The world has entered its third year of the pandemic and we are all beyond weary. What will it take to end it? Western public health experts say the answer has been obvious since the beginning and we’ve wasted opportunities to break COVID-19’s back.  

We need to get this right – and soon – they said, because it won’t be our last public health crisis.  

“It’s frustrating,” said virologist and Schulich Medicine & Dentistry professor Eric Arts. “I was on CBC talking about this at the very beginning. It’s not like I’m clairvoyant – everybody in my area knew this pandemic could have ended pretty quickly if we’d had global distribution of vaccines.”

Instead of prioritizing vulnerable populations around the world, wealthy countries prioritized vulnerable populations within their own borders. This not only gave the virus a ready reservoir of people in developing countries to ensure its continued spread, it allowed the virus to mutate and continue to infect, and re-infect, vaccinated people in places like Canada.  

Arts, who leads Western’s state-of-the-art Imaging Pathogens for Knowledge Translation (ImPaKT) facility, which tests COVID vaccines, treatments and provides virus surveillance, pointed to the public health system’s approach to Ebola vaccines to show how a virus can be properly contained using what health experts call ‘ring vaccination.’ This means localized outbreaks are stemmed by vaccinating people in places where transmission is actively occurring.

“It can be done. It just takes willpower and money, but nowhere near the same amount of money that we’ve already spent on SARS-CoV-2,” said Arts.

He said we had a second crack at ending the pandemic when the more transmissible but less deadly Omicron variant began to circulate. It would have been relatively easy to tweak the current mRNA vaccines to target Omicron, said Arts, but the world’s focus remained on third and fourth booster shots.

Beyond delivering doses

While distributing vaccines globally to people who need it most matters, equity involves so much more, said health studies professor and bioethicist Maxwell Smith. Delivery timing, intellectual property rights and technology transfer all come into play.  

As Smith pointed out, developing countries have had to make do with no doses, minimal doses and then so many doses that they are unable to use them before they expire.  

“If we stop at making sure Zimbabwe has X number of doses and forget they might need support in terms of infrastructure in delivering vaccines, then we’re not truly addressing the vaccine equity question,” he said.  

Pharmaceutical companies’ intellectual property rights are just as problematic. The World Trade Organization’s Agreement on Trade-Related Investment Measures limits generic drug makers’ ability to make less expensive vaccines. Some countries are advocating for a COVID-19 vaccine waiver to this agreement; and while Canada has said it will participate in discussions, it hasn’t actually committed to supporting the waiver.  

“If we think vaccines are a global public good that will get us out of this pandemic, we need to say intellectual property rights can’t matter at this point if it means saving lives,” said Smith.  

Technology transfer is also necessary for true vaccine equity. Even if a developing country has the ability to make vaccines, it may not be able to do it at scale without the necessary technology.  

“We can’t just give them the recipe and waive intellectual property rights,” said Smith. “It becomes a superficial commitment if we don’t address structural, logistical considerations.”  

Life after COVID-19  

Now that no part of the world remains untouched by the pandemic, we also need to think about what global health equity looks like for those suffering from the lingering effects that can come with long-COVID, said Western epidemiologist Greta Bauer.  

Early on, the conversation around equity was about who was at greatest risk of infection due to underlying conditions or their ability to isolate. But as we’ve learned more about the illness, Bauer said we should think about what health equity looks like long term.  

“We’re not thinking enough about the cumulative effects of COVID – people who have had it three or four times – or the fact even those with mild COVID can have long-term physiological effects,” she said. “Which groups will be most disadvantaged by that? Pregnant women? People disadvantaged due to social conditions?”

Understanding the long-term effects of COVID-19 and potential causes of lingering symptoms – brain fog, breathlessness, fatigue – are key to developing targeted treatment. Recently, Western made a breakthrough on this front.  

Using functional MRI, a research team led by Schulich School of Medicine & Dentistry professor Grace Parraga was one of the first to show these debilitating symptoms are related to microscopic abnormalities that affect how oxygen is exchanged from the lungs to the red blood cells.  

The next pandemic

While COVID-19 is not over, Western experts are already turning their attention to the next pandemic. “My biggest concern now is the next zoonotic jump from our increased contact with wildlife and our increased mobility,” said Arts.

A recent study published in Nature estimates in the next 50 years, at least 4,000 cross-species viral transmissions will occur as animals move to higher elevations, biodiversity hotspots, and areas of high human population density in Asia and Africa. Some of these will spill over and infect humans.  

Pediatric critical-care physician and researcher Dr. Douglas Fraser echoed Arts’ concern. During the worst of the pandemic, Fraser worked on developing biomarkers to predict which patients with COVID-19 would become most seriously ill. He also helped profile the body’s immune response to the virus.  

His current focus is on helping the country manage the next pandemic. Fraser is part of a team advising Ottawa on how to help research and community health teams mobilize quickly.  

“Canada did some OK things to deal with the pandemic, but for where we are in the Western world, we didn’t produce anything that went to an international level,” he said. “We didn’t act quickly and decisively.”

What we need now is to set the stage to rapidly respond in two areas – health research and innovation, and public health-care infrastructure. That means drafting agreements among various research bodies and government departments that deliver public health, establishing in advance who is responsible for what.

Most of the required resources already exist, said Fraser. “We have something like 20 different departments at the federal, provincial and municipal levels that have responsibility for public health crises,” he said. “But they’re not communicating with each other. You want to have the fire department ready before your house is on fire.”

Addressing inequity

There are other, less obvious, but just as important ways to prepare for the next public health crisis. Better education and communication around how vaccines work and their benefits, would be a good start. Despite anti-vaccine protests, most people in Canada have in fact agreed to be vaccinated. That’s not the case in various African countries where uptake can be less than 50 per cent.  

“We are now beyond the point where we can get vaccines into arms in those parts of the world because we’ve let misinformation spread so badly. People have a distrust,” said Arts, pointing to social media’s role in spreading lies and half-truths. “You can’t just bring something produced by the Western world and drop it on the African continent or any type of marginalized low-income populations. There’s been some history of bad outcomes.”  

If we want to take equity during a pandemic seriously, we also need to address root causes of health inequity, said Smith. That means being serious about alleviating poverty and providing housing and education. It also means preparing for, and reacting to, how climate change affects the spread of disease and the increased opportunities for zoonotic diseases that come with habitat destruction.

That, say Western experts, requires a global body that can enforce and coordinate. The World Health Organization could be that body, but it can’t do it on an operating budget roughly the size of a big Canadian city’s hospital networks. “It’s a pittance when we think about the task of global health guidance,” said Smith.  

Arts agrees a strong, over-arching global public health body could make an important difference the next time around: “Pharmaceutical companies are not inherently evil, but they need control so rich governments concerned about themselves don’t let pharma do what it wants,” he said.