Since the beginning of 2020, the world has changed in many ways, but no one predicted the changes that would result from a pandemic. For many years, epidemiologists predicted that this moment would come, but not many people paid attention. People and governments appear astonished to see the impact of a virus on the global economy. The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on our normal way of life, on our economic activities, and on the security of nations. Critically, it has highlighted our collective failure to invest sufficiently in pandemic preparedness and to fill the gaps required for countries to be better prepared.
Remarkably, scientific research and development in response to the pandemic has been unprecedented in terms of speed and the number of new scientific publications (1). Global research institutions and vaccine developers have developed new vaccines within one year of the identification of the virus that are now being administered in many countries, albeit mostly in high-income countries. But the science is not our biggest victory yet, because if science serves to accentuate existing inequities, then it cannot really be seen as progress. The biggest success would be if the world can come together in global solidarity to ensure equitable access to the vaccines, therapeutics, and diagnostics required to end the pandemic.
The COVID-19 virus is rapidly evolving (2). At least three strains considered variants of concern have already emerged that have massively increased transmissibility of the virus (3). Several countries in Southern Africa are recording a higher number of cases (4). There is urgent need for rapid new investments in science and development to stay ahead of the natural evolution that will select these variant strains. The current “variants of concern” will not be the last to evolve and could be associated with epidemiological changes in the pandemic or escape from diagnostic tests, treatments, or vaccines. Now, more than ever, countries need to work together to fight this pandemic.
The COVID-19 pandemic and response have brought several inequalities in global health into sharp focus. At the beginning of the pandemic, countries like Nigeria and others in Africa had limited access to diagnostics and therapeutics, which were largely manufactured in high-income countries (5). According to data gathered by Bloomberg, more than 94.4 million doses of COVID-19 vaccines in 62 countries have been administered by January 30, 2021. (6). Only three of these 62 countries are in Africa-Guinea, Egypt, and Seychelles. At the recently concluded World Health Organization (WHO)-convened Executive Board meeting, WHO Director-General Tedros Adhanom Ghebreyesus said “Rich countries are rolling out vaccines, while the world’s least-developed countries watch and wait. Every day that passes, the divide grows larger between the world’s haves and have nots.” We are confronting a pandemic that presents increasing challenges and as well as opportunities for global solidarity.
In thinking about the year ahead of us, we must be aware of various emerging scenarios and the role we are all playing in defining what the predominant narrative of 2021 will be. Across the world, the number of new cases and infections may remain high, partly driven by new, highly transmissible variants. There is considerable variability across countries in their ability to achieve control without a vaccine. Health systems are increasingly overwhelmed in many countries, and they are experiencing severe budget pressures between demands of investing in COVID-19 versus other priorities. Countries like Nigeria have continued to record outbreaks of other epidemic-prone diseases such as Lassa fever, yellow fever, and cholera (7). The number of deaths from COVID-19 and from other causes — including maternal and child mortality — could continue to rise significantly without urgent action. Some low- and middle-income countries may again be forced into strict lockdowns in response to the increasing number of cases. This could cause major disruption to various sectors such as education, businesses, and others and cause immense hardship. The inequality in access to vaccines could further exacerbate these challenges.
Multilateral organizations such as the WHO have continued to provide the required leadership needed for the world to control this pandemic. An important example is the establishment of COVAX, an extraordinary and unique global collaboration with the aim of providing innovative and equitable access to COVID-19 vaccines (8). COVAX could represent the world’s best hope of bringing the acute phase of this pandemic to a swift end. However, the work of the WHO or similar organizations is impossible without solidarity from countries. It will not achieve its goal if vaccines from COVAX are only available after the needs of rich countries are met.
Finally, we can clearly see from this pandemic that preparedness and response are global issues. Each individual country cannot expect to respond to such a pandemic threat in a vacuum; we cannot end a global crisis at national borders. For COVID-19 and other infectious diseases, the tools we need, such as vaccines, therapeutics, and diagnostics, should be seen first as a common public good and not only as business opportunities. All countries across the world must recognize that no country is safe until every country is safe. Solidarity is our best approach towards controlling the acute phase of this pandemic.