply chain management at Leeds University Business School, alight on global immunisation as the key fix for a disrupted world economy. Wong explained how the pandemic had thrown global supply chains into expensive disarray, thanks to a mix of border closures; export bans and restrictions on medical supplies; labour shortages caused by factory workers fleeing cities and deciding not to return; containers being in the wrong place (and costing ten times more than usual); and lorry drivers shunning ports due to backlogs.

[See also: The global race to contain Omicron]

While wealthy countries such as the United States are now frantically nurturing homegrown critical supply chains (Wong points out that the US, anxious to become less dependent on China, is showing new interest in the Democratic Republic of Congo, home to the rare minerals mined for electric car batteries), he believes “there’s no way out until everyone is vaccinated”.

Wong stresses: “You cannot just stop or replace the global supply chain. No country can be self-sufficient. You can’t just close your door. The only option is to stop the virus.” Even if it means waiving patents on the vaccines and the associated technology? “You can’t change the law easily but, specifically for this vaccine, we have to [be able to] buy the IP or pay companies or do something. The current business model is not helping us. It’s just making this mess drag on longer.”

The immense power of the pharmaceutical companies has not gone unnoticed. The London-based non-profit Bureau of Investigative Journalism reported in April that Pfizer, in its vaccine supply contract, had demanded that South Africa put up sovereign assets as collateral against possible future legal liability costs. The country’s former health minister Zweli Mkhize described it as like being forced to choose “between saving our citizens’ lives and risking putting the country’s state assets into private companies’ hands”. The company eventually backed down.

That is another surprising consequence of a pandemic-stricken world: the purveyors of vaccines, the closest things we have to silver bullets for saving lives and economies, now wield unprecedented political power. Israel’s former prime minister Benjamin Netanyahu reportedly contacted Albert Bourla, Pfizer’s CEO, 30 times trying to place orders. The Pfizer-BioNTech vaccine is now the best-selling pharmaceutical product in history. Pfizer, which once shipped penicillin to Allied troops on the front line and is now working on a jab tailored to Omicron, expects sales of its coronavirus vaccine to hit $36bn in 2021 alone.

As well as reaffirming the need for global cooperation, the pandemic has exposed national differences in how countries have confronted this extraordinary health and economic threat. Many countries closest to China – Taiwan, South Korea, Japan – fared relatively well. Perhaps they were chastened by the experience of Sars-1 from 2002 03, which killed nearly 800 people; these countries, with good health infrastructure, a cautious approach to infectious diseases and a culture of mask-wearing, acted swiftly to stop transmission.

Taiwan, which has never fully locked down but instead carried out early airport screening and stringent contact-tracing, has recorded fewer than 900 deaths in total. South Korea, with a population of just over 51 million, has had fewer than 4,000 deaths. New Zealand (50 deaths) and Australia (2,000 deaths) have also kept transmission incredibly low, albeit at the expense of cutting themselves off from the world. China, the source of the outbreak, is still chasing a zero-Covid-19 policy.

At the other end of the scale, Peru tops Statista’s chart as the hardest-hit country, with more than 200,000 deaths in a population of 32 million. One demographer estimates that Russia will have suffered a million excess deaths due to Covid-19 by the end of this year, despite the country’s early development of its own vaccine, Sputnik V (excess deaths offer a more accurate measure in countries where there are issues around counting).

Other countries that have struggled include the US, with around 780,000 confirmed Covid-19 deaths; Brazil, with more than 600,000; and India, which has officially lost around 470,000 citizens to the disease (research published in July estimated excess deaths to be ten times higher).

Tragically, the virus has exploited inequality, disproportionately hitting the poor and the marginalised. These people are more likely to have jobs that expose them to infection; to have underlying conditions, such as diabetes and heart disease, that predispose them to a worse outcome; and to live in cramped housing. Covid-19 divided society into the exposed poor and the shielded rich.

[See also: How the virus struck back]

The UK, which benefited from an early vaccine roll-out, has suffered 170,000 deaths. That is lower per capita than many eastern European countries such as Hungary, Poland, Croatia and Romania. Vaccine uptake explains some of the discrepancy, with only 38 per cent of Romanians fully vaccinated compared to the UK’s 69 per cent (Hungary has immunised 61 per cent, but opted out of the EU’s deal with Pfizer and chose vaccines made in Russia and China).

