After its identification in late 2019, COVID-19 was officially declared a pandemic by the World Health Organization (WHO) on March 11, 2020. On the one-year anniversary of the COVID-19 pandemic, there is much to reflect on.
As of March 11, 2021, COVID-19 has claimed the lives of over 2.6 million people worldwide. One fifth, or 20 percent, of the global death toll (over half a million) has come from the US, despite only accounting for 4.25 percent of the world’s total population. These deaths have been in the face of tight lockdowns and other pandemic measures.
The vast majority of us have not faced a public health challenge of this magnitude in our lifetimes. Recent outbreaks of polio and Ebola have slipped on and off the radar as they were generally thought to be relegated to specific countries or continents. The same mistake was made with COVID-19, and over a year later, we have seen the grave repercussions of that.
Amidst initial confusion, fear and chaos, masks and social distancing quickly became new norms, and now vaccines are the leading hope for a way out.
A great deal has transpired in the past year. We have learned about the shortcomings in our government and healthcare systems, our lack of public health emergency preparedness and the remarkable ways people and science can, and must, come together in global disasters.
In the first few months of the pandemic, much of the focus was on flattening the curve and treatments. As a novel virus, public health experts, scientists and clinicians faced challenges in how to effectively prevent its transmission, and how to best treat it in the most severe cases.
With vaccine shortages and slow rollouts in many parts of the world, the COVID-19 way of life continues in many places. And now, threats of a third wave of the pandemic have become a part of the conversation as new, more contagious and potentially immune-resistant SARS-CoV-2 variants have emerged. They have also become a part of vaccine strategies, with vaccine makers testing their existing vaccines against the new variants and developing variant-specific boosters.
Despite confusing and slow public health and government health messaging, most of us have, and continue to, rely on science to get us through, and to the end of, this pandemic.
In the initial weeks and months of the pandemic, we saw images of at-capacity hospitals in Italy and other places, brimming with ventilated patients and exhaustion-beaten hospital staff with N95 masks digging deep into their faces.
As a respiratory illness, COVID-19 hits the respiratory airways and lungs especially hard. In serious cases, clinicians were faced with having to mechanically ventilate patients, with the most severe cases requiring ventilators, and the worst being put on extracorporeal membrane oxygenation (ECMO). Mortality in ventilated COVID-19 patients is high, particularly for those of advanced age. And for those that do survive, recovery after such invasive procedures is difficult.
As COVID-19 cases and hospitalizations soared, there were grave realizations of potential ventilator shortages. This led carmakers and companies like Dyson and Tesla to pledge conversion of their assembly lines to making ventilators.
As more was learned about the clinical manifestation of the disease, clinicians were able to optimize treatments for better outcomes. For example, a study published in The Lancet, backing the experimental observations of many clinicians, reported that prone position (lying a patient on their stomach while ventilated) and lung-protective ventilation with low tidal volume and low driving pressure lead to better outcomes in invasively ventilated patients with COVID-19.
With hydroxychloroquine, and more recently the horse medication ivermectin, folding under the science with respect to their ineffectiveness as COVID-19 treatments, many pharma and biotech companies had far better approaches, delving into evidence-based drug repurposing and developing targeted drugs against SARS-CoV-2.
Although the antiviral remdesivir showed some initial promise, it proved to be lacklustre as an effective treatment for COVID-19, despite having shown some marginal benefit in shortening hospital durations. Unexpectedly, the cheap and readily available corticosteroid dexamethasone became the first drug to have the demonstrated the ability to cut risk of death among COVID-19 patients.
Eli Lilly and Regeneron have been scoring on the antibody front. While Eli Lilly received FDA emergency use authorizations (EUA) for two of its anti-SARS-CoV-2 monoclonal antibodies, bamlanivimab and etesevimab, which are administered together as a cocktail, Regeneron received EUAs for casirivimab and imdevimab for the treatment of COVID-19. Lilly recently announced results from an ongoing Phase III trial that show the antibody duo can reduce hospitalizations and deaths by 87 percent.
