While the pandemic is unlikely to fully end in 2022, we can hope to see some positive changes: more vaccine coverage, improved treatments and reduced mortality. But mitigation measures, such as mask wearing and social distancing, will remain crucial for controlling outbreaks and restricting the evolution of the SARS-CoV-2 coronavirus.
Maria Van Kerkhove, the technical lead on covid-19 at the World Health Organization (WHO), dislikes the phrase “learning to live with the virus”. She says: “I don’t think we should learn to live with it. There are lots of things we can be doing to stop the virus from spreading. No level of death from covid-19 is acceptable to me.” The next year will unfold how we allow it to, she says. “How we use the vaccine going forward among those most at risk will be critical to what happens.”
A crucial issue will be vaccine equity. By late December, more than 8 billion doses had been given globally, but only 8.1 per cent of people in low-income nations had received at least one jab. “Global leaders haven’t utilised the vaccine as they should have,” says Van Kerkhove. “If we’d used 8 billion doses differently, we’d be seeing a very different epidemiological situation right now.”
Advertisement
In December, WHO member states agreed to draw up a treaty by 2024 that will set out new international rules on preparing for, preventing and responding to pandemics. Forthcoming negotiations are expected to partly tackle the inequality of vaccine provision. “Just as countries have come together against tobacco and climate change, health security is too important to be left to chance or friendly agreements,” says Tedros Adhanom Ghebreyesus, the WHO’s director general.
at the French National Centre for Scientific Research says that, for Europe, overcoming vaccine hesitancy is key. He says covid certificates have proven an effective incentive in many countries, but they need to be non-discriminatory. “It is unacceptable if vaccines that are deemed effective by the WHO are not eligible for covid certification in some regions, as is the case in the EU,” he says.
Vaccination efforts, including the development of updated jabs to tackle new variants, should continue to lessen the impact of covid-19 in 2022. “I expect to continue to see a significant reduction in mortality in those who are vaccinated,” says Van Kerkhove. “We hope to significantly reduce the severe end of the covid spectrum.”
Progress with treatments against the disease adds to this hope. “Vaccines will remain the cornerstone of our fight against covid-19, but with various new variants coming along, the oral [treatments] may well have a very important part to play in the next year,” says at the UK National Institute for Health Research.
The UK, for example, is beginning to use antiviral drugs and artificial antibodies in those with an elevated covid-19 risk. People who are most vulnerable to infection – such as those with cancer, Down’s syndrome or weak immune systems – are eligible to receive the intravenous drug sotrovimab, a monoclonal antibody that is designed to block the virus, if they test positive for covid-19.
Specialist hospital clinics in the UK are also now offering the oral antiviral molnupiravir to people who aren’t classed as extremely vulnerable, but who are still at higher risk, such as those aged 50 and up or people with conditions like diabetes or severe asthma, as part of a large trial.
Taken early enough, the drug can prevent hospital admission, but molnupiravir has potential downsides. It works by introducing mutations in the virus’s genetic material, so isn’t suitable for use during pregnancy, for example. There is also concern that these mutations could lead to new variants or drug resistance. at University College London, who is involved in the trial, says mutations aren’t a big concern. “Once you’ve given [the drug] for a few days, the level of infectious virus is so low that you can’t even culture it,” he says. “But it is something that we need to keep an eye on.”
The start of this year will be dominated by the omicron variant, which has around 50 mutations compared with the original virus, of which 30 are in its outer spike protein that is targeted by vaccines. The extensive changes in this protein greatly reduce the effectiveness of antibodies against the variant.
It is possible that this variant evolved in an individual with HIV who caught covid-19 and was unable to shake off the virus for some time. There is no direct evidence that this is what happened, but the researchers who discovered omicron have called for efforts to tackle HIV to be stepped up. This underlines how important it will be to rein in infections, especially among people with weak immune systems, to reduce the potential for new variants to evolve.
But new variants could emerge in other ways too. Another scenario put forward to explain omicron’s origin is that the virus infected animals of some kind, acquired lots of mutations as it spread among them and then jumped back to people. Some of the mutations in omicron’s spike protein are the same as those seen in SARS-CoV-2 viruses that have adapted to spreading in rodents like mice, although this could just be a coincidence.
The repeated discovery of SARS‑CoV-2 in wild animals, for instance in white-tailed deer in the US, concerns at Erasmus University Medical Centre in the Netherlands, who says 2022 will be a “rough period”. The widespread infection of these deer in the US means there is a risk that other animals will get infected and that new variants will emerge and be passed back to humans. “It is something that we need to actively and aggressively monitor, in order to avoid creating new reservoirs for the virus,” she says.
It is also possible that variants could combine with each other or other coronaviruses. The virus will evolve because we aren’t doing enough to stop transmission, says Van Kerkhove. “I’m not talking about lockdowns, but social distancing, mask wearing, working from home, improving ventilation,” she says. “We need to open up societies carefully without abandoning these public health measures.”
Eventually, she believes covid-19 will become seasonal, with periodic spikes in populations with lower levels of immunity. But this won’t happen any time soon due to the virus thriving in all parts of the world, she says.
Other researchers are more optimistic. “In 2022, we will move more to the endemic phase of SARS-CoV-2 infection, where we continue to learn to live with the virus,” says Elizabeth McNally at Northwestern University in Chicago, Illinois.
However, Van Kerkhove remains positive. “It won’t be forever, we will get through this. That is something we can say for certain – the pandemic will end.”
When, though, is down to our actions, says Tedros. “The virus has demonstrated that it will not simply disappear. How many more lives and livelihoods it takes is up to us,” he says. “Ending the pandemic is not a matter of chance, it is a matter of choice.”
Sign up to our free Health Check newsletter for a round-up of all the health and fitness news you need to know, every Saturday
