Main challenges that await humanity in its fight against COVID-19 in 2021

Editor's note: Djoomart Otorbaev is the former Prime Minister of the Kyrgyz Republic, a distinguished professor of the Belt and Road School of Beijing Normal University, and a member of Nizami Ganjavi International Center. The article reflects the author's views, and not necessarily those of CGTN.

In the previous article on the evolution of the pandemic, I wrote that despite the optimism associated with the development of vaccines and the start of the vaccination campaign, it is likely that we will continue to live with the virus not for months, but years. There are several reasons why it will not be possible to quickly defeat the disease even with the most ambitious vaccination program in human history.

In this piece, I would like to discuss in more detail few critical challenges that humanity will face in its fight against the pandemic in 2021.

For obvious reasons, the vaccines cannot be distributed evenly over the planet. Just as the virus created a colorful kaleidoscope of infections, irregular use of vaccines will soon produce an even more diverse variety of "islands of immunity." It is also evident that rich countries will form those "islands" much earlier than poor ones. Even within an individual country, the vaccination campaign will be distributed differently. As a result, the acquired immunity will be remarkably diverse among different age groups, various kinds of "priority" groups, such as doctors and teachers, within big cities and small rural settlements.

Both healthy and infected people will move both within and between those clusters. Such processes will occur even at the level of individual families. We will observe a kind of "Brownian motion," which will significantly complicate the disease's localization and suppression. As practice has shown, full lockdown experience does not work well, except for highly organized and disciplined countries like China or Vietnam. People will continue to switch between "successful" and "disadvantaged" areas, adding additional chaos to control of the disease.

Which additional and unexpected problems have the global pandemic revealed? What long-term "trauma" can humanity face because of the pandemic?

The International Council of Nurses' latest analysis shows that among four million healthcare workers worldwide, more than 20,000 could have died from the COVID-19. In many countries, the healthcare workers are exhausted. For a whole year and almost continuously, they have been fighting the disease, and often without moral and material support. Even in the most advanced countries, medical institutions' staff is on the verge of their physical capabilities. Consequently, medical workers began massive layoffs. According to recent estimates, in the U.S., which is the wealthiest country globally, a fifth of all rural hospitals have been closed last year. Today in the U.S., there are more than 150,000 fewer nurses in hospitals than required. By last mid-November, more than 20 percent of all American hospitals were understaffed.

The same goes for chronic illness. Many patients who have been infected with SARS-CoV-2 are struggling for many weeks and even months with so-called "long COVID-19" - rolling waves of ongoing and distressing symptoms. Including extreme fatigue, psychological and memory problems, and sudden loss of energy that occurs after small bursts of activity. Some studies have estimated that from a quarter to a half of all infected people have at least one symptom that lasts for a month, if not several. Sufferers of long COVID-19 are sometimes called long-haulers. Some "long-haulers" will soon be marking the first year of their illness.

Although the SARS-CoV-2 virus's influence will weaken after large-scale vaccinations, it will remain among us for a long time. For example, polio vaccines were first created in the 1950s, but polio, although remarkably close to being eradicated, still exists. Unfortunately, a similar process occurs with many other vaccine-preventable diseases, including measles, tuberculosis, or cervical cancer. Or a relatively recent example, more than 1.7 million people worldwide were infected with HIV in 2019, even though drugs that block this infection have existed for many years.

What happens next with SARS-CoV-2 also depends on how our immune system responds to vaccines. And again, what will be the "response" of this virus to vaccines. Since the immune system's response is unknown and unpredictable, it is now impossible to say how the virus will evolve. The formation of individual immunity remains the biggest mystery for scientists.

For example, for some viral diseases such as chickenpox and measles, immunity can last a lifetime. But with a few other diseases, it disappears much earlier. For example, we all know that the immune system remembers less than a year how to deal with the viruses that cause the flu. Or another intermediate example - immunity against deadly coronaviruses like MERS and SARS can only last for several years.

Some immunologists suggest that the duration of immunity to the current virus maybe somewhere between one year and the whole life. It is already clear that this virus triggers immune memory, which lasts for at least six months, although a small number of people were re-infected earlier than this period. Immunity may not last a lifetime, and one may need to revaccinate after a few years. All this remains to be seen.

The biggest concern now is how the new virus will behave as more people are vaccinated. Scientists proved that a virus could mutate, that is, allow changes in its genetic code. For example, a new variant of the SARS-CoV-2 virus called B.1.1.7 was recently identified in the UK. This virus has undergone such mutations that make it more infectious and very quickly transmitted. Other mutations of SARS-CoV-2 have appeared. For example, the South African variant is trying to bypass the "attack" of new vaccines and infect people already immunized. If the virus behaves in this way, it could become like the influenza virus, that is, an ever-changing foe, which forces humanity to regularly "play catch-up."