‘This isn’t done’: Experts warn that no matter what our Covid end goal is, we have a ways to go

One year after an epidemiologist, a preparedness expert, and an infectious disease journalist presciently warned about the disruptions to come from the then-burgeoning Covid-19 pandemic, the same group cautioned on Friday that, despite recent vaccination successes, the world is not yet through the crisis, and it should prepare now for the twists the coronavirus could throw our way in the coming months.

“What is the end goal here?” said the epidemiologist, Michael Mina of Harvard’s T.H. Chan School of Public Health. “Is it to get to zero? Is it to stop hospitalizations and deaths? To just get them to an OK number? I don’t think society has agreed yet on what the goal is. But the one very clear thing is this isn’t done.”

Mina — along with fellow panelists, Juliette Kayyem, a former government homeland security official, and Helen Branswell, STAT’s senior writer for infectious diseases — pointed to reasons for optimism as well. Covid-19 vaccines were far more powerful than they would have predicted, and they also foresaw a fairly normal summer in the United States in terms of what life might look like. But they said it was time to recognize the SARS-CoV-2 virus isn’t going to disappear, and that they and many experts envision some sort of fall resurgence.

“We have to know how to respond to that,” Mina said at the event, hosted by the Harvard Kennedy School’s Institute of Politics. “If those surges are just cases and not hospitalizations and deaths” — because vaccines are preventing people from getting really sick — “do we want to shut down society again? If it comes with hospitalizations and deaths, at what level do we raise the red flag and we say we’re shutting down things? We can make those plans right now. We have a lot of information to work on.”

Mina added: “I feel like it’s Groundhog Day because I’m pretty sure I was saying this last April saying we needed to get prepared for last fall.”

Kayyem, the faculty chair of the Kennedy School’s homeland security and global health project, said preparations for potential future spikes should shift toward achieving specific goals, such as “a commitment to opening up schools, so really the question in the fall isn’t, ‘Are schools open?’ but is, ‘Why is that school closed?’”

Branswell also made the point that while the U.S. vaccine campaign is accelerating, the goal is not just to get people in this country immunized. With rich countries scooping up the vast supply of available vaccine, some countries haven’t even started doling out shots yet.

“It’s going to take a really long time to get even enough vaccine to them to vaccinate their health care workers,” Branswell said. “We don’t get to normal in one place. The pandemic needs to be over around the world for us to get to the point where parents can think about sending their university students to Europe for their third-year studies or something like that. If we want to get back to the life we had before, the world needs to be vaccinated, and we have a long way to go.”

Branswell, Kayyem, and Mina’s conversation Friday — on Zoom, of course — took place nearly one year to the day after they gathered for what turned out to be one of the last in-person events at Harvard. The three experts then were already warning about what might happen if Covid-19 reached vulnerable populations and how people would need to prepare for disruptions to their lives. Both events were moderated by Rick Berke, STAT’s executive editor.

Here are some other highlights from the event.

On the pandemic and politics

All three experts said that a better response from the U.S. government — one that was better coordinated, more organized, and featured better communication — could have saved hundreds of thousands of the more than 520,000 people who died from Covid-19 in this country.

“It’s hard to quantify, but just the Covid mortality could have been hundreds of thousands fewer,” Mina said, adding that the inability to control the virus also contributed to more deaths in other ways, including from drug use. The other two panelists nodded along.

The Trump administration’s haphazard response, which was rife with misinformation, featured a president who encouraged Americans to pursue activities that enabled the virus to spread. But at the same time, “it was the homeland that saved us,” said Kayyem, who served in the Obama administration. The gap in action and information from the federal government was filled with “responsibility by governors and mayors and CEOs.”

“You saw the system break, but the system also worked, worked in the sense — look, no one is justifying the 500,000 dead — but it wasn’t like we were all lost in the wilderness. There was a capacity at the local, state, tribal, territorial, and private institutional level that really was able to fill in the gaps,” she said. Without that, “for all the horribleness of our 500,000 plus number, it could have been worse.”

Still, the experts said they still struggled to grasp that the United States saw more people die from the pandemic than any other country, even if other countries had higher mortality rates per capita.

“I never in a million years would have thought that would have been true,” Branswell said.

On vaccines

Multiple vaccines going into people’s arms less than a year after scientists sequenced the coronavirus is an astonishing feat. But something that really stunned the panelists was how effective the vaccines proved to be. The mRNA vaccines from Moderna and Pfizer-BioNTech have shown to be greater than 90% effective.

“The one startling thing about this has been how useful and how high efficacy the vaccines have been,” Mina said. “It’s easy now to say, ‘Oh, it’s great they’re working so well,’ but I remember talking to reporters back in June and August and such and saying, ‘We’ll be lucky if we could achieve 75% efficacy.”

He added: “It’s not the speed, but it’s how good the technology is working.”

In her career, Branswell has seen lots of hype around the speed and promise of vaccine development only to see efforts fall short, which shaped her thinking as the candidates were being crafted and moved through clinical trials.

“I was warning people all year, like we need to be prepared for the possibility that these vaccines may fail, it’s very unlikely that all of these vaccines are going to work,” Branswell said. “And then boom, boom, boom, they not only work, they work really well. It’s nothing short of a scientific miracle, if that term is not an oxymoron.”

The panelists noted that hesitancy around the Covid-19 vaccine had decreased as the shots became available and so many people were joyfully receiving them. But Branswell lamented learning the recent news that Trump had privately been vaccinated in January without cameras capturing the moment.

“He had the opportunity to use the bully pulpit to encourage his supporters, some of whom are quite vaccine skeptic or vaccine hesitant. … He could have set an example for the people who follow him and he chose not to do that,” she said.

Preparing for the next pandemic

The world has had health scares in the past, but hasn’t learned the lessons from them to ready itself for something on the scale of Covid-19, the panelists said. “A few reports are written, but memories are short, and opportunities are lost,” Branswell said about the results from previous health crises.

Covid-19 is unlikely to be forgotten, but the experts stressed now was the time, when the world was fully aware how damaging and disruptive a pandemic could be, to take just a few of the billions of dollars that are being spent in recovery and dedicating them toward building up global surveillance networks for new pathogens, expanding the existing testing infrastructure, and bulking up global vaccine manufacturing capability.

“If we’re not doing it now, we’re not going to do it,” Mina said.

After all, another pandemic could begin at any moment.

“We don’t have to be taken off guard again,” Mina said. “But if another pandemic starts today, we will be taken off guard.”