Pfizer/BioNTech cracked open the COVID-19 vaccine space in North America and Europe as their candidate mRNA vaccine became the first to be authorized for emergency use by the FDA for the disease. This was closely followed by an EUA for another mRNA vaccine from Moderna late last year. This year, authorizations and approvals for viral vector vaccines from Johnson & Johnson and AstraZeneca/Oxford have been granted in North America, although the FDA has yet to approve AstraZeneca’s offering.
More vaccines are on the horizon, including subunit vaccines that may soon see authorizations and approvals. These include a protein-based vaccine from Novavax, and a plant-, virus-like particle (VLP)-based vaccine from Canadian biotech company Medicago.
In less than a year, the world has seen the development and deployment of over half a dozen COVID-19 vaccines, including more “traditional” live, attenuated and inactivated vaccines from China-based companies, as well as vaccines from makers in Russia.
SARS-CoV-2 variants of concern (VOC) such as B.1.1.7 and B.1.351 are being seen to put somewhat of a damper on the current vaccines. Nevertheless, studies, mainly in vitro studies so far, have shown that the current vaccines are generally as effective against B.1.1.7 as against the original strain, and offer some protection against B.1.351 as well. Ongoing studies are evaluating the efficacy of the vaccines against these and other variants in humans. In trials conducted in places like South Africa, where the B.1.351 has become the dominant strain, vaccines from Johnson & Johnson and AstraZeneca/Oxford yielded favorable overall efficacies and importantly, protected against hospitalizations by almost 100 percent, and death by 100 percent.
Vaccine Hesitancy and Inequities
The rapid development of vaccines has been nothing short of spectacular. Through pooling together the right resources (funding and expertise), technologies, collaborations and a clear unified direction, the global vaccine effort has been a great success so far, at least on the development front. However, the speediness of the vaccines has led to vaccine hesitancy among some.
Although steadily dropping, vaccine hesitancy has been especially high in minority groups including Black, Asian and Indigenous communities due to a general distrust many have with healthcare systems, as related to historic inadequacies in both access and care. However, there have been major successes in some Indigenous communities such as the Navajo Nation in the US, which was hit hardest by COVID-19 in the country. Through messaging in a culturally appropriate language and having leaders lead by example by taking the shot, over 142,000 doses have been administered so far in a population of 173,000.
Vaccine hesitancy can be readily overcome with information and combatting misinformation through educational and government-led initiatives. For example, in places like the UAE and Israel, governments and health agencies have been forthcoming in their vaccine delivery approaches, informing citizens about the benefits of vaccination and leading by example. Although many of these countries have smaller, more condensed populations, they have been vaccine success stories which countries like the US and Canada can learn from.
Despite having secured the most vaccine doses per capita, Canada has only vaccinated little over 3.5 percent of its population. Getting doses into the arms of seniors has been priority, and especially in Canada, where devastating outbreaks in long-term care (LTC) have resulted in LTC residents accounting for the highest proportion (81 percent) of all COVID-19 deaths in the country compared with other OECD nations.
In addition, despite the WHO’s COVAX Facility having pledged to ensure the equitable distribution of COVID-19 vaccines worldwide, most African countries have been dead last in vaccine recipiency. COVAX administered its first doses of the AstraZeneca/Oxford vaccine in Africa in Côte d’Ivoire and Ghana on March 1 of this year. In South Africa, vaccination began in the latter half of February, while Rwanda became the first African country to receive and administer Pfizer’s vaccine in early March.
Global inequities in vaccine distribution will have to be addressed with great seriousness as a global pandemic cannot be ended at the national level.
On the one-year anniversary of the COVID-19 pandemic, it is clear how science has impacted human stories, and vice versa. With the CDC having recently announced that vaccinated individuals can gather indoors without masks, the coming months will see the reuniting of friends, families and neighbors, and returning to some form of normalcy. This doesn’t mean that we’re in the all-clear though as we still have variants and inequitable vaccine distributions to contend with.
With unprecedented industry collaborations in vaccine development, including pharma rivals stepping up to aid companies to ramp up vaccine production, the pandemic has pushed boundaries and introduced innovations of all kinds. From the first mRNA-based vaccines to massive industry-academia (AstraZeneca/Oxford) and industry-industry (Pfizer/BioNTech) collaborations, the post-pandemic era may see many of these innovations become the new norm.