Foreign Policy: Pandemic is over What does that even mean?

The Foreign Policy magazine released an essay suggesting that COVID-19 is no longer a pandemic, but rather a never-ending nightmare. Caliber.Az reprints the article.

In early 2020, I widely predicted that the then-new COVID-19 pandemic would be a 36-month battle. I added at that time that choices made by governments in the first weeks of the pandemic would decide whether the 36-month point marked cessation of all human deaths to the new disease, or merely the virus’s retreat from explosive spread to a new, permanent threat to humanity, akin to HIV.

I was wrong. It wasn’t 36 months from the declaration of a pandemic in March 2020—it’s 38 months. I apologize for the two-month miscalculation.

Sadly, I was right about everything else.

Once Chinese President Xi Jinping announced in December 2022 an end to China’s  zero-COVID policies, leaders around the world began to yield to pandemic fatigue among their populations.

In New Zealand, which maintained a lower per capita death rate than the world average throughout the pandemic with a mix of tough behavioural and travel restriction policies, once-popular Prime Minister Jacinda Ardern shocked the world in January 2023 with her sudden resignation, citing the vitriolic response, at home and abroad, to the COVID-19 policies she oversaw.

Also in January, Japanese Prime Minister Fumio Kishida announced his country would downgrade COVID-19 concern by May, likening the coronavirus threat to that of influenza. Some days later, US President Joe Biden made a similar proclamation, saying the special emergency status of COVID-19 would cease in the United States, effective May 11—a promise he is keeping. Around the world, governments have followed suit.

The scientific advisory group that studies epidemics for the World Health Organization (WHO)—and determines whether a given microbe constitutes an emergency threat to mankind—told the agency’s director-general that the Public Health Emergency of International Concern should be lifted, and on the morning of May 5 in Geneva, Tedros Adhanom Ghebreyesus did so.

In predicting a 36-month war with COVID-19 back in 2020, I framed it as a defeat for humanity. Despite our technological tools, unprecedented amounts of money and resources put to the task, enormous economic costs to the global economy, and spectacular advances in genetic sequencing and analytical technology, the virus spread worldwide, killing millions of people. We are only able to guess how many people died of COVID-19, and how many more suffer terrible long COVID-19 ailments that are likely to have permanent impacts. Tens of millions cases of long COVID-19 have been diagnosed worldwide—certainly an undercount—with at least a third of those impacted suffering neurological or cardiovascular damage that is proving disabling.

Worse, the virus remains in early stages of evolution, adapting not only to Homo sapiens, but dozens (if not hundreds) of other mammalian species ranging from hippos to anteaters. There is no inevitable trajectory for COVID-19. Those who liken the coronavirus to influenza have noted that the H1N1 form of flu that killed as many as 75 million to 100 million people in 1918-19 remains in circulation today, albeit in less lethal forms that most people experience as mild disease. It is hoped that COVID-19 will follow a similar trajectory, dampening its virulence and pathogenicity over time to become, as Kishida forecast, just like the flu.

But there is another pandemic to turn to for clues to the COVID-19 future: HIV and AIDS. The AIDS pandemic never stopped—humanity simply ceased paying attention to it once effective treatment was found, which both reduces the risk of severe illness and lowers the amount of virus in individuals’ blood to as near-zero as can be measured, reducing the chance of passing it onto other people sexually or through contaminated blood and needles. But HIV is still spreading, sickening, and killing.

It never “vanished,” and the still-evolving virus shows no sign of dampening either its pathogenicity or transmissibility. Moreover, individuals must remain on their drugs for life, and the viruses within them may evolve resistance towards the first or second lines of therapy, forcing use of more complex cocktails of increasingly expensive therapies. From 2000 to 2015 alone, global spending on the HIV/AIDS pandemic approached $600 billion, peaking in 2013 and tapering off since.

It was this tragic history that came to mind as I read these two sentences in the WHO statement announcing the end of the COVID-19 public health emergency:

“This virus is here to stay. It is still killing, and it’s still changing. The risk remains of new variants emerging that cause new surges in cases and deaths.”

As was the case with AIDS, the muted victory now declared that COVID-19 was “won” with a tough mix of behavioural restrictions (less sex for AIDS, fewer crowded events for COVID-19), barriers (condoms/masks), drugs (antiretrovirals/antivirals) and “vaccines.” Dutch doctor Joep Lange famously declared some 20 years ago that anti-HIV drugs so effectively blocked transmission of the virus that treatment is prevention. Out of the limelight, in meetings with HIV research colleagues, Lange argued that the drugs, taken as prophylactics—dubbed PrEP—by sexually active individuals, were “vaccines,” as the medicines prevented most lasting infections.

And in practice, PrEP is now widely used to prevent HIV infection. But the drugs aren’t genuine vaccines, akin to measles immunization, for example, as they can’t be administered and boosted to provide lifelong protection against infection. Thus, the financial spigot must flow in perpetuity, and sexually active adults who fear their partners carry HIV, and drug users that share syringes, must take their PrEP assiduously and frequently.

