How the Coronavirus pandemic will end

Preface: This is a draft of an OpEd. Unfortunately it is too long. Also unfortunately, I can think of lots of ways to lengthen it (eg more discourse on the fallacy of “herd immunity”). Shortening it seems harder without loosing context or completeness. I welcome any suggestions on content or what I should do with this. RDS

Many people have speculated about how the pandemic will end.

The general consensus among experts is that it will become endemic, hanging around for the foreseeable future, waxing and waning in virulence, killing hundreds of thousands of people per year despite various interventions — “like the flu”. This scenario has long been presaged by the common phrase “the new normal” and other variations on this theme. Endemicity is a plausible outcome, but I will suggest the pandemic will end quite differently.

Other people have recently suggested that the highly contagious nature of omicron — approaching that of measles — will cause the virus to race through the population and burn itself out. The scenario is not plausible and represents wishful thinking. For one thing, there are no comparable examples of a virus behaving in this way. In addition the closest comparator, namely measles, was perennially in the top ten causes of death until the advent of an effective vaccine along with strong measures to implement it.

Personally, I believe the pandemic will end when a group of motivated and empowered individuals conclude that the world has had quite enough of this virus and dedicate the money and effort to deliberately eradicate the virus from the human population. The closest comparators are actually smallpox, poliovirus strains 2 and 3, and rinderpest.

It is well-worth examining the reasons why this scenario may or may not come to pass.

The key facilitating factors are the fact that we currently have at our disposal — without any additional research or unforeseen events — the knowledge, the technology, the personnel, and the money to end the pandemic. Now! Regarding technology, never before has such a stunning armamentarium been available to combat a virus! These tools include an array of high effective vaccines, multiple testing modalities, antivirals, simple but effective personal protective equipment, life-saving respiratory equipment, etc. Never in history has such an impressive and efficacious toolkit been available to eradicate an infectious disease. And more are coming online with unimaginable speed. In addition, despite the highly inequitable distribution of wealth, the vast accumulation of wealth in the economy could easily underwrite a comprehensive and rapid eradication effort. The overwhelming majority of the world’s population would reap immediate and long term benefits from such an eradication effort. Moreover, as we have seen throughout the pandemic, the wealthiest individuals and companies are likely to derive disproportionate large benefit. This should provide ample motivation to underwrite the effort.

Given all this, what could possibly be standing in the way? Some of the main factors include widespread misinformation, ill-informed comparisons with influenza, the benefit that some empowered individuals and corporation derive from having the pandemic persist, short-term thinking that devalues the long term benefits when compared against the immediate effort and expense, historical notions that such goals have been hard to achieve in the past (They never had the tools we have.), pandemic fatigue, a paradoxical notion (akin to the gambler’s fallacy) that we missed the opportunity to intervene early in the pandemic and now it is too late, the persistent fallacy that herd immunity will save us, shortsighted notions that rich countries need to look out for themselves (Short of complete isolation, viruses do not respect borders.), and wishful thinking that the pandemic will just go away.

So what would it take to overcome these barriers?

1. The conviction that we can actually do this.
2. Overinvestment in the tools we need. So far, we have consistently underestimated the need for vaccines, testing, equipment, and personnel. For example, Biden’s intention of providing 500 million tests is a drop in the bucket of what will actually be needed. As another example, we have already had time to upscale vaccine manufacturing to produce enough vaccine for the population of the world, but it still is not being implemented. Time and again, we have seen that trying to play catch-up is frustrating and ineffective.
3. Investment by rich governments and individuals.
4. International cooperation. Politics that interfere with the eradication efforts may have devastating consequences. We have seen this time and again in the efforts to eradicate polio.
5. Laws that require vaccination without provisions for religious or personal exemptions. These freedoms would be laudable if the virus respected such notions, if the virus was not highly contagious, and if other vaccinated individuals did not have to put themselves at risk and foot the bill for the unvaccinated. Such vaccine laws work. We have many current and historical examples. One excellent example is the California law that requires school children to be vaccinated for measles. There are also many examples that show that rewards such as lotteries do not work.
6. Programs that make it very easy for everyone to get vaccinated — including compensation for the time required to get vaccinated including recovery from vaccination side effects.
7. Development of multivalent and updated vaccines. mRNA vaccines provide the technology to rapidly tailor the vaccines to emerging strains. Given this ability to rapidly pivot, it is astonishing that we are still using the original vaccines. Clinical trials to test these vaccines should be continuously ongoing. Sign me up immediately.
8. Expeditious completion of well-designed clinical trials verifying the safety and efficacy of SARS-CoV-2 vaccines for children of all ages. Assessment of the benefits of these pediatric vaccines should include psychological benefits and benefits to society in curtailing the pandemic.
9. Enhanced support of efforts to develop additional vaccines including vaccines that do not require injections.
10. Widespread testing regimes including rapid tests, and sewage surveillance which can serve as an advanced indication of a coming surge.
11. Buy in by local and national leaders.
12. Additional factors that will help now and in the future include modifications to the licensing system and to the patent compensation system. These can be implemented without compromising the integrity of the rigorous clinical trial system and without eliminating the economic motivation to produce vaccines and medications.

While this may all be wishful thinking for the present, I remain optimistic that we will eventually (in 1 year, 5 years, 10 years) become tired enough of the pandemic to actually stop it. I certainly hope this comes sooner than later. The costs and the impact of waiting are likely to increase with time.

December 23, 2021