Global Scaffolding vs. Omicron

Two years into the COVID pandemic, there are lessons that remain unlearned globally. The three most critical are: optimizing epidemiological surveillance systems, building coherent global vaccination systems, and advancing the scientific optimization of treatments and monitoring. While the first two are largely matters of political agreement, the third is a technical problem that could be resolved quickly.

Global epidemiological surveillance systems require a standardized methodology based on population density. This demands sequencing infrastructure and a minimum number of COVID tests proportional to each country's population. Getting this right will allow us to contain any future pathogen attack far more effectively. Had this been in place from the start of the crisis, the fourth wave would not be generating the panic it now is.

I recall bringing the Imperial College paper to the attention of policymakers at the time. It showed that we would be entering continuous lockdowns, a scenario that governments in many countries dismissed as exaggerated and unrealistic. We now see they were entirely right.

Second, global vaccination systems must be understood as a single integrated system, not a COVAX, which was a failure. What is needed is a system with clear economic incentives where countries contribute to securing their own and their region's vaccine production, while achieving common minimum vaccination levels. This would stabilize production through regionally controlled pricing. There is a persistent belief that a vaccine cartel promotes usage for revenue. Whether or not that cartel exists, vaccines are needed. It follows that global funding mechanisms for public health researchers and academics must be created at scale: a dedicated pool from which individuals can apply through digital platforms with the goal of containing pandemics.

On treatment optimization and monitoring: after two years, it is inexcusable that we have not developed more effective COVID detection technology. Sequencing and detection systems using cutting-edge approaches have not been deployed to produce faster tests with shorter sequencing cycles. We should by now have new tests targeting the three genetic sections of the virus, delivering PCR-quality results in 10 minutes. Portable systems capable of detecting the virus through exhalation. The fact that we do not reflects a failure to clearly identify the primary bottlenecks. The real issue with vaccines is not production but distribution, and how to optimize it. The same applies to testing: where and when to test, and how to optimize sanitary cordons.

Facing the next COVID variant, it is clear that we are still operating with the same rudimentary systems we used at the outset. Health systems are on high alert at the prospect of vaccine failure. The CEO of Moderna publicly stated that the new variant carries 9 changes that undermine vaccine efficacy, plus 11 additional mutations that together could require an entirely new vaccine.

If vaccines fail, we will face excess demand for medical care once again, piling further pressure onto already fragile health systems. We have not beaten the virus, and we still have no effective treatments. Merck announced that its treatment is 30% effective. Is that meaningfully different from a placebo?

Two decisive research funding initiatives are therefore required, beyond the laboratories and companies themselves: one targeting pathogen detection technologies using novel approaches, and another targeting potential treatments. All of this research must be accelerated through clinical trials conducted by a consortium of willing nations, with speed as the primary criterion. This mechanism could be operational within a month, with results within a year that could reshape how any global public health challenge is addressed.

Solving the immediate problem carries a further advantage: it lays the groundwork to demonstrate that parallel, state-sponsored problem-solving systems are viable. For now, private companies have been the most efficient actors in addressing the pandemic.

Let us hope that the Omicron variant proves to be merely more contagious, and not more lethal.

Frequently Asked Questions

What are the three unlearned lessons from the COVID pandemic?

The three critical unlearned lessons are: optimizing epidemiological surveillance with a standardized, population-density-based methodology; building a single integrated global vaccination system with clear economic incentives; and scientifically optimizing treatments and detection technology to enable faster, more accurate results.

Why was COVAX considered a failure?

The article argues COVAX failed because it lacked clear economic incentives for countries to invest in securing their own and their region's vaccine production. An effective system would require region-controlled pricing and binding minimum vaccination level commitments.

What COVID detection technology should have been developed by now?

The article calls for tests targeting the three genetic sections of the virus that deliver PCR-quality results in 10 minutes, and portable systems capable of detecting the virus through exhalation, neither of which has been developed despite two years of pandemic experience.