Michael Rosen is well known to millions of readers around the world, and to even more of their children, through his books of prose and poetry. Early in 2020, the much-loved writer, now 74, caught Covid-19. We know that older patients are particularly susceptible to the coronavirus, and for seven weeks Rosen was in intensive care at London’s Whittington Hospital – six weeks breathing through a ventilator in an induced coma. His family thought at one point that they had lost him. He survived. But he has lost hearing in his left ear; his left eye is foggy, he has numbness in his toes, blood clots on his lungs and struggles with breathing.
The coronavirus pandemic of 2020 will have taken close to two million lives by the middle of 2021. It overwhelmingly kills older people with pre-existing medical conditions such as diabetes and heart disease. It also targets the poorest, people who are homeless, and those in prisons. It thrives in places where it is difficult if not impossible to implement the necessary social distancing, mask-wearing, and hand hygiene that can be the difference between life and death. It has precipitated the most severe global economic downturn seen in at least a century. Lockdowns in the poorest countries have had devastating consequences to lives and livelihoods, as Vinay Lal writes in his essay ‘Viral Corona Capitalism’; and, as Chandrika Parmar addsin ‘Swollen Feet’, India’s first lockdown led to the largest migration in the country’s history when nearly 140 million newly unemployed people left the cities to return to towns and villages.
The deaths have not been evenly spread. More than half a million have been in the United States and the European Union, countries that are the world’s biggest spenders on public health, and home to laboratories with some of the most advanced biomedical research facilities. In contrast, some of the lowest death rates are in the Asia-Pacific region, and in the countries of the Gulf, with the exception of Iran as Lila Randall notes in her article. As much of the world continued in the grip of second and third waves, life in China, New Zealand, Singapore, Thailand and Vietnam appeared to return to some kind of normal. And that includes economic and business life, too.
As with past pandemics in history, the coronavirus pandemic of 2020 will have longer-lasting effects. It will contribute to the changing balance of power between China and the United States; it will almost certainly contribute to lasting changes to how science is done and how medicines and vaccines are approved by regulatory bodies. It will affect how often we travel, how we travel and where we travel to. It likely will not impact the pace of industrialisation and urban development, but it will have other impacts that are as yet impossible to foresee.
I can remember sitting at my desk at the London offices of Nature, the primary journal of scientific research, overlooking King’s Cross station. It was a few weeks after the first reports that an unknown virus had begun to filter out of Wuhan in China’s Hubei province. This was late January 2020, and media were reporting some 300 cases. Although the overwhelming majority were in China, cases were beginning to be reported in Japan, South Korea and Thailand.
By January’s third week, six people were known to have died, but we weren’t completely sure whether the virus could transmit between humans. Even at that early stage, however, there were things we knew. Some of the first cases had been traced to a live animal market in Wuhan. The virus had also been identified as being in the same family of viruses that had caused Severe Acute Respiratory Syndrome (SARS) in the countries of East Asia, which had killed hundreds of people between 2002 and 2003. The SARS viruses infect humans via bats, a hardy animal with an extraordinary propensity to live with diseases, and the new coronavirus would subsequently be called SARS-CoV-2; and Covid-19 would be the name given to the disease.
As Colin Tudge points out, virusesare integral to ecosystems. Those that transmit diseases from animals to humans have been with us since the earliest times, and for as long as our two species have lived in shared spaces. But what are called zoonotic diseases seem to become more dangerous to humans, as humans continue to take over and convert natural habitats to serve human needs. HIV, which likely jumped to humans from chimpanzees, has infected around 75 million people and around 30 million people have died. The first SARS virus killed 15% of those infected, and half of those who were over sixty. In those first few days, I remember how tempting it was to think that the new coronavirus would be less lethal – only that assessment was fast changing.
Around the middle of January, researchers from a laboratory at Imperial College in London did some rapid modelling of people going in and out of Wuhan. On that basis, they estimated that there were at least 1,700 infections, and not 300. Looking at it now, it seems a trivial figure compared to what has happened since (nearly 90 million infections). But 1,700 was nearly six-times the number of reported cases, and to the untrained eye (in other words, most of us), that was a large multiple. Worse was to come as within days, China was preparing for the annual new year Spring Festival. If the Imperial College team was right, that meant the virus would potentially infect many more as hundreds of millions were planning on taking to the roads, rail and air, fanning out to all corners of China.
By common consent, the countries of the Asia-Pacific region have had much more success in taming the virus over the past twelve months, compared with the rest of the world. On my visits to China before the pandemic, I would often wonder why masks were commonly worn in public places – not only outdoors, to protect against pollution, but indoors in offices and in shopping centres, too. Clearly, they had absorbed the lessons from SARS. But there’s one aspect that will forever be debated: should China – indeed, could China – have locked down in the final week of January 2020 and stopped people from travelling for the Spring Festival holidays. And if it had, what would the impact have been on the rest of the world? It’s a question on which many papers will be written.
