When I listen to scientists talk about where we might be a year from now, two main scenarios emerge. The first one is good: Covid-19 keeps circulating but loses its sting. Most people in rich countries, and the most vulnerable in developing countries, get vaccinated in 2021. The vaccines prevent disease caused by all strains. Covid-19 weakens: once it finds potential victims protected either by vaccination or past infection, it becomes at worst a nasty cold. “The most likely thing is that it will mutate into a more benevolent form. That may solve the problem,” says Anthony Costello, a former director at the World Health Organization.
But there’s another scenario, less likely yet so momentous that we need to think it through: the world gets “long Covid”. Vaccine-resistant mutations cause years of mass death, repeated lockdowns, economic disaster and political dysfunction. What determines which one comes true?
Precedent favours the benign outcome. “Four human coronaviruses . . . circulate endemically around the globe; they cause only mild symptoms,” write Jennie Lavine of Emory University and others in the journal Science. These viruses may once have been deadly too, until humans acquired protective immunity through infection in infancy. When people were reinfected as adults, their immune systems knew how to fight back.
Covid-19 may make that same journey much faster, with vaccines hastening herd immunity. Even as mutations emerge, previous vaccines and infections should confer enough immunity to protect us at least from severe disease; some existing vaccines seem to be handling the British and South African mutations. In this benign scenario, poorer countries can wait for vaccines, as their young populations aren’t very vulnerable to Covid-19. (More than half of African people alive today were born this century.)
Yet the malign scenario remains plausible, says Costello. New variants have appeared fast. Philip Krause, chair of a WHO working group on Covid-19 vaccines, told Science: “If it is possible for the virus to evolve into a vaccine-resistant phenotype, this may happen sooner than we like.” It may be happening now in the Brazilian city of Manaús: devastated by the first wave of Covid-19, it’s being devastated again, possibly because victims of the first wave aren’t immune to the new strain.
Vaccine-makers could probably rejig them to combat new strains but it might take months. Then countries might struggle to summon millions of recently vaccinated people back for more jabs. And new vaccines might be only 50 per cent effective, like the flu vaccine. We also don’t know how long vaccines will provide immunity against Covid-19. Will people return for booster shots?
Worse, highly infectious mutations have raised a country’s bar for achieving herd immunity. Getting there might now require vaccinating 78 to 95 per cent of people aged over 12, warns the consultancy McKinsey. Some will refuse vaccination. Meanwhile Covid-19 keeps circulating and mutating, especially in poor countries. By mid-January, 29 low-income countries combined had vaccinated just 55 people, all in Guinea, said the WHO.
Ian Goldin, professor of globalisation and development at Oxford, sees a more likely scenario than global long Covid: a new pandemic. He notes the growing frequency of pandemics this century, as habitats of animals and humans become compressed, and global travel increases transmission.
Imagine a pandemic that lasts years, killing millions. Whole sectors — tourism, restaurants, the arts, aviation, conferencing — could collapse. So might democracies, as isolated people mainline conspiracy theories in their bedrooms. Bankrupt states would helplessly print money. The jobless young might grow up unequipped to deal with people off-screen. Many would rebel against lockdowns, fighting the forces of order. The mental-health pandemic would rage beyond control. A few countries — New Zealand, Australia, Taiwan, Vietnam — would become oases besieged by would-be immigrants from everywhere else. Between deadly waves, people would seek relief in the wildest experiences.
To avoid global long Covid, states need to hurry. The quicker humanity achieves herd immunity, the less time the virus has to mutate beyond control. We need to spend whatever it takes on wartime-style mobilisation to make, distribute and inject vaccines. Costello calls for a “Home Guard” of contact tracers and vaccine promoters, including retired doctors and nurses.
We also need to get vaccines to poor countries fast. The Covax facility — meant to ensure fair global distribution of vaccines — is fighting hard to reach 27 per cent of people in lower-income countries this year, in the face of underfunding and hogging of supplies by rich countries. Covax’s funding target for 2021 is $6.8bn. Compare that to the cost of a week’s lockdown in a rich country. In total, says Goldin, “Rich countries have found $12 trillion for themselves, but only $100 billion has been pledged to developing countries.”
“No one is safe until everyone is safe,” Tedros Adhanom Ghebreyesus, the WHO’s director-general, has warned. People in rich countries tend to dismiss such pieties. We’ve learnt from experience that we can be safe even while pandemics decimate the world’s poor. For once, this may no longer be true.
Follow Simon on Twitter @KuperSimon and email him at simon.kuper@ft.com
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