There is no AIDS cure, despite a handful of isolated cases of individuals treated with heroic measures to effectively clear HIV from their bodies. And there is no HIV vaccine.

We have followed the same path with COVID-19. The mRNA “vaccines” used by billions of people do not block COVID-19 infection or prevent the vaccinated individual from passing the virus on to others. Moreover, vaccine efficacy in preventing acute COVID-19 disease and death wanes within months, as the viral evolution process appears today to be primarily a natural selection phenomenon aimed at evading host immune systems. (Natural infection also provides very short-lived protection against future reinfections and severe disease.)

If PrEP is equal to a HIV “vaccine,” then the mRNA products are also vaccines. But neither fit classic public health definitions of immunization. Both are expensive, medicalized solutions to public health catastrophes.

We have now entered the post-pandemic phase of COVID-19, wherein the still genuine viral threat will be referred to in the past tense, all behavioural and social restrictions aimed at controlling spread will vanish, budgets for every aspect of viral control will slim down or evaporate, and politicians turn to the blame game, scouring for human beings to act as scapegoats or be pilloried on sharp sticks prominently displayed across social media.

Some of the blame targets are familiar ones, as they experience chastisement after every serious outbreak: the World Health Organization, the Centers for Disease Control and Prevention in the US and its counterpart agencies in other nations; the World Bank and other global funders; Big Pharma; and general themes of inequity, wealth gaps, health care worker shortages, and lack of clear leadership. The COVID-19 crisis has witnessed some additional targets for the “post-pandemic” thrashing, including science (writ large), the US National Institutes of Health, truth, Anthony Fauci, public health workers, vaccine promoters, and, inevitably, China (or the United States, if you’re Chinese).

As the blame phase continues through at least one round of national election cycles around the world, fueled by opposing politicians, the reform phase is also playing out, marked by an endless parade of expert panels promulgating reports delineating what went wrong with the COVID-19 response, and which great reformation ought to immediately ensue to be better prepared for the next time. In the end, having personally served on several such after-action expert panels, an ambitious reform agenda will whittle down to a list of largely symbolic changes both inside countries and in the global architecture of pandemic response.

Blame and reform co-mingle, often resulting in government or health changes that allow revenge against supposedly malevolent or incompetent individuals and institutions, but actually provide no defence against the next major infectious event.

When the monkeypox (now dubbed mpox) outbreak emerged in 2022 many gay men in North America and Europe, and African public health leaders raged against the repetition of mistakes made in response to HIV in the 1980-90s and COVID-19 in 2020-22: stigma, inequities in access to tools and treatments, failures to provide clear behavioural and social guidance to populations at greatest risk, absence of data and tracking, and achingly slow responses.

As was the case with HIV/AIDS, gay communities stepped up to the plate and took the helm in guiding behavioural changes that swiftly and dramatically lowered spread of mpox—they did not wait for government or for elusive pharmaceutical miracles. And though the new form of the mpox virus remains in circulation in at least a few nations worldwide, causing sickness and death, the inequities in access to vaccines are in parallel with a rich world amnesia, forgetting about the disease once North Americans and Europeans ceased succumbing to it.

But other threats loom. Several forms of avian influenza—especially the extremely lethal H5N1—are now spreading all over the world, infecting various animals (such as minks, bears and mountain lions, California condors, ferrets, sea lions, dogs, whales and dolphins, seals, skunks and racoons), sometimes human beings. Poultry farmers all over the world are bearing the brunt of the front-line fight against this latest evolutionary form of H5N1, culling literally billions of infected chickens, ducks, turkeys, and other avian livestock. But we aren’t ready. Though H5N1 has been circulating in birds, and occasionally people, since the mid-1990s, there is no commercially available vaccine, treatment, or even rapid point-of-care diagnostic.

Meanwhile, the flu scientists who monitor viruses, sequence their genomes, and try to determine whether any given new form is capable of spreading from one person to another are under attack. Caught in the COVID-19 blame game spillover, their laboratory hands are tied by those who insist the virus was “created” in a laboratory in Wuhan using gain-of-function research—a type of genetic analysis that seeks to identify forms of viruses capable of spawning catastrophic pandemics. Some Republicans in the United States want all forms of gain-of-function research banned and seek to eliminate National Institutes of Health funding for any forms of research that theoretically could enhance a virus. Flu researchers tell me they are afraid to do their work, fearing loss of research funding, and cannot prepare the world for a potential H5N1 (or H3N8, H7N9, or any other avian flu) pandemic by developing rapid diagnostics or vaccines.

So, it is with a heavy heart that I acknowledge that I was overly optimistic in early 2020—I was off by two months. And sadly, I repeat the wise words of the great sage, Yogi Berra: “It’s déjà vu all over again.”