While the pandemic is unlikely to聽fully end in 2022, we can hope to聽see some positive changes: more vaccine coverage, improved treatments and reduced mortality. But mitigation measures, such as聽mask wearing and social distancing, will remain crucial for聽controlling outbreaks and restricting the evolution of the SARS-CoV-2 coronavirus.
Maria Van Kerkhove, the technical lead on covid-19 at the聽World Health Organization (WHO), dislikes the phrase 鈥渓earning to live with the virus鈥�. She says: 鈥淚 don鈥檛 think we should learn to live with it. There are lots聽of things we can be doing to聽stop the virus from spreading. No level of death from covid-19 is聽acceptable to me.鈥� The next year聽will unfold how we allow it聽to,聽she says. 鈥淗ow we use the vaccine going forward among those most at risk will be critical to聽what happens.鈥�
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聽of people in low-income nations had received at least one聽jab. 鈥淕lobal leaders haven鈥檛 utilised the vaccine as they should聽have,鈥� says Van Kerkhove. 鈥淚f we鈥檇 used 8聽billion doses differently, we鈥檇 be seeing a very聽different epidemiological situation right now.鈥�
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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聽pandemics. Forthcoming negotiations are expected to partly tackle the inequality of聽vaccine provision. 鈥淛ust as countries have come together against tobacco and climate change, health security is too important to be left to chance or聽friendly agreements,鈥� says Tedros Adhanom Ghebreyesus, the WHO鈥檚 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聽be non-discriminatory. 鈥淚t 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,鈥� he says.
Vaccination efforts, including the development of updated jabs to tackle new variants, should continue to lessen the impact of聽covid-19 in 2022. 鈥淚 expect to聽continue to see a significant reduction in mortality in those who are vaccinated,鈥� says Van聽Kerkhove. 鈥淲e hope to significantly reduce the severe end聽of the covid spectrum.鈥�
Progress with treatments against the disease adds to this hope. 鈥淰accines 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聽important part to play in the聽next year,鈥� says at聽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聽infection聽鈥� such as those with聽cancer, Down鈥檚 syndrome or聽weak immune systems 鈥� are eligible to聽receive the intravenous drug sotrovimab, a monoclonal antibody that is designed to block聽the virus, if they test positive聽for covid-19.
Specialist hospital clinics in the UK are also now offering the oral antiviral molnupiravir to people who aren鈥檛 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鈥檚 genetic material, so isn鈥檛 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鈥檛 a big concern. 鈥淥nce you鈥檝e given [the drug] for a聽few days, the level of infectious virus is so low that you can鈥檛 even聽culture it,鈥� he says. 鈥淏ut it聽is聽something that we need to聽keep an eye on.鈥�
The start of this year will be聽dominated by the omicron variant, which has around 50聽mutations compared with the聽original virus, of which 30 are聽in its outer spike protein that聽is聽targeted by vaccines. The聽extensive changes in this protein greatly reduce the effectiveness of antibodies against聽the variant.
It is possible that this variant evolved in an individual with HIV聽who caught covid-19 and was聽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聽be聽stepped up. This underlines how important it will be to rein in聽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鈥檚 origin is that the virus infected animals of some kind, acquired lots of mutations as it聽spread among them and then jumped back to people. Some of the mutations in omicron鈥檚 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鈥慍oV-2 in wild animals, for instance in white-tailed deer in the US, concerns at聽Erasmus University Medical Centre in the Netherlands, who says 2022 will be a 鈥渞ough period鈥�. The widespread infection of these聽deer in the US means there聽is聽a risk that other animals will get infected and that new variants will emerge and be passed back to humans. 鈥淚t is something that we need to actively and aggressively monitor, in order to聽avoid creating new reservoirs for the virus,鈥� she says.
It is also possible that variants could combine with each other or聽other coronaviruses. The virus聽will evolve because we aren鈥檛聽doing enough to stop transmission, says Van Kerkhove. 鈥淚鈥檓 not talking about lockdowns, but social distancing, mask wearing, working from home, improving ventilation,鈥� she says. 鈥淲e need to open up societies carefully without abandoning these public health measures.鈥�
Eventually, she believes covid-19 will become seasonal, with periodic spikes in populations with lower levels of immunity. But聽this won鈥檛 happen any time soon due to the virus thriving in聽all parts of the world, she says.
Other researchers are more optimistic. 鈥淚n 2022, we will move聽more to the endemic phase of SARS-CoV-2 infection, where we聽continue to learn to live with the virus,鈥� says Elizabeth McNally at Northwestern University in Chicago, Illinois.
However, Van Kerkhove remains positive. 鈥淚t won鈥檛 be forever, we will get through this. That is something we can say for certain 鈥� the pandemic will end.鈥�
When, though, is down to our actions, says Tedros. 鈥淭he virus has demonstrated that it will not simply disappear. How many more lives and livelihoods it takes is up to us,鈥� he says. 鈥淓nding the pandemic is not a matter of chance, it is a matter of choice.鈥�
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