After two years and with the arrival of vaccines, the end of the pandemic is beginning to be in sight. An endemic future is beginning to emerge, in which we could cohabit with COVID-19. However, this requires global coordination and the fulfilment of a series of criteria and objectives.
Adelaida Sarukhan, science editor and one of the authors of a collection of analytical documents on COVID-19 at the Barcelona Institute for Global Health (ISGlobal), tells us about the future of the pandemic.
To begin with, can you explain the difference between endemic disease, epidemic and pandemic?
Of course! An endemic disease is one that is concentrated in a region, country or continent and whose transmission is relatively stable and predictable; there are no surprises. An epidemic, on the other hand, is a disease that in a specific area and at a specific time has a higher peak incidence than expected.
So, when an epidemic spreads to many countries and has a very wide geographical distribution, it is called a pandemic. This is precisely what happened with COVID-19; it started as an epidemic in Wuhan, China, but as it spread around the world it became a pandemic.
So what is the future of COVID-19?
The virus cannot be eradicated, as it has animal reservoirs, and eliminating it is very difficult, as it is extremely contagious. Therefore, the expected scenario is that the virus will become endemic and produce seasonal epidemic peaks, as is the case with influenza. Endemic does not mean mild. It will continue to affect many countries and there will continue to be cases and deaths, but transmission is expected to be more controlled and stable.
In countries with high vaccination coverage and a high level of immunity, the transition to the endemic phase may have already begun.
And what is the estimated time to reach an endemic phase?
It is very risky to answer that question, but getting to that point depends mainly on two things: on the duration of immunity, regardless of whether it has been acquired by exposure to the virus and/or through vaccination, and on the emergence of new variants that are more transmissible or more able to evade immunity.
Furthermore, in order to reach the endemic phase and remain in it, it is necessary to establish an overall coordinated strategy with a set of clear objectives and criteria.
Is it possible to establish the same objectives and criteria at the global level?
Well, the situation in each country is very different, as are the capacities of each health system. That is why, rather than setting indicators and criteria that are the same in all regions, we should focus on being in the same boat and trying to go on the same direction. The general intention must be to avoid saturation of primary and hospital care.
One of the main criteria for defining the endemic phase is that health services, both primary care and hospital care, are able to function normally and are able to treat any disease
But the vaccine has not been distributed equally globally.
It is clear that vaccines have not reached all countries equally. For this reason, we must insist that those countries that have not had access to vaccines previously, now have them. It has not only been a problem of availability, the form of transportation and distribution has also contributed.
However, new vaccines that are being developed may bridge this gap. We are starting to see more classical vaccines based on proteins, which are not as demanding in terms of distribution. And these new vaccines could be produced locally in low and middle income countries. This will help to equalise vaccine coverage globally.
What about patents?
I am not an expert on regulation and patents. But there has been a lack of governance, both nationally and globally, in the financing and promotion of products considered as a common good. And this is what has prevented equitable and affordable access to them. This is why releasing patents is absolutely justifiable in a crisis such as that of COVID and is the first step towards making vaccines available for production in middle-income countries.
Efforts must now focus on vaccinating the entire population. This means not only having vaccines available, but also having the resources to get them into the hands of the most vulnerable.
What is the situation in Spain?
Vaccination in Spain has been a real success, especially in the population over 65 years of age, which is the sector with the most risk. And we have achieved more than 80% coverage in the general population.
In addition, with the advent of second generation vaccines, we could achieve a more durable or stronger immunity against infection. We refer to protein-based vaccines or intranasal boosters that ensure mucosal immunity. Also the use of antiviral drugs to help minimise symptoms and treat the disease in the early stages of infection.
Will it be necessary to have vaccine booster shots?
What has been seen so far is that messenger RNA vaccines work very well, are safe and effective. But over time there is a decrease in the level of antibodies, which makes us more susceptible to infection. Therefore, the most vulnerable groups of people, such as the elderly or immunocompromised, will probably need additional booster doses. For the rest of the population and right now, the current 3 doses are sufficient.
There has been talk of a “new normality”, what can we expect from it?
It is important that we are prepared, both as individuals and as governments, to take some measures if we have to face again with a new variant or a new peak in the number of cases. In the case that health systems are put under threat again, it would be necessary for the authorities to intervene and put in place a series of restrictions. But when transmission is low we can be more relaxed.
With some very simple and relatively low-cost actions we can have a very high positive impact. There are two key points here that can make a big difference. On the one hand, there is the individual’s willingness to keep the mask on in indoor spaces when the situation warrants it (e.g. when being ill). On the other hand, and more dependent on government and institutions, there is the need to improve ventilation in public places.
Thank you very much Adelaida! We hope that the end of the pandemic will come soon.