A couple of years after the discovery of the coronavirus that causes Covid-19 in Wuhan, China, the world seems to be closer to the end than the beginning of the pandemic. However, for this end to become a reality in 2022, it is necessary to reduce the inequality in the distribution of vaccines.
It must also be ensured that at least 70% of the world population receives doses of this immunizer in the coming months. That is the assessment made by the World Health Organization (WHO) in a series of recent communications.
Tedros Adhanom Ghebreyesus, WHO Director General
WHO Director-General Tedros Adhanom Ghebreyesus noted that the world “already knows the virus very well and has the tools to fight it”. Reuters
The end of the pandemic?
In a press conference on December 22, the general director of the organization, the Ethiopian biologist Tedros Adhanom Ghebreyesus, projected that “2022 has everything necessary to be the year in which the Covid-19 pandemic ends”. In his opinion, after 2 years of intense health crisis and more than 5.4 million deaths, the world “already knows the virus very well and has the tools to combat it”.
Mentioning these tools, the WHO representative referred to vaccines and preventive methods (use of masks, social distancing, crowd disincentives); also, systems for epidemiological and genomic surveillance of the virus and accumulated knowledge on the treatment of the disease.
Cautious optimism
The specialists interviewed by BBC News Brazil agree with these projections and convey cautious optimism for the coming months:
“The trend is for 2022 to be better than 2021 and stand out as the year the pandemic will end. But it is clear that, until then, we must continue with all precautions”, said epidemiologist Pedro Hallal, a professor at the Federal University of Pelotas.
“It is worth clarifying that 2022 may mark the end of the pandemic situation, but this is not synonymous with eradicating the coronavirus. Everything indicates that we will continue to have cases and deaths, but we will no longer continue in this situation of lack of control and collapse of hospitals”, reflected microbiologist Natalia Pasternak, president of the Instituto Questão de Ciência.
Below we tell you how some aspects related to the pandemic, such as vaccination, the availability of new treatments and the appearance of variants may evolve throughout 2022.
Vaccination: More global equity, third dose, periodic campaigns and protection of children
From a global point of view, the biggest obstacle to overcome in relation to vaccination against Covid-19 is the inequality in the distribution and access to these products.
Although some countries, such as Israel, are already studying the application of a fourth dose to their population, others have not even managed to protect the most vulnerable groups, such as the elderly and health professionals. The situation is particularly worrying in the poorest countries: Haiti, Chad, Burundi and the Congo have not yet vaccinated even 1% of their population.
“And donating batches of vaccines is not enough. It is necessary that international organizations help these countries to create a distribution and communication structure. This is so that the campaigns effectively reach people”, warned infectologist Nancy Bellei, professor and researcher of respiratory diseases at the Federal University of São Paulo (Unifesp).
A man being vaccinated
The inequality in the distribution of vaccine doses in the world has meant that many countries, especially in Africa, have not even started the immunization campaign. Getty Images
There should be no shortage
In this area, the good news is that there should be no shortage of doses in 2022. According to calculations by the International Federation of Pharmaceutical Manufacturers Associations, around 24,000 million units of immunizers against Covid-19 should be manufactured in June. By comparison, 12.5 billion were delivered in 2021. The amount projected for 2022 would be enough to protect the entire world population.
Seeking greater equity in vaccination is not just a matter of solidarity between peoples. As the name suggests, the pandemic is a global problem and as long as there are unprotected people, all of humanity will remain in danger.
A slap given to everyone
“The Omicron variant came precisely to give us a ‘slap’ and show what happens when there is no equality in access to vaccines. As long as there is no homogeneous protection, we will be subject to the appearance of new versions of the coronavirus”, warned Pasternak, who was selected by the BBC as one of the 100 most inspiring and influential women of 2021.
The microbiologist highlighted that the arrival of Omicron also confirmed the need to administer t3 doses of vaccine to ensure a good level of protection against the most serious forms of Covid-19. “This changed our perspective: before we thought of 2 doses; now we know that 3 are necessary”, she added.