The UK has, however, come off worse than many comparable economies, including Spain, France, Sweden and Germany. It has relied heavily on vaccines to keep deaths and severe disease at bay despite consistently high infection rates since July. It has scrambled a response to Omicron: putting several countries in southern Africa on its red list (a move that infuriates South Africa, which complains it is being penalised for information-sharing), strengthening mask mandates, and reintroducing mitigations in schools. The impact of travel bans is likely to be limited: the variant, reported in more countries by the day, has already spread to the UK. Boris Johnson’s government will review measures in the run-up to Christmas and further restrictions remain impossible to rule out.

Kate Bingham, a venture capitalist, was head of the Vaccine Taskforce – which secured early access to effective vaccines – as the UK battled coronavirus in 2020. Her verdict is that the country did “stunningly well on vaccines… We’re the only country in the world that’s taken an academic vaccine and manufactured two billion doses, which has vaccinated 20 per cent of the world, all not for profit.” She declines to be drawn on what the politicians got wrong.

She did, however, recently give a headline-grabbing speech at Oxford University on how the country can better prepare for future pandemics. She advocates appointing a full-time pandemic security adviser who reports directly to the Prime Minister, just as she did: “My relationship with Boris [Johnson] was clearly a positive thing because it meant if I WhatsApped him, I knew he would read it and respond, which was an incredible lever.”

Another recommendation is to make the UK a welcoming destination for biomedical manufacturers, whether they are making vaccines, pills or other supplies. She describes the government’s decision to pull out of a vaccine contract with the French biotech company Valneva, which had set up a factory in Scotland (those jobs have since gone to eastern Europe), as “inexplicable”.

The government is also reported to have put up for sale a vaccine manufacturing facility it had funded in Oxfordshire. It was meant to provide vaccine capacity on tap in future pandemics, and its proposed disposal has alarmed Clive Dix, Kate Bingham’s successor as head of the Vaccine Taskforce.

Bingham, a biochemist by training, would also like the civil service to recruit more graduates with scientific, industrial, commercial and manufacturing skills. Patrick Vallance, chief scientific adviser to the UK government, has noted that “a serious lack of scientific expertise… threatens [Britain’s] ability to compete with nations such as China”.

Only one in ten of those recruited to the civil service fast-track has a background in Science, Technology, Engineering and Maths (Stem) subjects; ministers are appointed for their political skills rather than epidemiological nous – and are usually not in positions long enough to master their briefs. This lack of expertise leaves a blind spot in decision-making. It is notable that Chen Chien-jen, vice-president of Taiwan, a country celebrated for its pandemic practice, is an epidemiologist. 

The UK’s lack of knowledge at the top has become painfully evident to Ravi Gupta, an infectious diseases doctor and professor of clinical microbiology at Cambridge University. He describes tending to scared Covid-19 patients, some of whom ended up dying alone. “The thousand or so people a week dying of Covid-19 has become normalised. It’s seen by policymakers as acceptable but many of us think it is unacceptable because it’s avoidable. It’s very upsetting to walk on to the wards in the hospital and see people suffering and dying in an era when we have vaccines. This shouldn’t be happening. Part of that is because we’ve allowed community transmission.”

Gupta’s list of policy mistakes includes lifting mask mandates prematurely and dithering on child vaccination: “The big shock to the economy is lockdowns and nobody wants them; but lockdowns will be on the table for as long as policies don’t reflect good practice in infection control and public health.”

He praises those academics who have bravely questioned the UK’s approach to Covid-19 but says he is shocked that so many senior voices have stayed silent. Gupta recently decided, after careful thought, to enter the fray: “We take this oath to protect people and not cause harm, and when you see things that cause harm, whether it’s misinformation or a lack of policy, you end up with a moral obligation to speak up.”

In June 2020, I wrote in these pages that I feared the virus would be with us for years rather than months. If vaccines could not completely stop transmission, then they, like flu vaccines, would offer “protection against a foe that never goes away, rather than a time machine capable of transporting us back to a pre-Covid world”.

Today, with so much uncertainty over how Omicron might play out, it is harder than ever to imagine that we will return to a pre-Covid world in 2022. When your enemy is a ferocious virus that has turned the whole of humanity into its playground, an uneasy truce might be as good as it gets.

Anjana Ahuja is co-author with Jeremy Farrar of “Spike: The Virus vs The People” (Profile Books)

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This article appears in the 09 Dec 2021 issue of the New Statesman, Christmas Special