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[Jerome H. Kim] Pandemic day 1000: milestones, tombstones, millstones

Dec. 5 marks the 1,000th day since the World Health Organization declared the COVID-19 pandemic. With social distancing, vaccines and other interventions as well as natural infection, the world may be seeing a glimmer of light at the end of the pandemic tunnel.

But the pandemic is still not over. China has posted record numbers of cases lately and concern is growing that the COVID-19 in China will not respond to “Zero COVID” policies of the past. The question: Is China ready? Vaccination rates were low, particularly in the elderly -- a group at high risk for bad outcomes. Will the currently approved Chinese vaccines prove sufficiently effective to keep COVID-19 infected patients from filling hospitals and intensive care units? Is there additional capacity? Are there stockpiles of personal protective equipment, anti-COVID-19 antiviral medication, adjunctive medicines and personnel? Is there a provision for remote care (“telemedicine”)?

Communication seems muddled. Perhaps we don’t have visibility, real-time data, on the status of the pandemic in China, so perhaps this worry is premature, or unwarranted. But we do know that COVID-19 has shown us the human and financial cost of unpreparedness, and we know that uncontrolled outbreaks have generated ever more elusive variants.

Korea, in contrast, is in its seventh COVID-19 wave, with the daily cases jumping from 10,000 to 60,000 (Nov. 24) over the past several weeks. With high rates of primary vaccination and boosters, and with new bivalent boosters, there are still unfortunate hospitalizations and deaths, but the life of the nation has accommodated the “new normal.” This new normal will depend on continued vigilance, vaccination and medical care -- controlling what can be controlled (for instance, influenza) to mitigate the impact of the triple-demic of influenza, COVID-19 and respiratory syncytial virus that is overwhelming hospitals in other parts of the world.

We do need better vaccines. Ideally these novel vaccines will: 1) give a higher level of protection against disease for a longer period of time (higher magnitude and durability); 2) provide better cross-protective responses against new variants (universal COVID vaccine) or all coronaviruses (pancoronavirus vaccine); 3) prevent infection (current vaccines do protect against disease but aren’t great at protecting against infection; 4) prevent transmission (maybe the same as No. 3).

The easiest way to do this is to add a new vaccine to an older one; this is how we get the “bivalent” COVID-19 vaccines from Pfizer/BioNTech and Moderna. Vaccines that are broadly protective against multiple strains are entering early testing in humans, complicated by the fact that almost all human populations have a mixture of vaccinated, previously infected, or “hybrid” (both vaccinated and previously infected) persons. The pancoronavirus vaccines are still in animal testing, and vaccines that prevent infection are also in early development.

COVID-19 vaccine development has taught us that innovation can move quickly, if it has adequate funding -- $20 billion for Operation Warp speed, billions spent by the Coalition for Epidemic Preparedness and Innovation as well as the European Union and the United Kingdom. It is possible, but slower, to innovate for less. The race isn’t between a naive human population and a novel coronavirus anymore, but the proliferation of variants (the BA’s, the XBB’s, the “Taurus” mutant -- BA.2.75.2) is worrisome, but unpredictable.

Is the world better prepared than in March 2020? The five inequities remain unaddressed -- in diagnostics, R&D, vaccine manufacturing, vaccination access and vaccination. The gaps in diagnostics, manufacturing and vaccination remain unbridged, hobbled by the gap in global leadership. As the world, bruised by COVID-19, struggles to carry on, we remain globally exhausted, vulnerable and unprepared. Unless we bridge the gaps or remove the inequity millstones, the “next omicron” or, less likely, next novel pandemic could yield the familiar litany of deaths and catastrophic financial disruption. As Korea used the lessons of MERS to successfully (mostly) mitigate the impact of COVID-19, we need to act on lessons learned and address the inequities and gaps that killed at least 6.6 million, or as many as 18 million, people. We need global leadership in pandemic response, and we need to start now.

Jerome H. Kim,

Jerome H. Kim is director general of the International Vaccine Institute and a visiting distinguished professor at Seoul National University. -- Ed.

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