It’s easy to forget, as pubs reopen and children fill school playgrounds again, what a brutal winter Britain faced. The second wave took more lives than the first, schools remained shut, and a stay-at-home order was enforced across the country during the coldest, darkest months. A more transmissible variant of Covid-19 was identified in Kent just days before Christmas, derailing the government’s plans to ease restrictions. Hospitals struggled to cope with a steep rise in ICU admissions, and the mayor of London declared a “major incident”.
Fortunately, Britain is now in a far better position. As of this week, more than 60% of the adult population has received at least one dose of a vaccine. The number of confirmed Covid-19 cases and ONS estimates of prevalence and test positivity all continue to fall week on week. We can look forward to a summer of outdoor lunches and, in the longer term, indoor dinner parties, cinema trips and concert halls. It seems likely that Covid-19 will become a disease we can vaccinate against, much like measles, rubella, diphtheria and pertussis.
But the UK’s position is the exception to the rule. Other countries are still struggling against the pandemic. New lockdown orders have been enforced in France and Germany, and daily confirmed cases are increasing across the world. The contrast between life in Edinburgh, where I live and work, and Delhi, India, could not be more stark. Confirmed case numbers in India top 300,000 per day, while real infection numbers are several times higher than this. Official death tolls cannot be relied upon: people are being cremated in the street with no death certificates, while hospitals are running out of oxygen, ventilators and beds.
When a contagious virus overwhelms a country, it doesn’t just affect those who become seriously ill. The stress it places on health systems means that anyone who needs medical care and support – including children who require oxygen for pneumonia or adults having heart attacks – won’t receive it. At the same time, lockdown measures in poorer countries where there is little state support have catastrophic effects. If people have to choose between going hungry or risking getting Covid-19, the latter will win out.
Just a few months ago, India had thought it was through the worst. Its sudden change of direction is a reminder to other countries: never underestimate this virus, particularly its capacity to mutate. If we are concerned about the UK going back into lockdown, we must be watching the rest of the world to anticipate future outbreaks, and learning from and supporting other countries. The priorities for Britain now are twofold: first, it must protect the progress it has made so far, and continue along its path of domestic economic and social recovery. Second, it must help other countries facing humanitarian crises as a result of the pandemic. This isn’t just an issue of ethics – though the moral case for helping other countries is stark. The pandemic won’t be over so long as the virus is still spreading in other countries.
There are several clear steps the government can take. To ensure a full domestic recovery, England’s border policies around international travel require strengthening. The government’s “red list” approach to travel, which instructs arrivals from red-listed countries to quarantine in a government-approved hotel, has no scientific basis: India, for example, wasn’t on England’s red list for days despite it having the highest caseload in the world. At the same time, Hong Kong stopped all flights from India after a single flight from New Delhi led to 47 imported cases.
England should follow Scotland’s lead and adopt universal border restrictions and managed quarantine. It can look to proposals in the US and EU that would give fully vaccinated individuals vaccine passports, allowing them to travel internationally without quarantining. While we cannot completely stop new variants from entering the country, we can delay their spread. Border measures give scientists time to assess the situation and identify whether new variants that may emerge are more transmissible, whether they are more severe in younger demographics, and whether they could undermine our natural immunity to Covid-19 or partially evade our vaccines.
The next step after this will be helping other countries to suppress Covid-19 and vaccinate their populations. Part of the reason for India’s surge may be the new variant (B1617) that is potentially more transmissible and severe. Meanwhile South Africa has struggled against the B1351 variant, which has forced the government to suspend delivery of the AstraZeneca jab and instead use the Johnson & Johnson vaccine. In Brazil, health authorities have struggled with the P1 variant, which seems to be able to reinfect people who have already had Covid-19.
It’s notable that we have not seen variants emerge from New Zealand, Taiwan or South Korea, countries that continued to suppress the virus and aimed to eliminate it completely. Variants have emerged in places with uncontrolled transmission, where the virus has had the ability to replicate and change, leading to variants with a Darwinian selective advantage that can spread more rapidly.
If we really want the pandemic to be over, we not only have to vaccinate at home, but vaccinate everywhere. This is the only way to prevent the emergence of variants that could escape our immunity, or affect children more severely. Here, science is racing ahead to provide solutions. Researchers are already working on a pan-coronavirus vaccine that would both vaccinate against the virus that causes Covid-19 and prevent future spillover events.
Coronaviruses are usually spread by bats, but can also infect camels (like Mers), birds, cats (like Sars), mink, tigers, lions, pangolins and many other mammals. All it takes to set off the next pandemic is for these viruses to recombine and infect a human through usual respiratory mechanisms. While scientists can continue chasing specific viruses, a better strategy is to create a vaccine that can protect against numerous coronaviruses. This isn’t science fiction: it’s already happening, with positive results from early trials. But delivering such a vaccine will require investment in scientific research, forward thinking, and planning for manufacturing and distribution across the world.
While we enjoy the return to normality in Britain, we must remember that we’re a tiny island on a massive planet. All you have to do is spin a globe to recognise how our health is connected to that of others – and why we therefore need a concerted global effort to end this pandemic.