Offline: Complacency threatens progress against COVID-19

Abstract

Hans Kluge, WHO's Regional Director for Europe, has been reported as saying that European nations could soon be entering a “long period of tranquillity” as the pandemic abates. Pointing out that mortality from COVID-19 seemed to be plateauing, he suggested the continent was approaching a “plausible endgame” and an “enduring peace”. As WHO's chief spokesperson for the 53 countries that make up his regional responsibility, Kluge was no doubt seeking to strike an optimistic and encouraging note. But it is disappointing that he took such a narrow geographical perspective about a global pandemic. His words promote a false reassurance that could breed complacency, even conceit. Omicron has spread across Europe from west to east, with countries on the eastern reaches of the continent still experiencing increased transmission. The Institute for Health Metrics and Evaluation (IHME) predicts that half the population of Europe will have been infected by March 1. Infections are estimated to be a staggering 10 million per day. R is greater than 1 in at least 24 countries in the region. Hospitalisations and deaths are still increasing in some areas. With over 5000 deaths each day, COVID-19 remains the second largest killer after ischaemic heart disease. Health systems will experience particular pressure in the next few weeks, not least because of shortages of health workers. Daily hospitalisations will peak at 1·1 million in early February. In the coming weeks, IHME predicts that 45 countries will endure high or extreme stress on their intensive care facilities. 174 000 additional deaths from COVID-19 are predicted between Jan 31 and June 1. This period cannot be defined as tranquil. Although the aftermath of the omicron wave will most likely usher in a relatively quiet spring and summer, IHME predicts that “COVID-19 will return”. Waning immunity and an approaching winter will create conditions for a further surge of infections later in 2022. There is no immediate endgame in sight. The available data point to a much more uncertain future. Indeed, the vaccination status of Kluge's member states reveals a sharply divided continent. Western European nations have achieved relatively high levels of vaccination. 22 countries have double vaccinated over two-thirds of their populations. But as one looks eastwards, the picture is far more bleak. 19 countries have vaccinated fewer than half of their citizens. Rather than celebrating an “enduring peace”, Kluge should be urging countries to be vigilant for new (and old) SARS-CoV-2 variants, build stronger surveillance capacities, address vaccine hesitancy, expand access to antivirals, maintain clear public health messaging about protecting those most vulnerable to the virus, and be wary of animal reservoirs that could reseed human populations with the virus. Europe is not an island. The continent exists amid an evolving global pandemic. R is greater than 1 in 71 countries. Estimated infections still stand at more than 40 million per day. Hospitalisations are around 1·9 million per day. Deaths have increased to over 17 000 per day. COVID-19 is the third largest cause of death worldwide, after heart disease and stroke. IHME predicts that 754 000 deaths from COVID-19 are expected between Jan 31 and June 1. And a huge question mark hangs over China, where the omicron surge has yet to hit. Amid these daunting statistics, new evidence is accruing about the lessons we can learn from this pandemic—lessons that should be embraced more assiduously by global health leaders. Perhaps the most striking finding came recently from the COVID-19 National Preparedness Collaborators. They found that the measures of pandemic preparedness we have relied on in the past do not explain variations in infection fatality between countries. What has been missing from understanding why some countries performed better than others was political context. Countries with low levels of trust in government suffered more. It is this political context that WHO's leaders shrink from underlining. It is far easier to point to technical weaknesses in national and global responses. But WHO should also be more vocal in holding political leaders accountable for the fractured trust their regimes have fostered. A lack of honesty in the assessments of pandemic responses by global health leaders indicates that these lessons have not been learned. And while WHO continues to avoid these inconvenient truths, the world's peoples remain at risk from political ineptitude and dysfunctional governance.