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This time last year, Mike Ryan, head of the World Health Organization’s health emergencies program, was strenuously urging the world to try to contain the new virus that was spreading in and from China.

The world, he said, had the necessary tools: contact tracing, isolation, and quarantine. “There’s enough evidence to suggest that this virus can still be contained,” he told STAT in an interview for a story published Feb. 1, 2020.

The world didn’t move swiftly enough to put SARS-CoV-2 “back in the box,” to borrow an expression sometimes used by scientists to describe viral containment. More than 100 million people around the globe have been infected with Covid-19, and more than 2.3 million people have died.

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STAT caught up with Ryan over the weekend to get his read on where things stand with the vaccine rollout, when he thinks life may get closer to something that approximates normalcy, and what that might look like. (Sooner than we expect, different than we might imagine, in his view.)

Excerpts of the conversation are below, lightly edited for clarity.

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Early in the pandemic, you repeatedly urged countries to try to contain the virus. Given that we have seen that it can be controlled, if countries get on top of the virus and stay on top of the virus, is it frustrating that some countries never really tried?

It’s still my strong belief that, despite the criticisms that governments get, that most governments have tried to do their best.

But it certainly didn’t help that in February, March, April there was an active downplaying of what that threat would represent. I wouldn’t say downplaying, but an overconfidence. This was just going to be one of those things. We’ve got it.

You can understand governments not trying to scare people. Fear-mongering is not functional. But finding the appropriate level of alert and concern and matching that with the appropriate level of response and then being able to adapt that quickly — no one gets it right first time around.

In the U.S., we haven’t gotten it right the second time around, or the third time around …

That’s all about cohesion.

I was asked [a few years ago] what are the three most important things about epidemic preparedness and response. I said governance, governance, and governance.

We’ve seen countries do lots of really laudable work in different areas, be it testing or contract tracing or the implementation of public health and social measures or the implementation of travel restrictions and lockdown/stay-at-home orders. Diagnostics — all of that. I think the missing magic dust in that was the cohesion, the integration. The pulling together of them into a comprehensive set of strategies. A national plan.

Collectively, if you give the globe a scorecard, then clearly there’s been a rigidity in some of the stuff we’ve done. There’s been maybe a lot of running down rabbit holes. The latest big thing, you know. The answer is this.

Now the question a year on is: Can we pull all of that together into a better, more cohesive strategy that will actually deliver what everyone wants, which is for this thing to end as a major public health crisis? People can get on with their lives. That’s where we need to be.

You’ll probably asked me next: Do you think we can eradicate or eliminate this thing?

That’s not a question I was planning to ask.

Thank you. I’ve been asked it so many times in last week. It’s the same in any journey, you know: Are we there yet?

There are certain things you need to achieve before you can even ask that question.

Get everyone to focus now on reducing the hospital admissions, reducing the deaths — and that’s both with the measures that are in place and the vaccines.

And then, when we get there, and the heat is taken out of this thing and the tragedy is taken out of this thing, then we can ask ourselves the question: Where do we go next? How far can we go with this?

Because if we have suppressed transmission to a great degree and the vaccines are rolling out and we get up to high levels of coverage and the concerning variants don’t take over, particularly in terms of vaccine efficacy, then we may be able to ask ourselves the question, “How far can we go to rid the world of this scourge?”

But we just may have to accept that this virus will just become another virus in the great pantheon of viruses.

Where do you think this is headed? What do you think coming out of this will look like?

The virus still has a huge amount of kinetic energy out there in society. And what we’ve learned is even when you take the kinetic energy out, there’s just a huge amount of potential energy left. And unless and until a huge proportion of the world’s population is immune to this virus, the potential energy in the virus will remain. It’s a fact.

What I see emerging ultimately is a Covid-19 control program, hopefully integrated into our influenza control program, so we have a much better way of dealing with respiratory viruses as ongoing threats. Because for me, respiratory viruses have shown again their potential to rip us asunder.

If we have to update coronavirus vaccines every year, if we have to give people a booster shot every year, particularly the vulnerable, then so be it. It’s just another control program. One where we’re in control. I think we have to evolve into that. But we’re not ready to go there yet.

I was asked the other day on Facebook: “When can we get back to our old lives, the old normal?” And I said: “I don’t want to go back there. It wasn’t a safe place — for our planet, or for social justice or for extremism or for human health. I want to go forward to something new that’s better. More sustainable. Fairer. More alert.’’

That’s the moment we’re in right now.

When do you think we’ll be in a place that’s more livable than where we are at the moment?

I don’t know. But if we can come out of the current waves and get to some more comprehensive sort of plan of keeping the virus suppressed, without going back into massive lockdowns and if we can protect the most vulnerable in our society from the severe consequences of this disease and include health care workers in that, if you can achieve those two things, then I think we can begin to think about how we achieve some level of normality.

So, do you think that’s within … a couple of years?

No, no, I think it’s shorter than that — if we’re smart and we do it right, and we can start to roll out vaccines much more quickly to those vulnerable groups. But it’s going to be months — months! — before we get there.

But if you can see a world where sometime over the second, third quarter of this year we get to the point where the most vulnerable are vaccinated and health workers are vaccinated all over the world and we have better control of the virus in our communities in terms of the measures we have in place, then the world can think about how we deal with it, because then you have different decisions you can make. It’s a risk-rewards matrix.

You just get the ability to make different decisions.

We buy ourselves more options?

Indeed. But for this year, the rest of this year at the very least, we’re just going to have to be very careful about social contact, regardless of vaccines and regardless of lockdowns.

But let’s imagine the glorious moment where we get all our vulnerable people vaccinated. And we’re rolling vaccines out into the general communities and people are still adhering to basic measures to protect themselves and others and doing that consistently, then we are in a different place. We’re in a control program, not a response program.