The year 2022 should also provide more answers about the need for booster doses of immunizations against Covid-19, as is the case with influenza vaccination. “We are still not sure what the frequency of vaccination against Covid-19 will be like, since we need to observe the dynamics of the virus circulation, the intensity of new variants and the behavior of the immune system for a longer period”, said the infectologist Julio Croda, from the Oswaldo Cruz Foundation (FioCruz).
Reinforcement
“But it is likely that part of the most vulnerable population needs reinforcements, such as the elderly, the immunosuppressed and health workers”, added the doctor, who is also a professor at the Federal University of Mato Grosso do Sul.
“In recent weeks, we have seen a significant increase in the proportion of children hospitalized with Covid-19 in many parts of the world”, Croda noted. “It is essential that vaccination also advances in this age group”, added the doctor.
Variants: Growing optimism about Omicron and fear of possible new versions of the virus
The detection of the Omicron variant in South Africa at the end of November represented a real bucket of cold water. Quickly classified as a variant of concern by the WHO, this new version of the coronavirus drew attention to the number and variety of mutations.
Many of them indicated a greater capacity for infection and a potential to circumvent the immunity obtained with a previous picture of Covid-19, through vaccination.
Girl being vaccinated
Regulatory agencies and experts point out that the benefits of childhood vaccination against Covid-19 outweigh any risks. Getty Images
A month and a few days after the discovery, some of these more pessimistic projections turned out to be true. For example, Omicron has spread rapidly toward many parts of the planet and has become dominant in many countries.
Fewer hospitalizations
It is also behind recent records of new cases: on December 28th, for example, more than 1 million coronavirus infections were recorded globally in 24 hours for the first time.
On the other hand, studies published in recent days bring hope that Covid-19 caused by this variant may be milder and cause fewer hospitalizations and deaths. “We can already say, with some certainty, that omicron is much more infectious than the original virus, but it seems to be less aggressive. And especially among people who have already been vaccinated”, said Hallal, who is also a visiting professor at the University of California, San Diego. “But we must consider that this information is still preliminary and needs to be confirmed by other research”, added the epidemiologist.
Sars-CoV-2 virus illustration
It is still early to fully understand the impact of omicron, but recently published data raises scientists’ hope that infection caused by this variant may be milder. Getty Images
“What we need to understand better now is whether this variant has any disadvantages and cannot replicate very well in the lungs. This would lead to less severe diseases, or if the lower aggressiveness observed at this time is the result of a statistical factor. And like the fact that vaccinated people are more protected from hospitalization and death”, Pasternak explained.
A less aggressive virus
And that this variant is potentially less aggressive does not mean that it will wreak less havoc on the health system. With millions of people infected, the demand for access to hospitals and emergency rooms tends to increase, although less frequently compared to previous waves.
This, in turn, can lead to a lack of supplies, beds and health professionals. Even while those forecasts are not confirmed, the very fact that such an infectious new variant has emerged serves as a warning to the entire world, experts say.
Nothing prevents even more fearsome viral versions from appearing in 2022, especially if vaccination continues to make slow progress in the world’s poorest countries, and in richer nations where there are many citizens who refuse to be inoculated.
Medicines: Finally, a true early treatment (which should be more accessible)
In 2020 and 2021, doctors working on the front lines had to learn on a day-to-day basis how to treat hospitalized patients with Covid-19. In real life experience, healthcare professionals understood the importance of oxygenation and certain anti-inflammatory medications, while other research has shown the ineffectiveness of some drugs against Covid-19, such as hydroxychloroquine, ivermectin, and nitazoxanide.
New therapeutic alternatives have also come onto the market, such as representatives of the classes of monoclonal antibodies and interleukin-6 receptor blockers. But they are only indicated for the most serious cases and have a very high price, which makes access difficult.