Critical questions are also being asked of the World Health Organization, which, by its own account, swung into action as quickly as it could. At the end of January, the WHO declared the virus to be a Public Health Emergency of International Concern. This is an official designation that is meant to trigger a cascade of actions by the world’s public health agencies. In line with these actions, the WHO reminded all nations that they needed to test and isolate infected cases, and to do the same for the contacts of infected people. With the virus infecting people minute-by-minute, speed is of the essence. The WHO does not recommend creating some great technological infrastructure, but advises public authorities to recruit, train and deploy groups of community-health volunteers, locally-based, prepared to go house-to-house, door-to-door, checking on the health of households, identifying infected people, ensuring they stay home for a week or two, and then doing the same for their contacts. Pandemic management is a centuries-old practice as two essays in this issue from Nomanul Haq and Usama Hasan reveal. Our present knowledge has since been honed by the WHO after decades of experience working with health agencies tackling infectious diseases in the Global South.
Whereas countries in the Global South did indeed follow WHO advice, it was a different story in the northern hemisphere where the response continues to be inconsistent, contradictory, and which has cost lives. In the United States, the former president Donald J. Trump downplayed the virus’s propensity to kill, disputed expert advice on social distancing and the wearing of masks, withheld support from states, and took the unconscionable decision to remove the nation’s public health agency – the Centers for Disease Control and Prevention – from the heart of coronavirus decision-making. Policymakers in the US – and in many countries of the European Union – seem to have accepted that the virus should be allowed to circulate at a certain level, in line with how seasonal influenza is managed. What this action amounted to, in effect, was to tolerate a minimum level of what the actuarial and statistical communities call ‘excess deaths’. Michael Rosen put it much more directly in his poem, J’accuse. ‘J’accuse a small group of scientists of peddling the idea of “herd immunity” without vaccination as a viable and ethical policy even though they knew that it necessitated the deaths of hundreds of thousands of people,’ he would write.
This was in contrast to the approach adopted by many leaders of Asia-Pacific countries, which sought to eliminate the virus altogether, aiming to have zero deaths on the grounds that every life is worth saving. But the leaders of the countries of the North did worse things than ignore WHO advice in those crucial early months.
Pandemics can bring out both the best and the worst in people and their governments. Cooperation and concern goes hand in hand with rule-breaking, corruption, competitive behaviour, and xenophobia. Reducing the risks of the latter is the key reason why viruses need to carry technical-sounding names, such as Sars-CoV-2, or HIV, and why they absolutely must not be named after identifiable people or places, according to an international agreement reached some years ago. But fate would mean that this pandemic arrived in the midst of an escalating trade war between China and the United States. China was becoming sensitive to criticisms that it could have acted faster, and its government officials are now starting to deny that it originated in Wuhan. For Trump, the Wuhan origins of the first cases, and that the WHO’s director-general Tedros Adhanom Gebreyesus had close ties to China’s leadership, gave enough reasons to call it the ‘China virus’, and accuse the WHO of being in China’s pocket. Trump would eventually pull the plug on US membership of a global body that Washington had helped to bring to life seventy years ago.
The WHO often gets a bad rap during infectious disease outbreaks. Some expect the WHO to behave like the world’s health service, which it cannot be on a budget which is far lower than what one developed country will spend on its public health in a year. Others criticise the agency for what in the past they have seen as undue alarmism. But the WHO works through a consensus of its member states, guided by researchers and public health bodies. It is far from perfect, but is unusual in the UN system in that expertise is more likely to trump other considerations in the search for best practice on what to do when there is a risk of harm, such as when an outbreak happens. Its advice is closely followed in countries that lack public health infrastructure. And when the coronavirus hit, countries in the Global South especially knew what they needed to do and got on with doing it. That seemed a bridge too far for Trump, and in his vindictiveness he moved to punish the agency for doing its job.
The rest of the world had more sense and stood firm against Trump’s action, but pandemic nationalism takes many forms. Once a pandemic had been declared, nations needed to have sat down with each other and their science advisers, and try to come to a common understanding on some basic measures: for example, when to open and close borders; when to start and end lockdowns, and crucially, how to distribute vaccines once it became clear that these would be ready much earlier than expected. Such cooperation is equivalent to the first law in how to end a crisis in an interconnected system, as no country can be safe until every country is safe. It is how nations reacted when the 2008 Global Financial Crisis hit – ministers of finance quickly mobilised to recapitalise the banks. A different administration in the White House would almost certainly have coordinated a global pandemic response, but instead the past year has often been an object lesson in selfishness.
