Covid-19 Pandemic: Part 9: Public Health & Medical Lessons Learnt From the Pandemic

Published in June 2022

In this paper we have discussed various lessons learnt from the pandemic and how it will be remembered in the future. There are great positive lessons of developing vaccines with full safety in record time and controlling the disease and limiting mortality. On the other hand, we also understand the limitations of science and how social behaviors can limit the acceptance of public health measures, how distrust can creep in, how despite good intentions vaccine distribution globally fails to reach the poorest of the poor and how behaviors change communication improvement is vitally important. 

We discussed the historical context of Covid-19 pandemic, followed by the signs, symptoms and how it affects our body, various diagnostic tests, and the virus and its variants, general measures of protection and types of vaccines and their doses and vaccine hesitancy and limitations and how did we reach to the end of pandemic.  In this month’s edition we discuss public health and medical lessons learnt from this historical pandemic

There are several ways to look at the Covid-19 pandemic. One is that for such a huge universal pandemic, we weren’t prepared for — worsened by inequality, policy mistakes and dominated by misinformation claimed more than 6.3 million lives and over 525 million cases of Covid 19 and stalled the lives and livelihoods of billions of people around the world. As the pandemic starts declining gradually into its third year, it’s hard to see it any other way even with its decline.

But another story of the pandemic focuses on its unprecedented scientific achievements: In record time, scientists went from discovering a new virus to unpacking its genome to developing multiple effective ways to prevent and treat it, fueling what may be the largest public health effort in history, as of now that is.

Let us discuss public health and medical lessons we learnt and experienced in this month’s issue.

1. Infectious diseases are a social issue and not just a medical issue. One in every 1,250 people alive in 2019 has died from infection with coronavirus diseases by Mid-May 2022, but when we look back on COVID-19 in the future, the direct health impact may look less important. Indirect effects on health, like delayed routine and preventive care, overstressed healthcare systems, and the increased mental-health burden, may eventually seem more significant. Children—especially those from low-income families—suffered significant harm in their disrupted preventive care and routine vaccination program and other reduced health services. And the economic harm and dislocation that the pandemic caused have decreased the quality of life for people around the world that we will discuss in the next month.
2. The vaccine development paradigm is a splendid achievement. Two and half years on, it is easy to forget how remarkable the development of COVID-19 vaccines was. Moving in just 326 days from a genomic sequence to the authorization of a COVID-19 vaccine by a stringent regulatory authority is unparalleled and a splendid achievement in the field of public health. This happened in a number of countries. In addition, biomedical science delivered multiple vaccines with high efficacy against severe COVID-19 and a strong overall safety profile. This has raised the public health global capacity and we can believe we are better prepared for future infectious disease and can hope to get vaccines in even shorter time than this!
3. Inequality in production and distribution of vaccines is not acceptable!  Despite the successes of vaccine R&D, there have been persistent inequalities in access to its fruits. Research suggests that enough vaccines are produced to cover 70 per cent of the global population of 7.8 billion. However, most vaccines are being reserved for wealthy countries, while other vaccine-producing countries are restricting the export of doses so they can ensure that their own citizens get vaccinated first, an approach which has been dubbed “vaccine nationalism”. The decision by some nations to give already inoculated citizens a booster vaccine, rather than prioritizing doses for unvaccinated people in poorer countries is considered to add to the inequality. Put simply, the rich countries are getting most vaccines, with many poorer countries struggling to vaccinate even a small number of citizens (See fig 1). This is not only an ethical issue but keeps the virus alive and circulating easily among the unvaccinated and thus, threatens a new variant for global pandemic!

4. Mistrust is one of the most unfortunate components of pandemic response observed in this pandemic. Before the pandemic, it might have been assumed that safe vaccines offering high levels of protection against a frequently fatal and society-altering disease would be in high demand. In some countries, they have been, but in others, including the USA, vaccine skepticism has limited demand.  In this pandemic, like so much else, success in public health has depended on both the public’s trust in government and in a shared social contract among citizens. Trust is hard to manufacture during a crisis of pandemic. Building confidence is important. Science is always changing and so the statements coming with new knowledge may sometimes sound contradicting to the previous ones but are coming from better knowledge. Emerging evidence—on such topics as the benefits of masking, the chance of repeat infection, the risk of new variants, the difficulty of achieving herd immunity, and the benefits of boosters—has required policy and behavioral changes. Countries, businesses, and other stakeholders have had to balance the benefits of incorporating new evidence into their response plans against the confusion and frustration that frequent changes can cause. 
5. Behavior Change Communication is crucial. Lock downs and mass mandate played out in a couple of ways, in early 2020. These were largely effective, but their effectiveness varied, depending on how seriously people took the rules and the ways in which people mixed. Later that year, when several manufacturers announced vaccines within a span of several weeks, hopes soared that countries could reach herd immunity quickly. That dream was no match for the realities of vaccine hesitancy. Around the world, a significant part of the population declined to take the vaccine. That may have helped SARS-CoV-2 to mutate and spread and bounce back with more variants and kill more people. Scientific information alone fails to motivate people to modify their age-old beliefs and habits. Behavior Change is hard to achieve, and communication needs to be modified keeping culture and belief of the people in consideration while recommending certain life changes.
6. Public-health measures are more important than economic stimulus. In early 2020, there was a public debate on the trade-off between protecting people from the virus and protecting the economy. This framework was off the mark—there is no trade-off. Two years on, the facts are clear: no country kept its economy moving well without controlling the spread of the virus as well. The inverse is also true: countries that struggled to control the virus suffered worse economic outcomes. The size of the fiscal-stimulus package did not matter much. The ability to solve simultaneously for both problems, the virus, and the economy, did. This is not to say economic stimulus should not have been given, but in isolation, it helped little if at all. 

In next month’s issue, we will discuss lessons learnt from economic and social consequences of the pandemic and recommendations for better preparedness for the future.