Do you believe people will continue to observe precautions? It feels like the whole thrust now is: Give me that vaccine, so I can go back to my spin class. Give me that vaccine so I can go to Cabo San Lucas for spring break.

To an extent that’s true. But people have suffered in terms of jobs, and people have lost the trajectory of their lives in terms of income or education. So there is a natural desire to get back to that.

The thing is convincing them that the fastest way back to that is actually to move from an emergency response to a much more comprehensive control program that will include sustaining personal behaviors into the future.

And that we’re going to have to be extremely wary — you see what Australia is doing — so that every time this virus rears its ugly head that you have the systems in place to go after it.

With all of that, put together with vaccination, we get our civilization back.

But if people think that we can exchange vaccines for personal behavior, and that getting the vaccine is the passport to spin class, I think they’re going to be sorely shocked when we sleepwalk our way back into the next surge, into the next wave, and then into the next lockdowns.

And that’s that will be my biggest fear. The optimist is telling me it can be avoided and the realist is telling me we’re not there yet, psychologically.

Let’s talk about vaccine distribution and equity. There is zero talk here about whether it’s ethical for the United States to vaccinate its entire population before health workers in less resource-rich countries can get vaccinated.

I think that conversation is starting to happen.

You do?

Yes, I do. I see evidence of it, not necessarily in the U.S. yet, but you can hear there’s nuance language there around that. Leaving aside the U.S., all governments who currently have access to vaccine are in a pickle.

There’s such an extreme limitation on supply it is very difficult for governments to turn around to their populations and say, “Hey we’re filling up a few planes and we’re sending them off.” That’s a tough message.

But India is sending vaccine to Bangladesh and to the Maldives, even though their population isn’t vaccinated yet. So, it can happen.

I think what we need, frankly, is citizens need to give their governments permission to begin to share. Because I think at the moment, politicians are understandably caught in a difficult position. Everyone is saying: “You’re not getting reelected unless you get me my vaccine.”

We want to see people vaccinated so the danger here is that it turns into a polemic argument. The argument isn’t that. The U.K., the U.S. are going to continue to roll the vaccine out to wider and wider age bands. And that’s a reality. And anyone who thinks that’s going to stop while everyone does “Kumbaya” and transfers all of the vaccines into some global pool — it’s not going to happen.

But what can happen is that as countries reach the point where they have vaccinated their most vulnerable and have vaccinated their health workers, that they can begin to share with others. They can go down a dual track — continue to expand their national vaccination campaigns, but at the same time, share a portion of the vaccines, so we can catch the other countries up in terms of vulnerable people.

Do you have any sense that that’s going to happen?

Well, I’m a hopeful person. You can’t do my job and not be optimistic. You wouldn’t last a week.

But if this just turns into a knife fight over vaccines, it’s not going to work. We have to find a civilized way.

  • “There is zero talk here about whether it’s ethical for the United States to vaccinate its entire population before health workers in less resource-rich countries can get vaccinated.”
    —————
    Which countries have more COVID related deaths than the US? Ethics here is irrelevant. Other countries don’t have the population mobility of the US(or the EU) and as a result have fewer overall infections and deaths.

    Besides countries in Europe or North America only India and Brazil have or had similar catastrophic infection numbers on their hands, and India is in the process of getting this under control with a self-sufficient approach. Most health workers in Brazil can easily be vaccinated with Chinese vaccines, as China has this pandemic under control within its territory and has a limited demand(surplus) of its own vaccines.

    The US needs to get its own pandemic under control before it starts sending vaccines to other countries. Besides – the Moderna and Pfizer/BioNTech vaccines are poorly suited for countries with limited infrastructure.

  • Mike Ryan has been a brilliant communicator from the start of the pandemic: he has a great ability to talk to the issues in lay person language. My only disagreement would be that there was one other thing missing from much of the global response -good public health communication from the authorities, even in countries that are wealthy and well equipped to deal with the pandemic. The UK for instance.

  • He was “strenuously urging the world to try to contain the new virus that was spreading in and from China” while at the same time, the WHO was telling everyone to keep flying on international flights and not close their borders.

    The WHO has been consistently incompetent at their pandemic response, from masks to international travel, to airborne microdroplets, and finally today, their absurd pantomime they call an “investigation” into the virus’ origin, without actually examining any physical evidence themselves. No hard drives, no physical samples, nothing but translated testimony.

    The WHO has not helped, but obstructed every scientific effort to deal with this pandemic, and Mike Ryan and Tedros should be put in front of the ICC as war criminals to answer for the millions dead.

  • What insightful, probably realistic , somewhat frightening, but knowledgeable, wise and hopeful comments. If public health officials and Governments will only read these comments and follow them.
    Thank you !!

  • Oh right. The same Dr. Ryan who said public health “officials” would take children out of homes where someone tested positive. That Dr. Ryan – he is just such a compassionate and caring doctor. Let’s hang on his every kind word.

  • This conversation is very helpful. I want to join the speaker on the optimism side, but am worried about what I keep seeing as too many who cannot seem to follow advice about what would protect more people…

  • I would like to think the fiduciary duty of a vaccine maker (Pfizer, Moderna, J&J) may encompass prioritize he health of all of its US stockholders. Thus shipping out their vaccines before all of their US stockholders could be grounds of class action lawsuit. There is nothing wrong with vaccine nationalism IMO. Any US politician advocating otherwise could be impeached at worst and not re-reelected at best!

    • The companies sell to governments or to the international pool run by the World Health Organization, Gavi and CEPI.
      What governments do with the vaccine doses they purchase is up to each government.

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