There is no greater example of this than in how vaccines will be distributed. The world has finite vaccine manufacturing capability and the vaccines now being authorised will need to be taken in two doses – a main dose and a booster, a few weeks apart. In a world of better channels to international cooperation, a system would be found to ensure some degree of equitable distribution. But at the time of writing, Australia, Canada, the United States and the United Kingdom had each pre-ordered between six and eight doses for each member of their populations. The European Union has pre-ordered nearly four doses for every person in their twenty-seven member states. The peoples of the Gulf states and the larger equatorial countries (Brazil, Mexico, India) are on track to receive two each. That still leaves something like 150 countries, including most of the continent of Africa, with little to no prospect of universal vaccine coverage during 2021.
In contrast to the actions of those we elect to lead us, the pandemic has had a different effect in the world of science. Researchers can easily match politicians and business people in a contest of ruthlessness and competitive behaviour. But the pandemic has also enabled many to show what science can achieve when researchers set aside the desire to compete and work towards a greater, shared goal. The speed of cooperation in science during this past year has been on a scale that I have not seen in more than twenty-five years in science journalism.
Credit here needs to go to China’s researchers. Within days of those first cases of the virus, they were able to identify its unique genetic code. For decades, China’s researchers have been collaborating with peers all over the world, so it was a no-brainer to see them upload this data to international databases for their peers around the world to access. These early actions enabled public health bodies in every country to develop coronavirus testing kits. And they allowed teams of researchers from different countries in a branch of science called structural biology to take this genetic information and use it to construct an image of what the virus looked like – the now famous spherical organism covered with spikes. This, too, was shared freely with the world, and enabled pharmaceutical companies, within days, to begin the task of designing vaccine candidates. That these candidates were being deployed just twelve months later is because regulatory bodies agreed to change their processes. Vaccines need to be tested on cells outside the human body, on different groups of human volunteers in a sequential process where one set of results often builds on the next. Some regulatory bodies allowed some of these processes to take place in parallel and encouraged pharmaceutical companies to provide them with access to data in real time (as opposed to at the end of trials).
The research underpinning all of this – from the biology of the virus, how it infects people, and how vaccines provide protection – still needed to be published in peer-reviewed journals to maintain confidence that short cuts were not taking place. But journals, too, changed their processes, in effect working around the clock across time-zones to assess the research coming their way. All of the world’s research publishers ensured that all coronavirus research papers, past, present and future, would be free to access.
This was happening at the same time that researchers were themselves uploading and sharing their data and findings to websites known as ‘preprints’. Conversation and critique are at the heart of the research process, but the pandemic had closed down many of the usual avenues where these conversations happen, especially scientific conferences. With many labs also shuttered, researchers turned to preprints to tell the world, and their peers, what they were doing – and in the process allowed hundreds, if not thousands more people, lay and expert, to become part of the research process. This is a development that will likely survive the pandemic, even as conferences and face-to-face working resumes.
It’s not only preprints that are changing how science is communicated. The flow of scientific information has relied also heavily on social media. Twitter especially has been critical in conveying ideas; challenging new findings, or just alerting people to the existence of new research. This ability to communicate more quickly and more easily with vast numbers of people has a well-known downside, too. It is also fuelling what the WHO has been calling an ‘infodemic’ – a pandemic of misinformation and ‘disinformation’ – misinformation that is deliberately aimed at misleading. As Nidhal Guessoum shows, none of this is new, but social media has inserted rocket boosters underneath fringe ideas, allowing them to penetrate vastly more numbers of people than would have been possible in the past.
Social media is especially fuelling vaccine hesitancy, though, paradoxically, people with vaccine-sceptical views are now more likely to be found in the developed countries. People in countries with few pre-pandemic memories of what it means to battle an infectious disease seem to have become complacent about the value of vaccination, and why it is essential to protecting against disease. So, although their governments have gone ahead and pre-ordered the overwhelming majority of the world’s vaccine stock, it is not yet clear whether sufficient numbers will agree to take the jab for their nations to be fully protected against contracting the Covid-19 disease.
The rapid development of vaccines has shown what collaboration can achieve. Indeed, the world possesses the means to defeat the pandemic within a year. It will take an enormous effort, a combination of leadership and logistics, but sufficient vaccines could be distributed to vaccinate the world if there is a will to do this. As Anwar Ibrahim writes so movingly on his experiences with institutions of politics and democracy, ‘the notion of justice has been mythologised through a great many historical impediments. Casting it as some higher form, forgetting that it is lived tradition, it becomes a peak we can no longer summit’. Having so comprehensively mismanaged the pandemic, justice demands that the leaders of the developed nations, those with the means to produce and buy vaccines, now take steps towards equitable vaccine distribution. Sufficient vaccines will soon exist for all of the world’s peoples to be vaccinated. In my fleeting moments of optimism, I believe it could happen. Even if it is a summit, it is one we can climb!