How the world can end Covid-19 as a public health threat

The journal Nature published today global consensus recommendations to end Covid-19 as a public health threat. It took a panel of almost 400 independent-thinking scientists, doctors, and representatives of community groups from more than 100 countries (we were among the co-chairs) some 14 months to develop and agree on these recommendations.

There have been times when we wondered if it was worth the effort.

After all, it seems like most of the world’s political leaders are already rushing to declare victory over Covid-19. Countless groups of experts, most recently a quartet of former Biden advisors, and a legion of TikTok influencers are coming up with endless variations on the same theme.

Look around nearly everywhere in the world. It is hard to see evidence of basic risk mitigation, like wearing a face mask in crowded indoor places. Interest in getting vaccinated has run into a wall of resistance. Fewer people are accepting booster shots, and fewer still are choosing to vaccinate their children.

So why bother to assemble a global panel and then run ourselves through the rigorous hoops of the Delphi method (a process developed in the 1950s to create agreement on military threats) to come up with still more recommendations on a topic that most people seem inclined simply to wish away?

We did it because we believe that if a large, diverse group of experts who have spent the last three years of their lives trying to understand and control a virus that, in its multiple mutations, has infected far more than the reported 625 million global citizens and, according to the Institute for Health Metrics and Evaluation, has cut short some 20 million lives, could agree on some basic steps to end Covid-19, then perhaps we could convince leaders who can effect change to act on them.

If there is one key message in the consensus recommendations, it is that building global consensus may be the most important step of all, not just to end Covid-19 but to address similar challenges in the future.

The panel unanimously recommended that ending Covid requires the engagement of the “whole of society” in the process. This means all nations, private and public sectors, all professions and trades, all races and religions, and more. No one can be left out — or left behind — when everyone is at risk.

The panel also unanimously agreed that national governments need to avoid silos of responsibility for managing Covid-19 and adopt a “whole of government” approach to understanding and addressing it.

The panel stressed that although Covid-19 vaccines are an essential factor in controlling the disease, they will not win the day by themselves. Testing and wearing masks, along with financial support measures, are also of great importance. And the buildings where people work, shop, study, pray, and entertain crowds must be better ventilated.

Better vaccines are still needed, so they can lower transmission as well as prevent hospitalizations and deaths. And the world needs a more equitable way of distributing vaccines and other life-saving medical resources.

Another unanimous agreement: Communications about Covid-19 have been ineffective from the start. To end a pandemic, information about the disease, its transmission, prevention, and treatment must be clear. To do this, health education messages must be tested for accuracy and impact. Spokespersons must be trained and culturally sensitive. Community leaders must be identified, and communities everywhere must be engaged.

The consensus panel highlighted that the aftereffects of Covid-19 must not be neglected. The debilitating symptomology of long Covid requires systematic attention, and those who suffer its symptoms must not be stigmatized.

And world leaders and multilateral organizations must be held truly accountable for coordinating the response.

The Independent Panel for Pandemic Preparedness and Response, which was appointed by the World Health Organization, issued a report in May 2021 stating that, “Current institutions, public and private, failed to protect people from a devastating pandemic.” That group warned that, without change, these institutions will not be able to prevent a future pandemic.

The consensus recommendations made by the Nature panel offer decisionmakers a roadmap to achieve the change required to end the pandemic as public health threat. But if the world’s nations cannot cede real authority and resources for pandemic control to the World Health Organization and other multilateral organizations, the wheel spinning on Covid-19 could go into an uncontrolled skid.

Jeffrey V. Lazarus is co-director of the Viral and Bacterial Infections Programme at the Barcelona Institute for Global Health and lead chair of the Covid-19 Consensus Statement published in Nature. Adeeba Kamarulzaman is an infectious disease physician; former dean of the faculty of medicine and professor of medicine and infectious diseases at the University of Malaya in Kuala Lumpur, Malaysia; and co-chair of the World Health Organization’s Science Council. Agnes Binagwaho is a pediatrician, vice chancellor of the University of Global Health Equity, the former Minister of Health for Rwanda, and a senior adviser to the Director General of the World Health Organization.