“The COVID-19 pandemic has directly or indirectly impacted all counties, independent of the actual virus toll. It has become clear how vulnerable we are to rapid spread of virus, given extensive global travel. However, no other human threat has resulted in such a strong concerted focus of biomedical research across the world, to provide testing capacity, new vaccines and treatment options,” said Ulf Gyllensten of the Department of Immunology, Genetics and Pathology, Uppsala University, Sweden. “The enormous resources used globally to understand and handle COVID-19 has made us better prepared for handling future similar threats. However, not all is good, and one of the most painful understandings is that despite research efforts and the development of powerful vaccines, many countries are struggling with a disbelief in science and government/authorities that has delayed the vaccination programme and will prolong the pandemic. An important part of our preparedness for further pandemics will have to be in education and information, if the benefits of science are to be fully realised.”
STIAS fellow Gyllensten is involved in a long-term collaboration with researchers at the University of Cape Town to model screening strategies for gynaecological cancers, in particular cervical cancer, for developed countries and low-resource settings, but for his seminar focused on the topic “we all have to relate to every day – COVID-19”.
“COVID-19 has introduced a new vocabulary and understanding of science,” he said, pointing to words like ‘PCR tests’, ‘COVID types’, ‘DNA sequencing’, ‘mRNA vaccines’, ‘vaccine breakthrough variants’ – terms used every day in the lab, some of which represent successful, Nobel-prize winning technologies, “which most people only heard for the first time in the last year, along with more negative terms like – ‘vaccine imperialism’, ‘vaccine colonialism’ and ‘anti-vaxxers’.”
“These have changed the way science is transferred to the public, hopefully resulting in a better understanding of the value of basic science,” he added.
He also pointed to the wide variation in interventions to curtail the spread of the virus. “My country Sweden positioned itself at one end of the spectrum by not implementing a formal lock-down.”
This strategy drew substantial international criticism. “It was described in media and other sources as the ‘world’s cautionary tale’, ‘a crackpot strategy’, ‘an experiment on the population’ and a ‘scandal’ but also received support, for example, in ‘Be like Sweden’ protests in Minnesota in the US. Speculation was rife about whether Sweden was doing this for economic reasons or in an optimistic belief of quickly achieving herd immunity.”
But Gyllensten explained the strategy was actually legally prescribed. The Swedish Constitution mandates freedom of movement and the independence of public agencies in the 23 regions.
“The government does not have the legal right to curtail personal freedom and can’t tell people to lockdown unless it changes the Constitution,” he explained.
Regional devolution of power also meant that the central government did not have the ability to enforce healthcare policies. The approach was therefore recommendations rather than hard-and-fast rules. These included voluntary physical distancing, minimal socialising, handwashing, self-isolating when sick, working from home, minimal travel, remote education, reductions in numbers at gatherings and distancing in visiting old-age homes.
Like in many countries, initial infections in Sweden were related to travel and mortality peaked in elderly populations in facilities and in immigrant populations. “There was no preparation for handling it, people didn’t isolate, there was very little PPE available. The death rate was high in particular in the elderly care homes, and in immigrant populations who also have many elderly and often live in multi-generational family settings.”
Although not enforced, there is evidence that the Swedes did abide by the recommendations – there was less travel and a decline in other seasonal viral infections – “Norovirus and sapovirus infections disappeared almost completed,” said Gyllensten, “also the 2019/20 flu season was much shorter with less cases probably due to physical distancing.”
“Interestingly, more recently we are seeing a very early and strong rise in Respiratory Syncytial virus or RSV – in a pandemic after-effect – probably due to people’s immune system becoming more naïve due to isolation.”
Circle of trust
Gyllensten ascribed some of this to high levels of interpersonal trust which is a feature of Swedish society. “Interpersonal trust is among the highest in the world in Sweden,” he said, “63% of the population say most people can be trusted, this is only 30% in the US. There is also strong trust in public institutions, accountability, honesty and the rule of law. People expect the government to deliver the proper response.”
A Corona Commission is presently examining the Swedish government’s handling of the pandemic and their second report was released at the end of October. This highlighted that the initial response was too slow and too little, that protection measures and infection control were insufficient, and the response unclear. Gyllensten hopes the final report will include more recommendations – especially around the centralisation of healthcare. “I’m hoping the pandemic has generated sufficient energy for change. This is one of the most-needed changes in order for our healthcare system to become more efficient, not only for future pandemics, but in general to be able to respond to future medical needs.”
So what have we learnt?
Turning to the broader question of what the world has learnt from the pandemic, Gyllensten highlighted technologies like the ability to track virus evolution in real-time – “an area in which South Africa is a global leader”. This means although variants are changing we can locate this and make decisions on testing and vaccine effectiveness. He also mentioned studies looking at COVID-19 in wastewater, “an inexpensive way to predict population surges in specific geographic areas”.
“We have also learnt how the virus works in the body. We can measure amounts of virus (viral titres) in individuals. Higher viral levels in infected people mean that the pandemic is on the rise. Looking at how viral amounts change is a novel monitoring tool allowing us to predict case peaks and be more prepared.”
He also pointed to the rapid surge in testing technologies (35 new laboratory tests, 161 FDA-approved viral RNA tests in three months and 45 COVID serology tests); new methods for vaccine development; and, increased stockpiling of PPE and test reagents, in preparation for future pandemics.
The discussion focused on the evidence predicting the pandemic; the lack of preparedness and action by many countries; the tendency by the developed world to turn a blind eye to ongoing epidemics and pandemics in developing countries; and, the likelihood of future pandemics.
“More pandemics are likely,” said Gyllensten. “There is more travel, more people, crowded cities, more contact with animals, and greater encroachment on natural areas. These offer fertile ground for pandemics. Health systems are better but not ready for this type of event. We need to build in more monitoring but even this may not be quick enough.”
“We have to consider new ways of thinking in how to develop and organise society.”
But none of this will help if we can’t tackle misinformation and build trust.
“There are frightening levels of misinformation circulating regarding COVID-19 and the new vaccines in most societies,” he said. “We need to understand how to transmit an understanding of science more effectively.”
“The pandemic has resulted in people taking on the tools of science more readily. There is new thinking by taking on the words and concepts. This is encouraging but now people need more understanding and trust in scientific achievements. Science has been incomprehensible for a large part of the population.”
“In Russia currently 1100 people a day are dying from COVID-19, but only 30% of the population is vaccinated – the vaccine is readily available and it’s not that they don’t trust the vaccine, they don’t trust the government. Science can provide the tools, but if we can’t build trust between governments, the science community and people we are in for a rocky ride.”
Michelle Galloway: Part-time media officer at STIAS
Photograph: Noloyiso Mtembu