Redefining the exit plan for COVID19
CONTEXT An ever-evolving virus and socioeconomic disparities render the goal of elimination infeasible.
COVID- PRESENT, POSSIBILITIES
- After reeling under the onslaught of the COVID-19 pandemic for over a year, the world is now waiting for some respite.
- There has been a reduction in the incidence, severity, and mortality related to COVID-19 locally in some countries, including India, which meets the definition of what is termed as “control”, as per Centers for Disease Control and Prevention (CDC).
- But the end to the pandemic will not be instantaneous. The virus is still evolving to cohabit with humans, and this can include a range of possibilities, from the virus becoming less lethal, more infectious to it becoming virulent.
- Thus, there exists the possibility that the SARS-CoV-2 virus is likely to remain alive and around.
“Elimination Strategy” also known as zero-COVID-19 strategy is wherein replication of the virus is reduced to a bare minimum and no new cases occur in a defined geographical area. The strategy has three elements —
- rapid reduction in the number of infections to zero,
- creation of virus-free green zones,
- prompt outbreak management when new cases occur occasionally.
Rich countries’ elimination strategy is to vaccinate every citizen in the country. But the plan is well-suited for geographically isolated countries that can afford strict border control measures, such as New Zealand.
Even there, the goal of zero COVID-19 cases is elusive since the virus continues to be in circulation in other countries as-
- Firstly, the risk of infection from elsewhere, and thus outbreaks, would always be imminent.
- Secondly, there has to be universal coverage of vaccines with consistent upgrades, as the pace of vaccine development may not match the new variants’ emergence.
- Thirdly, a zero-COVID-19 strategy will worsen global health inequities by creating green zones of free travel among richer countries, thus alienating poorer nations.
EXPERIENCE WITH OTHER DISEASES
- Previous experiences with other diseases like measles and neonatal tetanus shows that, though elimination programmes for them have been ongoing for more than 20 years now, the goals have not been completely released.
- Polio, eradicated from southeast Asia, is still endemic in Afghanistan and Pakistan.
- Maternal and neonatal tetanus, which has an 80% to 100% case fatality rate, caused deaths of nearly 25,000 newborns in 2018.
- Despite the global efforts to vaccinate children over the last few decades, these preventable diseases still remain major public health challenges in the developing world.
FEAR OF EPIDEMIC
- So far, there is no empirical evidence to show elimination of the SARS-CoV-2 virus is feasible in the near term. Immunologists opine that the virus will become endemic, i.e., some regions will see a constant presence of COVID-19.
- The level of endemicity depends on how the world reduces inequities of all kinds, including access to vaccines, and how well public health measures, such as containment, are followed.
Pursuing Universal Health Coverage
- The pandemic has reversed the gains made in programmes like tuberculosis control, caused economic hardships, worsened inequalities, and pushed the poor towards the brink of catastrophe.
- The focused efforts against COVID-19 must not ruin the progress made in other disease control programmes and our commitment to Sustainable Development Goals (SDGs).
- It is also essential to resume pursuing the agenda of Universal Health Coverage (UHC).
Combined Global Efforts
- As long as disease control is neglected in even a few parts of the world, every other part is at risk of importing infections due to free travel.
- Instead of isolated strategies for a few countries, there is the need of global leadership and resources to vaccinate the vulnerable population and strengthen epidemiological and genomic surveillance for COVID-19.
- Global elimination of COVID-19 in the immediate term is a huge task.
- The zero-COVID-19 strategy seeks luxury that few countries can afford, and does not reflect field realities.
- Such a plan if adopted may result in diverting most of our attention, funds, and time.
- Excessive focus on one virus in select countries will only worsen the poor global preparedness to fight other pandemics in the future or tackle the devastating burden of non-communicable diseases.
For global health, every idea must be assessed based on its merit while ensuring that there is maximisation of benefits for people across the world. At this stage of the pandemic, the goal of elimination will divert focus and steer the world in a different direction altogether. A pragmatic goal of controlling COVID-19, not elimination, combined with a renewed emphasis on UHC can restore and rejuvenate an ailing healthcare system and bolster our progress towards realistic goals.