Somehow a global pandemic becomes a wedge issue
It’s a regular day here in Geneva. As I was walking to the shop to buy my sandwich, it occured to me that the ongoing COVID-19 pandemic is becoming the new climate change, in a lot of ways:
- It kills people, but relatively slowly and mostly far away (for now at least).
- As an individual, the impact of your actions is almost imperceptible.
- We have a box full of solutions and improvements, but they are mostly still in the box.
- The debate is ridiculously polarised, even when the science is very clear.
At most times it seems like I’m the only person in a mask, in work meetings, in the shops. I’m also the guy who is in the process of installing solar panels on my house because of climate change, in an attempt to go Carbon Zero, so being an outlier isn’t new to me.
So the big question is, as a society, how did we get here and why?
It’s partly a story of failures by our institutions, our political leaders, and partly due to the particular virus we are facing. Of course, it’s a perfect storm, because only perfect storms are worth writing about. To start with the easy part, the virus spreads very rapidly via airborne transmission (and also via fomites, but airborne is clearly the main means of spread and superspread), and is transmitted before individuals become symptomatic. This is a significant difference to SARS and MERS, where the infectious phase starts in parallel with the symptoms. I recently watched a great talk from back in 2020, using things which we already knew about the virus back then, Arijit Chakravarty was able to forecast many of the key impacts from SARS-CoV-2.
- Symptomatic quarantine is insufficient to stop the spread of the virus
- Natural immunity is short lived
- A modestly effective vaccine will not be enough
- The cost of non-compliance with public health measures will be significant
Sure, there are other elements which are missed – but if we had used this approach, we would arguably be in a better position right now.
And politics.
One of the stand-out moments in the early pandemic was then UK Prime Minister Boris Johnson’s pro-freedom speech at Greenwich on the 3rd February 2020. This was followed by disastrous dithering and delays in implementing a nationwide lockdown that arguably cost tens of thousands of British lives. Add to this the scientific prejudices against airborne transmission which were seized on by politicians around the world, meaning a fatal dose of bad advice was being dished out to the public at large.
It was soon followed by the ritualistic publication of daily death counts from every advanced nation and far more press conferences than anyone should have to endure in a lifetime. At some point the penny dropped and the message about masks started to get out, only to lead to the very shortages that the initial misguided public health messaging had been trying to avoid.
The cavalry came over the hill in 2021 with the arrival of mass vaccination in rich countries that had pre-purchased doses. Not all the vaccines were created equal however, some had undesirable side-effects and others were not particularly effective at preventing severe disease. But most significantly, none of the mass market vaccines developed to date (July 2023) are effective at preventing transmission. This was another message that took far too long to diffuse via our politicians. I remember a work meeting in late 2021 where everyone was proudly talking about their vaccination status and suggesting maybe we could all remove our masks? (We didn’t..)
The US seemed to be a fertile battleground for political disagreements on the wearing of masks. I cannot understand why anyone would reject something relatively innocuous that has major health benefits for the individual and their friends and family. But that’s humans.
A litany of missed opportunities
Another tragedy of the pandemic is the failure of the West to release vaccine related IP to the world. I’ve never been much of a fan of Bill Gates, or those who consider him to be the locus of a global conspiracy to do all kinds of terrible things. However, I’m afraid his fingerprints are all over this particular failure.
If we take a step back, we have a highly contagious, rapidly mutating virus that’s spread across the world. One possible response is to build a slew of national (or even regional) mRNA vaccine factories across the world on a common platform. This would enable very agile, localised production and distribution of whatever new vaccine we come up with (and it could also be used for other mRNA vaccines too, license terms permitting). We have already seen four or five major shifts in the Covid-19 genome (from the Original Wuhan variant to Alpha, Delta, Omicron and now beyond Omicron sub-lineages), it’s abundantly clear that the vaccine will need to evolve at a similar pace to have any value at all.
One of the downsides of narrow mRNA vaccines that is starting to get some public attention is the fact that they are very narrow. The Pfizer and Moderna vaccines code for the production of the spike protein, however it is the same spike protein that has changed in each iteration of the virus. There is also the problem of immune system patterning, where our immune systems retain the strongest response for the first version of the pathogen (or vaccine) they encounter. This means that instead of starting your vaccination course with shots for the original Wuhan variant, you may be better off jumping directly to an Omicron targeted shot. Unfortunately we don’t have much data for this, as most people in countries where trials are easy to do have already had at least the first round of shots.
The mutagenicity of coronaviruses was news to me, but I’m not a virologist or an infectious disease specialist. To those in the know, it’s obvious and is the reason why we don’t yet have a vaccine for the common cold. So it would seem obvious that a worldwide network of vaccine factories, that can retool output overnight if needed, is exactly the prescription for a Covid-19 type viral pandemic. But this threatens the financial interest of Pfizer and Moderna, amongst others. It also seems that the ability to reduce transmission is higher for other types of vaccine that aren’t as easy to produce
Where next?
I wear an FFP2 mask in public. I take a rapid antigen test if I’m feeling unwell with symptoms that could be Covid-19. I don’t mix with people unmasked unless it’s really important and we’ve all taken precautions. Thanks to these measures (and a couple of HEPA filters), the last time Covid-19 came to our household I managed to avoid infection. If you have read this far, you are probably also careful about avoiding infection.
But billions of my fellow humans either do not have the means, or the inclination, to protect themselves in this way. This means millions of infections every day/week/month, which in turn allows the virus to mutate. Some mutations are benign, others spread more easily and can be more deadly. If you think of the human genetic code as a lock, with each mutation the virus gets closer to opening it.
A difficult problem
If we are going to ever regain control of the situation, each of us needs the means to protect ourselves and our families. These need to be secured by a mixture of give and take, both materially and in terms of social permission. It’s not okay to abuse someone for wearing a mask, just the same as it isn’t acceptable to abuse someone for their race or for being disabled.
From a hardware point of view, we need to make high quality masks available and affordable for all. The more people wear FFP2/N95 masks, the fewer people are going to catch and spread Covid-19. The more of us who are vaccinated (worldwide), the lower the burden of severe disease will be.
No silver bullet
There is very seldom a single silver bullet in biology, from what I understand. Mostly because vampires and werewolves are not real. We need a new vaccine, probably something administered intra-nasally, which will provide sterilising immunity (or something very very close). This will be able to stop transmission in its tracks. We probably also need to be wearing masks, just so that the few mutant viruses which could evade our upgraded security don’t wind up in somebody’s lungs. And then life can go back to normal, until the next pandemic.
To end on a not very cheerful note, the fact that we’ve had SARS, MERS and SARS-CoV-2 all in the space of 20 years is not an accident. It is a consequence to some degree of human expansion into the natural world, increased air travel, and directly or indirectly, climate change. Ultimately all things are linked, and solving one problem makes it easier to solve others. We just have to start, and be guided by our compassion for our fellow humans – rather than greed or fear.
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