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2022 The Year Ahead: Endgame, Or Endemic? Whatever The New Year Brings, It Calls For A Shot

By: Kenneth Mohanty


Last Updated: January 01, 2022, 16:50 IST

Greater vaccine equity and antivirals that can be taken at home will be key to reining in the novel coronavirus as the pandemic enters its third year. (Reuters)

Greater vaccine equity and antivirals that can be taken at home will be key to reining in the novel coronavirus as the pandemic enters its third year. (Reuters)

Access to vaccines in poorer countries remains a concern even as experts say that waning immunity from shots means boosters will be crucial going forward

Wildfire may be an apt metaphor for this pandemic, in how Covid-19 has flared, and continues to flare, through countries. But if a gap in the undergrowth, the firebreak, is the recommended course of action to stop a forest fire in its tracks, bridging the gap — in vaccine access between the rich and poorer countries — is what the doctor has advised for the current outbreak. As the world ushers in its third new year in times of Covid-19, people and health experts are wiser and more wary at the same time about the tricky customer that is the novel coronavirus. Not that the virus has not evolved though, taking on multiple new avatars and, just when the world was finally gearing up to get out of pandemic mode, Omicron struck. But does its emergence signal the climax in the years-long Covid saga, one way or the other?

How Did The Spanish Flu Crisis End?

While India has been on the edge through most of the latter part of 2021 over fears of a third wave hitting the country, some countries have encountered and scrambled out of a fourth, even a fifth, wave of infections. The last comparable global health crisis, the Spanish Flu crisis of 1918, though had played out in three big waves that stretched through two years.

Caused by the H1N1 virus — it is argued that “it has never been completely eradicated" — the virus infected an estimated 500 million people, about a third of the global population at the time, and claimed more than 50 million lives. Of course, public health reporting then was not what it is today, so the true count of cases and deaths could have been higher. It can be argued though that neither do we have a true measure of the spread of the novel coronavirus with experts pointing out right since the pandemic’s beginning that the actual burden of cases is higher than that confirmed through tests, even if deaths have been harder to miss.


As the world enters 2022, there have been close to 290 million cases of Covid-19 that have killed nearly 5.5 million people. The Spanish Flu outbreak — there is debate over the nomenclature with historians suggesting that the disease actually arose elsewhere but was first reported in Spain, much like controversy over the naming of variants in the current pandemic — is estimated to have killed 17-18 million Indians while the toll from the novel coronavirus is under 5 lakh so far. Globally, with close to 35 million infections, India is second only to the US on case load.

“With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly." This description by the US Centres for Disease Control and Prevention (CDC) of the global experience with Spanish Flu could quite easily apply to how the world is dealing with the Covid pandemic. Though Covid-19 has seen scientists develop vaccines and therapies at unprecedented speeds, the gulf in access to vaccines between the rich and the not-so-rich countries is one of the aspects of this pandemic that has been noted with despair by health experts.

What’s The Status Of Covid-19 Vaccinations Globally?

The first vaccines against the novel coronavirus were rolled out at the end of 2020 and, at the end of 2021, more than 9 billion shots have been administered globally. However, the majority of the doses have gone to people in the richer countries, most of which are now already well into the process of handing out booster doses amid indications of the decline in protection offered by the jabs and the rise of ever new variants, the latest of which — Omicron — is seen as being more transmissible than the earlier avatars of the novel coronavirus.

India has authorised what PM Narendra Modi termed a “precaution dose" of a third Covid-19 shot while experts in Israel have recommended a fourth shot already, months after it became the first country to go for a third shot. All this has meant that use of the bulk of vaccines has been limited to a handful of countries. According to WHO, at the end of 2021, “globally about 20 per cent of Covid-19 vaccine doses, daily, are used for booster or additional dose vaccination", mainly in high- and upper-middle-income countries.

“If these doses had been distributed equitably, they would have been enough to cover all health workers and older people globally," it said. The global health agency, which had set a target for all countries to vaccinate 10 per cent of their populations by the end of September 2021, said that more than 50 countries — most of them in Africa — were unable to achieve that goal as they were “effectively excluded from the global vaccine marketplace". It warned that even more countries were poised to miss the target of vaccinating at least 40 per cent of their eligible populations by the end of 2021 and 70 per cent by the middle of next year.

