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Welcome to Year 3 of the Age of Covid.

We’d hoped by now, with the country awash with vaccine doses, that the pandemic would have entered a different phase. We frankly thought that, after the stunning science that brought multiple SARS-CoV-2 vaccines into use around the globe in less than a year, countries with highly vaccinated populations might be heading toward a time when humans and SARS-2 could co-exist in a way that didn’t crash hospital systems and end lives.

But the dastardly virus keeps upping the ante. As Year 2 of the Age of Covid comes to a close, the global death toll has topped 5.3 million; in the United States, more than 800,000 people have died of the disease.

Covid’s ongoing rampage is having knock-on effects through health care delivery around the globe. Kids in lower-income countries — and some higher-income countries too — aren’t getting the vaccinations needed to fend off measles, rubella, and other serious illnesses. Preventative health care has been put off. These are things we’ll pay for down the road. 

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Given that the virus has defied predictions so many times, it may be foolhardy to try to foretell what lies ahead for us in 2022. But it’s a STAT tradition, and so look ahead we will. Here are three issues in the world of global health and infectious diseases that we think bear watching.

Whither Covid?

Will 2022 be the year Covid starts to settle down, to show signs of being more endemic, less pandemic? Some experts think so — especially if the Omicron variant infects huge swaths of people worldwide. 

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Vaccine doses, which have been disproportionately used in wealthy countries to this point, should start to be more widely used in lower-income countries in 2022. As more people acquire some immune defenses against SARS-2 — via vaccination or infection or both — hopefully this virus will pose less of a threat to us.

And then there’s the question about the Covid vaccines. Will they need to be updated to target the Omicron variant? That’s a bit of a crapshoot, given that it would likely take several months to update the messenger RNA vaccines and perhaps longer to change and produce mass quantities of some of the other products. Will Omicron still be the dominant virus by the time that work is done? Will a vaccine based on Omicron protect as well against future variants? 

There are tough questions ahead and no easy answers. We wish we had a more positive take to offer. 

Whither the World Health Organization?

The WHO has been in a challenging position for years. Its member countries have repeatedly refused to increase their assessed contributions — the dues they pay to sustain the global health agency. Those dues now make up a startlingly small portion of the WHO’s budget — 16%. The rest comes from voluntary contributions from wealthy countries and philanthropies. 

But much of that latter form of funding is earmarked, with the programmatic priorities of the donor dictating how it must be spent. This limits the agency’s ability to plan long-term and to hire; many staff work on month-to-month contracts. A number of programs, paradoxically including the health emergencies program that runs the WHO’s response to crises like the Covid pandemic, are perennially underfunded.  

Supporters of the WHO and the agency itself say the pandemic has led to a greater sense of urgency to crack the funding conundrum. A committee has been working on a proposal that will eventually make its way to the WHO’s annual meeting, the World Health Assembly, in May. It is recommending that the assessed contributions should be increased to make up half the agency’s funding. The change would be phased in gradually, starting in 2024.

“I think we do all have the sense that now is the moment,” Jane Ellison, WHO’s executive director for external relations and governance, said during a recent briefing on the effort.

The attempt to rework how WHO is funded is not the only move afoot to reform the agency. In late November, a special meeting of the World Health Assembly convened to debate establishing a new international agreement for pandemic preparedness. Some countries are pushing for a legally binding treaty; others are likely going to want to agree to something that falls short of that. There was general agreement to proceed, but figuring out how far the global community is willing to go will take time. 

The WHO has the powers and funding that it has because that’s what its member states have been willing to give it. Has the pandemic changed their views? We’ll know more in 2022.

All this appears set to proceed under the continued leadership of Director-General Tedros Adhanom Ghebreyesus, who is running uncontested for a second term in office. The World Health Assembly will vote on whether to give Tedros another five years at the WHO’s helm at the May meeting.

Whither vaccination rates?

In lower-income countries, the pandemic has had a devastating impact on efforts to deliver important disease-preventing vaccines to children. The WHO and UNICEF — the United Nations Children’s Fund — estimated that in 2020, 23 million children didn’t get essential vaccines; of them, 17 million may not have gotten a single shot. Making up that ground will be, at the very least, hugely challenging.

Missed vaccinations during the pandemic have also been a problem in the U.S. And here, another threat to the control of diseases through vaccination looms. 

There is evidence that the opposition to Covid-19 vaccine mandates, which has taken root largely in right-wing circles, is metastasizing to encompass requirements for other types of vaccinations — for school entry, or as a condition of employment, such as requiring hospital workers to be vaccinated against influenza.

If the deep-seated objections to Covid vaccine mandates — and the hesitancy to get vaccinated against Covid — spreads to other types of vaccine, the legacy of this pandemic will be even more damaging than is already apparent.

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