Leaders 91E
venmiracleshavetheirlimits.Vaccinesagainstthecorona-
virus have arrived sooner and worked better than many peo-
ple dared hope. Without them, the pandemic threatened to take
more than 150m lives. And yet, while the world rolls up a sleeve,
it has become clear that expecting vaccines to see off covid-19 is
mistaken. Instead the disease will circulate for years, and seems
likely to become endemic. When covid-19 first struck, govern-
ments were caught by surprise. Now they need to think ahead.
To call vaccination a miracle is no exaggeration. A little more
than a year after the virus was first recognised, medics have al-
ready administered 148m doses. In Israel, the world’s champion
inoculator, hospital admissions among those aged below 60,
who have not received a jab, are higher than ever. By contrast,
among the largely inoculated over-60s they are already nearly
40% below their mid-January peak and they will fall further. Al-
though vaccines fail to prevent all mild and asymptomatic cases
of covid-19, they mostly seem to spare patients from death and
the severest infections that require hospital admission, which is
what really matters. Early evidence suggests that some vaccines
stop the virus spreading, too. This would greatly slow the pan-
demic and thus make it easier to alleviate lockdowns without
causing a surge of cases that overwhelms intensive-care units.
Those findings, and many more, will harden up over the next few
months as more data emerge (see Briefing).
However, despite all this good news, the co-
ronavirus is not finished with humanity yet. Co-
vid-19 will continue to circulate widely. There is
a growing realisation that the virus is likely to
find a permanent home in humans, as “The Jab”,
our new podcast, which launches on February
15th, will explore. That has profound implica-
tions for how governments need to respond.
One reason the coronavirus will persist is that making and
distributing enough vaccine to protect the world’s 7.8bn people
is a Herculean task (see Graphic detail). Even Britain, which is
vaccinating the population at a faster rate than any other big
country, will not finish with the over-50s until May. To add to the
burden, the potency of a jab may fade, making boosters neces-
sary. Outside the rich world, 85% of countries have yet to start
their vaccination programmes. Until the billions of people who
live in them have felt the prick of a needle, which may not be
before 2023, they will remain fuel for the virus.
Another reason for covid-19’s persistence is that, even as vac-
cines are making sars-cov-2 less infectious and protecting peo-
ple against death, new viral variants are undoing some of their
good work. For one thing, successful variants are more infec-
tious—anything from 25-40% in the case of b.1.1.7 which was first
found in Britain. Infection is governed by the dizzying mathe-
matics of exponential growth, so cases and deaths accumulate
rapidly even if the variant is no more deadly. To get a given level
of viral suppression, more onerous social distancing is needed.
In addition, new variants may withstand current vaccines.
The ones found in Brazil and South Africa may also be defeating
the immunity acquired from a previous covid-19 infection. The
hope is that such cases will be milder, because the immune sys-
temhasbeenprimedbythefirstencounterwiththedisease.
Even if that is true, the virus will continue to circulate, finding
unprotected people and—because that is what viruses do—
evolving new strains, some of which will be better at evading the
defences that societies have mounted against them.
And the third reason sars-cov-2 will persist is that lots of
people will choose to remain a target by refusing vaccination. A
total of 10m Britons are vulnerable to the disease, because of
their age or underlying conditions. Modelling suggests that if
just 10% of them declined to be vaccinated and if social distanc-
ing were abandoned while the virus was still liable to circulate at
high levels, then a tremendous spike in infections and deaths
would result.
In reality, the share of the overall population that remains un-
vaccinated is likely to be much higher than in that thought-ex-
periment (see Briefing). Vaccines are not yet licensed for chil-
dren. Minority communities in many countries, which are most
vulnerable to infection, tend to have less trust in the government
and the medical establishment. Even among some care workers,
as many as half refuse vaccination, despite having seen the rav-
ages of covid-19 at first hand. With the new variants, about 80%
of the overall population needs to be immune for an infected
person, on average, to pass on the disease to less than one con-
tact, the threshold at which the epidemic sub-
sides. That will be a tall order.
For all these reasons, governments need to
start planning for covid-19 as an endemic dis-
ease. Today they treat it as an emergency that
will pass. To see how those ways of thinking dif-
fer, consider New Zealand, which has sought to
be covid-free by bolting its doors against the
world. In this way it has kept registered deaths
down to just 25, but such a draconian policy makes no sense as a
permanent defence: New Zealand is not North Korea. As vulner-
able Kiwis are vaccinated, their country will come under grow-
ing pressure to open its borders—and hence to start to tolerate
endemic covid-19 infections and deaths.
Across the world governments will have to work out when
and how to switch from emergency measures to policies that are
economically and socially sustainable indefinitely. The transi-
tion will be politically hard in places that have invested a lot in
being covid-free. Nowhere more so than China, where vaccina-
tion is slow. The Communist Party has defined every case of co-
vid-19 as unacceptable and wide circulation of the disease as a
sign of the decadence of Western democracies.The new coronormal
The adjustment to living with covid-19 begins with medical sci-
ence. Work has already started on tweaking vaccines to confer
protection against variants. That should go along with more sur-
veillance of mutations that are spreading and accelerated regula-
tory approval for booster shots. Meanwhile treatments will be re-
quired to save more of those who contract the disease from death
or serious illness. The best outcome would be for a combination
of acquired immunity, regular booster jabs of tweaked vaccinesHow well will vaccines work?
They will not simply eradicate covid-19. Governments need to start thinking about how to live with the virusLeaders