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COVID-19: next phase and beyond

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After living for more than 2 years with COVID-19 with over 62 million confirmed deaths (but probably many more, with about 20 million excess deaths) and over 510 million confirmed cases, the world is at a critical juncture. The omicron wave, with its high transmittance and smoother performance than previous variants, especially for persons who are fully vaccinated and without concomitant disease, is diminishing in many places. Restrictions are being eased and people are slowly turning to pre-pandemic activities, including rallies, office work and cultural events. Mask mandates are being removed in many countries. Testing and supervision have decreased and travel is resuming widely. People are exhausted and want to forget the pandemic. This would be a grave mistake.

First, the pandemic situation is not the same everywhere in the world. China, for example, continues to use its so-called dynamic zero COVID strategy of mass testing, quarantining those tested positive, and closing districts or even entire cities (most recently Shanghai). The Chinese authorities have implemented these measures harshly and ruthlessly, regardless of human costs. The goal is, according to Chinese officials, to avoid further spread, to protect the health system and to avoid deaths. The problem is that older and vulnerable people are often not fully vaccinated and the efficacy of licensed vaccines is non-optimal. For China, the top priority should be to accelerate an effective vaccination strategy. The current approach is not a long-term solution for the Chinese.

Second, the global vaccination strategy is far from being on the right track. Unacceptable vaccine inequality persists. The WHO goal of fully vaccinating at least 70% of people in each country by June 2022 is very unattainable. Although 597% of people worldwide have received two doses of the vaccine, in more than 40 countries less than 20% are fully vaccinated. Even in high-income countries, a significant portion of the population continues to refuse vaccination. The emergence of a new variant of SARS-CoV-2 is almost inevitable with a high degree of continuous transmission. The first variants of omicron BA.4 and BA.5 are being closely monitored for the first time in South Africa. Continuous vigilance is needed everywhere.

Third, vaccine inequality is reflected in the slow and delayed access to one of the few effective oral treatments for COVID-19paxlovid. When taken early, paxlovid reduces the risk of hospitalization and death by 89%. Although high-income countries are ordering millions of doses from the manufacturer, Pfizer, the mechanisms for making paxlovid available in low- and middle-income countries through the Drug Patent Group are slow. An agreement has been reached with 35 generic manufacturers in 12 countries, but the drug is not expected to be delivered before 2023.

Finally, now is the time to plan, learn from mistakes, and build strong resilient health systems, as well as national and international sustainability strategies. The capacities of health systems need to be strengthened, not only to be ready for future pandemics, but to immediately cope with delays in the treatment, diagnosis and care of other diseases after the cessation of the last 2 years. Vaccination campaigns for diseases such as measles are urgently needed. Preparedness plans, both nationally and internationally, should have a strong emphasis on early data sharing and transparent oversight. A Health should be the basic principle, taking into account both human and animal health. At the 75th World Health Assembly (May 2229, 2022), there is an opportunity to review progress in reviewing International Health Regulations and to further discuss a pandemic treaty, the process of a treaty has been very slow. The progress report of the Intergovernmental Negotiating Body is not expected until 2023.

At the national level, countries need independent investigations into their responses to COVID-19. Learning from mistakes is never easy and governments may even be reluctant to admit that they were made. When the UK High Court ruled last week that it was illegal to discharge hospital patients into care homes without testing for COVID-19, the UK Government claimed it had acted on the best available evidence in that time. This is an open lie. Evidence for asymptomatic transmission was clearly available by the end of January 2020.

Now is not the time to leave COVID-19 or rewrite history. It is time to engage vigorously, redouble our efforts to end the acute phase of the 2022 pandemic for all, and lay a solid foundation for a better future with clear responsibilities and acceptance. honest of unpleasant truths.

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