Covid: what do we do now?

(I need to start this by saying I have no medical or epidemiological qualifications and I’m not a statistician, though I do have some knowledge there – so if anyone who is any of these things spots an error, let me know.)

Around this time last year I was telling people that I thought Covid-19 was a 50-year problem – as it would take that long (at least) for childhood-acquired immunity to be sufficiently widespread to allow humanity to relax.

By the summer that looked pessimistic. Yes, the Delta variant was more transmissible but we had the weapons to fight back and it was seemingly sufficiently genetically stable to present a hard target that the might of human science was bearing down on a truly impressive manner.

Now, sitting in London, quite possibly the world’s worst-hit city, with local infections (at ward level) heading past 2% of the population and the R number climbing to 1.4 or higher, that all feels pretty hubristic.

We still don’t know what is perhaps the most important thing about Omicron – what its hospitalisation (and ultimately, death) rates will be – the comparison with Guateng so beloved by those ideologically opposed to firm action seems pretty specious given the different histories of infection and population.

Perhaps the infection will be less severe – though there is zero evolutionary biological reason I can see for that: the virus will likely only evolve to be less dangerous if there is an advantage in that, but where is the evolutionary pressure to do that? The fact is that our weaponry (unavoidably) is likely pushing the virus in pretty much towards becoming more dangerous – to multiply faster to spread faster and to evade the vaccines by mutating the protein spike we are are targeting. It’s a war of technology and the virus isn’t suing for peace.

The prospect of our hospitals system collapsing under vast number of ill people (especially in places like London where relatively few have been jabbed) is therefore very real and we won’t know for a few weeks yet if the worst will happen.

But my question here is not about what we do in the next month, but what do we do in the next decade. so here are some thoughts:

Boosters are going to be here to stay, like they are for flu – we need to restructure our health services to handle the task of annually jabbing over 60 million people. And also create the expectation that people will take their booster – both through carrots and sticks.

Related to that we need to have a system that shares the risks and costs of the annual booster updates: given that it will effectively be a guaranteed income stream for the pharma companies the level of risk will have dramatically reduced, but we should be wary of thinking that means we can expect companies and shareholders to tie up capital for no return. As the pandemic has demonstrated that our health security truly has to be global, the expectation must be that the richer countries subsidise this for the less well-off. Nor can we tolerate – globally – health care systems that limit access to vaccines, even in rich countries, by ability to pay.

We need a network of international treaties that cover this – not least because international travel for business or tourism is going to broken for a long time without them (just another reason why Brexit was a stupid idea, but that’s not for this post).

We will need to restructure our economies – not just because a new balance between home and office working is likely to be permanent, but also because an economy that relies on a season of excess in the middle of winter is now broken. There isn’t going to be a “normal Christmas” anytime soon and governments need to face up to that.

And – and this is perhaps the most long-term issue. If vaccines were the Manhattan Project – a massive effort that delivered a working weapon in the face of a pressing need, we are now on to the search for the thermonuclear device, which in this case means something that deals with the cytokine storm that is still killing people even though the infection has been seen off.

That will require a long-term partnership between government and pharma to incentivise the (economically) highly-risky leading-edge research that is needed here. Yes, we could just rely on university medical schools to do this but why shouldn’t we instead ensure private capital is deployed? The benefits of new therapies here are likely to stretch well-beyond Covid-19 but we may not see them for decades.

But that’s the point – we have lots of time.