The scenario began to change recently, with the arrival of the first antivirals against Covid-19. Some of these drugs, produced by Pfizer and Merck, have already been authorized by regulatory agencies in the United States and Europe.
Antiviral drug capsules
Molnupiravir will be administered twice a day to newly diagnosed Covid-19 patients. Getty Images
“These antivirals are good and can play an important role, but the pharmaceutical companies themselves were careful to make it clear that they are not miraculous”, Pasternak said. Bellei, who also works as a consultant for the Brazilian Society of Infectious Diseases, the Brazilian Ministry of Health and the WHO, points out that, in order to obtain a satisfactory result, these new drugs must be offered at the beginning of the coronavirus infection.
“You have to give them early to get a good result”, she noted. The infectologist emphasized that it is essential that antivirals reach the market at an affordable price so that they can really be used on a large scale.
Mask and distancing: Non-pharmacological measures (and new habits) will be adapted to the reality of each moment
Hallal also regretted that the measures to prevent covid-19, such as the use of masks, social distancing and the prevention of crowds, have been seen in some countries as if they were political-ideological issues. “This must be approached from a technical and scientific point of view. These measures will be more or less necessary depending on the stage of the pandemic”, clarified the epidemiologist. “A month ago, in California, the number of cases and deaths from Covid-19 was very low, so it made sense to say that those vaccinated did not need to wear a mask. Now, with the advancement of Omicron, going back to the use of masks is an appropriate measure”, she exemplified.
Hospitalizations: The key
In other words, the trend is that, throughout 2022, the restrictions and relaxations of measures will increasingly depend on the epidemiological scenario. And it is important that public policies are updated quickly, according to the current situation. FioCruz’s infectologist, Julio Croda, agrees: “The return of any restrictive measures must be related to an increase in the rate of hospitalizations and deaths”.
Experts advise being attentive to the recommendations of the health authorities and carrying out a risk assessment of each situation and context. As long as the pandemic persists, it is worth avoiding crowds where possible and wearing good quality masks when leaving home. Outdoor meetings must also be prioritized, in addition to, of course, receiving the 2 or 3 doses of the vaccine within the stipulated periods.
Bellei, from Unifesp, hopes for her part that the experience with Covid-19 has taught people a fundamental habit: solidarity isolation when we have symptoms of respiratory infection. “Those who have symptoms of the flu, cold or Covid-19 need to stay home as long as they cannot transmit the virus to other people”, she said.
Vaccination passport
The doctor also believes that the requirement of a vaccination passport to enter some establishments may become an increasingly common practice from now on. “Viral respiratory diseases are social diseases. If I am infected, I can affect the lives of many people around me”, said the infectious disease specialist. “I am in favor of education, but we are talking about a disease for which there is a vaccine. If a person chooses not to get vaccinated, they are at greater risk of becoming infected, incubating the virus in their own body, and putting others in danger just by singing or talking”.
“Covid-19 will not disappear from the map”
In general, experts understand that the year 2022 will start much better than 2021. “The start of 2021 was terrible; perhaps the worst in our history. We had no vaccines available and we were with the Gamma variant spreading throughout the country”, Hallal recalled. “The year 2022 begins with the spread of Omicron, but now we have immunizers as great allies”, added the epidemiologist.
Croda reinforced the message that the eventual end of the pandemic scenarios in 2022 does not mean that the coronavirus will no longer be a problem. “Even if the pandemic comes to an end, Covid-19 will not disappear from the map. It will continue to be an endemic disease, with a great impact on health services, but nothing compared to what happened in 2020 and 2021”.
Bellei, for her part, emphasized that the current experience will serve as a learning curve for other infectious diseases with a high potential for spread. “We need to understand that other pandemics will come. And we will need more agility in the actions and evaluations of public policies”, she predicted. “Everything we have learned in the last 2 years will help us to face this and the future health crises that we will see in the future”.
