Richard Danzig, a former Navy secretary, is a senior fellow at the Johns Hopkins Applied Physics Laboratory. Jeremy Farrar is director of the Wellcome Trust. Richard Hatchett is chief executive of the Coalition for Epidemic Preparedness Innovations.
With the omicron variant starting to recede in parts of Europe and the United States, people have become tired and impatient. But if we have learned anything, it is that covid-19 is still evolving. Our experts cannot predict how, where or when it will strike again. It is imperative, therefore, to prepare for the possibility of further waves, even while we celebrate the ebbing of this one.
Viruses mutate every time they are exposed to a host. Hundreds of millions of people have been infected by the coronavirus. Hundreds of millions more are likely to contract it over the course of this year. Tens of millions have active infections as you read this article. Increasing human immunity protects us but also favors the survival of new viral mutations that can overcome that immunity.
If flu and other illnesses are a reliable guide, a fluctuating equilibrium might eventually develop. Successive versions will evolve and become dominant for a time, but widespread prior immunity and possibly vaccinations are likely to hold each iteration in check. The virus will be endemic, but not nearly so deadly, disruptive and costly as when it is pandemic.
Have we reached that stage? We don’t know. There is a chance that we have in some parts of the world. But there is a significant chance that we haven’t — and certainly not globally. Remember, we have coexisted with the flu for thousands of years; we are just two years into our relationship with covid-19.
Experts did not anticipate omicron. They do not know how it accumulated several dozen mutations without being detected by our surveillance systems. These mutations defeated two of our most powerful treatments and undermined previous vaccine strategies. There is no assurance that this variant, like delta before it, will not be followed by another variant equally (or more) capable of evading our defenses.
The prospect of declaring victory is seductive at a time of widespread fatigue. Moreover, the challenge of unpredictability is daunting. Since we can’t predict how the virus will present itself, how do we prepare for it?
Four actions can considerably improve our position. First, governments and experts should forswear pretensions of comprehension and conclusion. It is tempting to imply that the end is in sight — that omicron, disruptive as it is, can immunize us from future disruptions. But if the future does not conform to these premises, we will have neglected preparations, undermined our credibility and amplified the fatigue inherent in a long war. We should emphasize that we do not know what comes next and must prepare for a range of possibilities.
Second, we must complement our emergency actions with longer-term investments that better prepare us for future waves. Instead of targeting variants now dominant, as we are currently doing, these investments should be chosen to be effective across all possible scenarios.
A recently formed White House task force moves in the right direction with its goal of undertaking “projects that could be used to manage waves of new variants.” What is needed, though, are not just “projects” but strategies for expanding home testing capacity and the supply of high-filtration masks, improving the built environment to provide more effective ventilation, and investing in therapeutics and vaccines that are effective against a broad range of possible variants with the long-term goal of pan-coronavirus vaccines and treatments.
Third, we need a system to quickly assess new variants. We have numerous data systems and analytic efforts, but we need a focused effort to answer key questions. Government, for-profit companies, foundations and academia all have critical roles in understanding and countering viral response, but they are not well coordinated. A more efficient focus on research questions, protocols and analytical methods should enable rapid assessment of critical attributes of new variants, including their dominant mode(s) of transmission, and their transmissibility in vaccinated and unvaccinated people as well as the likely efficacy of different medical interventions. We must invest in these capabilities with the presumption that covid-19 is not going away.
Fourth, we need to reassess non-pharmaceutical interventions with the expectation that this is a long war, not a short one. Decisions about any more restrictions, school closures, mask compliance and messaging must better account for population fatigue, economic resilience, sustainability, uncertainty and the likelihood of recurring fluctuations in risks from the virus.
We are now doing something very human: acting on the premise that what we hope is happening is indeed happening. We need to be more clear-eyed and candid: The virus’s persistence and the factors driving its evolution create a substantial chance that another wave of covid-19 will again threaten our societies.
The virus is not disappearing. It is adapting. We must do the same.