What will COVID-19 look like in 2022?

It is tempting to think the worst of the pandemic is behind but the virus is still evolving and the future of COVID-19 is not clear cut. Here two of Gavi’s experts Dr Lee Hampton, medical epidemiologist, and Dr Gustavo Correa, Senior Manager for Data Systems and Information, discuss what we might expect over the coming year.

  • 21 February 2022
  • 8 min read
  • by Priya Joi
Person wearing mask using mobile phone searching airline flight status and sit social distancing chair in airport
Person wearing mask using mobile phone searching airline flight status and sit social distancing chair in airport

 

1. Restrictions

The early days of the pandemic brought restrictions on public life that most of us had never experienced before, with people not allowed to leave their homes except for essential purposes. Schools, workplaces, restaurants and shops shut. Until Omicron, these restrictive lockdowns seemed like they might become a distant memory. But then the surge of cases that happened when the new variant emerged in late 2021 plunged countries such as the Netherlands, parts of China and Hong Kong as well as Canada back into lockdown. Could we see more lockdowns and widespread restrictions over the rest of the year?

The thing to remember is that COVID-19 could become more virulent but so could other airbone viruses.

Dr Gustavo Correa expects that “It is hard to foresee what will happen with the pandemic, but I don`t see a scenario where we have a widespread lockdown such as the one in the initial COVID-19 wave. We have learned a lot on what works and what doesn`t work, and the costs and benefits of lockdowns. We have vaccines, masks, treatments and other tools to better respond to the pandemic. However, I think it is still likely we will see some localised and balanced responses to increasing cases, hospitalisations and deaths.”

Dr Lee Hampton adds that, “If we get another variant that causes more mortality than Omicron, then I think we'll see more restrictions put back in place. The world has learnt a lot over the last two years about the costs and benefits of interventions for preventing the spread of respiratory viruses, so it seems unlikely we will see school closures happening unless in extreme circumstances.”

2. Masks

Mask-wearing has become uneven across the globe, with some countries not requiring masks anywhere, and others still requiring them in most settings. Dr Correa explains: “In this pandemic we have learned a lot about mask usage at the community level, and how well it worked. It has been very important to control transmission of COVID-19. We have also learned that the mask is particularly helpful when the virus is widely circulating, in closed spaces or when people cannot maintain safe physical distancing. In the future, I expect this will be often used as a public health tool to control outbreaks of airborne diseases, and that may include COVID-19, flu or any other emerging dangerous diseases.”

3. Vaccines

Most experts think that we will need to have COVID-19 vaccines for the next few years, but whether they will be given on an annual basis the way that we do for flu, where scientists predict what vaccine composition is needed, is unclear.

“The system for producing the flu virus doesn’t work incredibly well," points out Hampton, adding that a universal COVID-19 vaccine would be far more useful. It would make a lot of sense to try to move ahead with developing and testing various adapted COVID-19 vaccines.

Correa agrees that aiming for vaccines that can better reduce severe disease will be beneficial at avoiding future outbreaks with high rates of hospitalisation and deaths. “We need to have a system in place as to how the vaccine is working, and also target rollout to the most vulnerable groups. But different countries will need different strategies.”

There have been concerns that new variants might contain mutations that allow them to evade vaccines, and indeed existing vaccines don't perform as well in preventing Omicron compared with Delta, for example. What does this mean for future vaccine development?

Dr Correa says: “Preventing hospitalisation and death rather than transmission should be the goal. We also need to understand better what types of vaccines can boost a better response from memory immune cells (as these help prevent severe disease and guard against reinfection) rather than just antibody production.”

Dr Hampton adds that “it would be ideal if, in future, vaccines could potentially be targeting multiple antigens on the virus, not just the spike protein. But we have to be realistic about what we can expect from future COVID-19 vaccines.” The reason, Lee explains, is that “it’s significant that the virus is quite capable of reinfecting people who have natural immunity. And vaccines are about teaching our immune system how to respond to pathogens that they haven't seen before. It’s difficult to have a vaccine that gets the immune system to function better than it does on its own because our immune systems are enormously sophisticated.”

The push to get people vaccinated has not happened equitably despite the COVAX Facility making strides in vaccinating those in low- and middle-income countries, so if we continue to need vaccines against COVID-19, will the most vulnerable have access to them?

“What happens going forward depends a lot on the virus,” says Dr Hampton. “If it turns out that we get severe variants that can cause a lot of mortality, then trying to continue to build on current vaccination efforts and vaccinate new adults on a regular basis against COVID-19 makes a lot of sense. If on the other hand, the virus evolves in a direction where it causes less and less mortality over time, and starts looking more like other coronaviruses that are in circulation, then it may make more sense to focus on other diseases that cause more morbidity and mortality.”

Dr Correa adds, “I expect COVID-19 to becoming a more kind of a routine vaccine that is embedded in adult vaccination programmes. However, vaccine equity has to be seen in the context of the epidemiological needs of each country. Countries can then rationally think about their priorities with the resources they have and reprioritise according to the cases and deaths caused by different diseases. In addition, many low- and middle-income countries are not yet fully prepared for adult vaccination strategies being part of routine immunisation, so we need to increase their resiliency, capacity in terms of number of vaccinators and have better systems in place as currently they are operating in emergency mode, and that's not ideal.”

4. Endemic vs. pandemic

Many people are treating COVID-19 as if it is already endemic, when it is not quite yet, and as Dr Hampton says “people are using the term 'endemic' as a shorthand for “When can I stop worrying about this disease?”

But in practice, he says, “We’re not going to be able to stop worrying about it, because even if it gets the point where it’s not much of a threat for the vast majority of the population, we’ve got ample indications that for people who are immunocompromised this virus is dangerous.”

Gus agrees and says that people are getting too hung up on a definition when in fact “we need to go beyond that and say what we need to do to ensure that we are safe with the resources that we have, and what is an acceptable risk. That’s a hard decision to be made.”

5. New variants

Because Omicron seems to cause less severe disease than previous variants (although vaccines also curb severe disease), there is an assumption in some media reports that SARS-CoV-2 is becoming a milder virus. But how the virus evolves next is a “multi-billion dollar question”, says Dr Hampton.  

The thing to remember is that COVID-19 could become more virulent, but so could other airbone viruses, says Dr Correa. “We know that the SARS-CoV-2 virus is going to become endemic, but it’s hard to say whether it will have a seasonal pattern and if that seasonality is going to be stable, or if there will be outbreaks every now and then because of these new variants.”

6. Pandemic preparedness

The COVID-19 pandemic has raised a lot of questions about why scientists’ warnings about ensuring adequate pandemic preparedness were ignored by governments and donors. It has also brought new analyses of what we might do better in the future.

“This pandemic has shown a lot about what the world can get right and get wrong in terms of responding to new diseases,” says Dr Hampton. “I hope that while it’s still fresh in people’s minds, that there is a real effort to get ready for the next pandemic and also more broadly to think about how to deal with infectious diseases in general. It’s easy for people to not have to worry about these things when they’re not in their daily lives.”

Dr Correa concludes, “We should not be complacent, but we should not panic at the same time. We need to keep working together and addressing these issues as a global community, because we are all in it together.”