WHO has noted that even if there is a decline in the protection offered by vaccines against mild or asymptomatic infection, the immunity conferred is still sufficient to prevent severe disease in the majority of people. Thus, WHO Director-General Tedros Adhanom Ghebreyesus called for a “moratorium on booster vaccination for healthy adults until the end of 2021 to counter the persisting and profound inequity in global vaccine access".

Even though most manufacturers have “largely spurned the opportunities to share technology and know-how and public health-oriented licensing" on vaccines, WHO notes that “there are enough doses of vaccines globally to drive down transmission and save many lives, if they go to the people who need them most around the world".

Monthly vaccine production globally now stands at nearly 1.5 billion doses — as the world’s largest vaccine maker, India is a vital cog in the supply chain — and, so, the lack of access is “not a supply problem; it’s an allocation problem", says WHO, adding that “worldwide access to Covid-19 vaccines offers the best hope for slowing the coronavirus pandemic, saving lives, and securing a global economic recovery".

Stressing on its message of nobody being safe unless and until everybody is safe, experts have pointed out that universal availability of vaccines would go a long way in guarding against the rise of new variants of concern like Omicron even as experts say that the world may have to eventually adjust to living with the virus as it goes endemic, imposing a need for yearly inoculations with updated versions of Covid-19 vaccines, much as it is in the case of the seasonal influenza.

Are New Variants Making The Virus Milder?

The shock among experts at the unprecedented number of mutations that they found the Omicron had taken on was accompanied by speculation that the newest WHO-designated variant of concern was likely to cause milder disease even if it was able to spread more easily among people. However, this assumption is moot because, as long as a large number of infections — and reinfections among those who have already recovered from a bout of Covid-19, or breakthrough infections in those who are vaccinated — is liable to occur, the chances of higher hospitalisations and deaths cannot be ruled out.

As Dr Maria Van Kerkhove, WHO’s technical lead on Covid-19 explains, “if we have more cases, more cases mean more hospitalisations, and if a healthcare system is overburdened, people will die because they won’t get the appropriate care that they need". So, even if Omicron causes milder infection — and Van Kerkhove said “initial reports… suggest that Omicron is less severe compared to Delta" — it is “really critical that… we still do everything that we can to reduce transmission in all populations, people who are vaccinated, as well as people who are not vaccinated".

While some researchers have expressed hope that Omicron would hasten the virus’s transition from pandemic to endemic, it is noted that it could still swell the number of hospitalisations and deaths. Thus, the best-case scenario, as summed up by Dr David Ho, a Columbia University professor, is for Omicron to work like “a rapid-fire" that burn through very quickly but then puts itself out. But the more common view is that Covid is eventually set to go endemic. It’s a view that was echoed by Microsoft founder Bill Gates who has said that “at some point next year, Covid-19 will become an endemic disease in most places".

Endemicity will mean that people will have to get used to living with the disease, coming to rely on regular vaccinations and antiviral treatments to ensure that outbreaks are less severe and localised. Gates pointed to the emergence of new antiviral Covid drugs as an important aid in keeping the disease in check.

Consultancy major McKinsey said in a report that the “clinical management of Covid-19 has come a long way since the early days of the pandemic" and that the “availability of effective monoclonal antibodies, dexamethasone, and other treatments and the use of non-pharmacological interventions… have meaningfully increased the chances of survival for those with access to high-quality healthcare". It said that, further, the development of antiviral pills like molnupiravir, which India, too, has cleared for use, underscores “a material advancement and increase the chance that the impact of the Omicron variant can be controlled".

“Oral therapeutics that significantly reduce the chance of progression to severe disease after symptom onset may enable a higher fraction of cases to be managed as outpatients. Such therapies are also easier to administer in lower-resourced regions than injected or infused treatments are," McKinsey said.

Thus, the direction Covid-19 takes in 2022 would depend on how fast and how widely vaccines — and perhaps eventually, booster doses — are distributed around the world and the development of antiviral therapies. And, with experts noting the “public fatigue" around the observance of safety protocols like masking, distancing and frequent hand-washing as the pandemic drags into its third year, the need for “finding the right combination of public-health measures will be critical" towards getting a firm grip going forward over the novel coronavirus.

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first published:January 01, 2022, 13:46 IST
last updated:January 01, 2022, 16:50 IST