In late January 2020, Vaccines Today posted a new article, Wanted: Coronavirus vaccines. The story picked up on news from China where a new coronavirus was spreading rapidly. A handful of cases (but no deaths) had been reported in Europe and the WHO had just declared the situation to be a Public Health Emergency of International Concern.
Despite the steady stream of bad news and frightening forecasts, few of us had even begun to absorb the extent to which our daily lives would change. The January 2020 article on coronavirus vaccines didn’t even refer to COVID-19, as the term was not in widespread use at the time.
Based on background interviews with researchers, the piece asked how long it would take to develop a vaccine against this new virus. Even if ‘new’ mRNA technologies could speed up development, widespread distribution was expected to take ‘two to three years’. This would still be unprecedented and require cooperation between companies, regulators and governments to develop and test safe vaccines.
We updated the article daily to reflect rising numbers of cases and deaths as the virus spread around the world. By early March, we decided to pause our regular updates, allowing time to focus on the wider impact of the outbreak and the search for vaccines. On 11 March 2020, the WHO declared a global pandemic.
One year on
Last week, the WHO held an online meeting to reflect on the past 12 months and consider what the future may hold. More than 120 million cases have been detected, 2.5 million people have died, while social and economic life have been disrupted. An ‘infodemic’ of vaccine misinformation erupted, trust in institutions was stretched, and global inequality widened.
In a year of unpleasant twists and turns, there have been positive stories too. Diagnostic tests were introduced rapidly. Most people learned how to reduce their risk of catching or spreading the virus, through hand hygiene, mask wearing and social distancing. The clinical management of severe COVID-19 improved, helping to reduce death rates.
‘The good news is that we now have medical countermeasures,’ said Sylvie Briand, Director of the Pandemic and Epidemic Diseases Department at the WHO. ‘There has been progress on treatment, we know more about how the disease spreads, and the vaccine is being rolled out.’
The big question throughout 2020 was when would COVID-19 vaccines become available. There were many hurdles to clear, questions about how well they might work, and debate on who should get the first doses.
By November, there were 154 potential COVID-19 vaccines in preclinical development, 44 in clinical trials and 10 in phase III trials (the final stage before applying to regulators for approval). Then, in December – less than a year since the virus was sequenced – the first COVID-19 vaccines were approved.
Today (11 March 2021), EU regulators are likely to approve a fourth vaccine, exactly one year since the pandemic was officially declared. Millions of doses have been administered around the world as green shoots of optimism emerge.
‘This is bringing a lot of hope and happiness in many parts of the world,’ said Dr Briand. However, she noted that most vaccine doses have been administered in just a handful of countries. Israel, a frontrunner, has reached half of its population with one dose, while most countries have yet to begin vaccinating.
Advance orders from European and North American countries, along with some high-income Asian and Middle Eastern governments, mean a large volume of vaccine supplies are earmarked for months to come. COVAX, a global initiative aiming to bring 2 billion vaccines to low and middle-income countries, has made its first deliveries to 15 countries. The issue of global vaccine equity is likely to feature strongly in the next phase of the pandemic.
When will it be over?
The ultimate question is when will COVID-19 fade into the background instead of dominating our lives, the news headlines, and the energy of scientists and political leaders. Vaccines will help answer this question, but so too will the emergence of variants of the SARS-CoV-2 virus.
‘Even if there is a lot of hope at the moment, we know the virus is changing and could undermine the efficacy of vaccines,’ Dr Briand warned. She said the variants currently known to be in circulation ‘do not yet require a fundamental change in response strategy’ but must be closely monitored.
Predicting the end of the pandemic would be unwise, but Dr Briand said better weather and the impact of vaccines would soon begin making life progressively easier in the northern hemisphere. The need for masks and hand hygiene is unlikely to end in the short term, but school closures and the suspension of social activities ease.
‘In the long term, we may end up with a situation similar to that of influenza where we have seasonal outbreaks,’ she concluded. ‘Fragile groups at higher risk of severe disease may need to be re-vaccinated, but the disease will not affect the lives of the population as it did in the first wave.’