Two years of covid-19, what is left to do?

With the production of vaccines growing, the main challenge has become that they reach the whole world. For this reason, the COVAX initiative (Global Fund for Covid-19 Vaccines) has shifted its investment to distribution logisticsExplain Adelaide Sarukhanbiologist at the Barcelona Institute of Global Health (ISGlobal).

For this purpose, the new protein vaccineseasier to produce and that do not need freezing chains (like those of Novavax, Corbevax or the Spanish one of Hipra).

“In perspective, it will be important to develop broad spectrum vaccinescapable of producing us against various sarbecoviruses [grupo al cual pertenece el SARS-Cov-2]Sarukhan says.

In this pandemic, vaccines have arrived long before treatments. Until now, drugs used for other diseases have been adapted to covid-19. But now antivirals designed expressly against the coronavirus are about to hit the market. These are pills, easy to apply in the early stages of the disease, to avoid hospitalizations.

That’s crucial for people who cannot take the vaccines for medical reasons or who have a compromised immune system unable to generate antibodies. For this group, which has been confined for two years, the pandemic is far from over. “In the long term, we must look for broad-spectrum antivirals that prevent the replication of various coronaviruses,” adds Sarukhan.

It is estimated that between 10% and 30% of those infected by covid-19 (millions of people) suffer from persistent covid. “We are definitely underestimating this problem,” he says. Sonia Villapolresearcher at the Methodist Hospital Research Institute in Houston (Texas) and co-author of the largest meta-analysis on this disease.

At the moment, there are no complete laboratory tests that accurately diagnose this condition. Villapol considers it essential that health systems apply all their knowledge to carry out personalized medicine for these patients. “Health systems must create specific care units“, it states.

Preventing other viruses from jumping from animals to humans should be paramount. But actions aimed at this goal are in their infancy. The WHO has provided itself with the Group of Experts on One Health. However, much more is needed than the advice of two dozen experts, according to Carlos Das Neves, a researcher at the Norwegian Veterinary Institute and co-author of an Intergovernmental Panel on Biodiversity (IPBES) report on pandemics.

Avoiding zoonoses requires regulating the trade in wild species, stopping deforestation, protecting biodiversity and putting a spoonful in the world of farms. For this, you need a permanent and well-financed institution, such as the Intergovernmental Panel for Climate Change (IPCC), according to Das Neves. In December, the WHO announced that it is working at a new pandemic treaty possibly going in this direction.

“The pandemic has shown that we were not ready for a global health emergency. Each country has gone its own way and we have invented responses on the fly. We need a manual,” says Vespignani. “Some countries were better prepared: the Asians who had been through SARS and MERS or the Africans who had been through Ebola,” he says. Helena Legido-Quigleyprofessor of public health at the London School of Hygiene and Tropical Medicine and a member of the independent panel on the WHO pandemic.

Vaspignani asks that they be deployed all over the planet centers that continuously collect data on the evolution of viruses (as if they were weather stations) and that there are permanent structures that process them (such as centers that warn of the arrival of hurricanes). “We need current in real time. The longer you wait, the more damage,” she says. The WHO has established a outbreak analysis center in Germany, however, it is too embryonic a structure, according to Vespignani.

“Public health has pulled us out of the quagmire after being abandoned in recent years. It is clear that it must be strengthened,” says Pere Puigdomènech, a CSIC researcher and promoter of a book on the lessons of covid-19. Puigdomènech points out that the debate on the weight of private healthcare is open in Catalonia. A commitment to the public requires rethinking regional financing. Legido and Vespignani highlight the preventive role of public health. Its capillary presence in the territory and its effect in reducing inequalities are essential to mitigate the effects of a pandemic.

The groups of scientists who have advised the health spokespersons in Spain were opaque, scarce or non-existent, Puigdomènech and Benavides stand out. It was never known who was advising Fernando Simón. In Catalonia, it took until the end of last year to establish an advisory committee, which does not publish the minutes of its meetings.

Most experts ask for a Spanish Public Health Agency. Legido points to the German Robert Kock Institut as an example to follow, for being well endowed and enjoying a certain independence from politics. Another model is that of Uruguay, which weathered the pandemic for almost a year also thanks to a committee with dozens of experts from all fields.