As COVID-19 Ends, COVID-21 Begins

In the end, Haseltine said, we might hope for a universal vaccine that protects against all strains of SARS-CoV-2, as well as future coronaviruses that might emerge. Early research has shown some promise using nanoparticle immunization technology, which combines fragments of different viruses. Fauci and others have been pursuing a universal influenza vaccine for years, and they are now, at last, seeing some indications of success. A universal coronavirus vaccine should theoretically present fewer obstacles, because the viral structure is more straightforward, and it changes less readily. As the race to develop the current generation of COVID-19 vaccines finishes, the race for a universal vaccine begins.

Between Gandhi’s vision and Haseltine’s is another, quite disturbing, one. Imagine that the vaccines work well, but not indefinitely. The virus continues to spread and mutate. COVID can still have severe, even life-threatening, effects. Vaccination brings rates of serious disease and death down substantially, but not close to zero. And we come to think of this as pretty much okay.

In other words, imagine a world in which the disease persists, and is accepted, as something that is far less deadly than it was last year—more like a bad flu than a common cold. As with influenza, the world might lose hundreds of thousands of people to this illness each year. And yet we would come to see its toll as being within the bounds of acceptable loss. As with diseases like malaria, HIV, influenza, and so many others, enormous effort and resources would go into preventing infections and treating sick people. But the singular global war against the SARS-CoV-2 virus that began in 2020 would fade in intensity. Instead of working toward a post-COVID future, we’d come to see the disease as yet another unfortunate but inevitable feature of the modern world.

This version of COVID-21 would be most dangerous, not because the virus has developed some new, sinister mutation, and not because our vaccines turn out to be inadequate. The risk instead would come from the way that it’s normalized. As the bioethicist Jackie Scully wrote in 2004, diseases morph “partly as a result of increasing expectations of health [and] partly due to changes in diagnostic ability, but mostly for a mixture of social and economic reasons.” They change with how we perceive them, and react to them.

We are at an inflection point that will change the reality of this disease. The most insidious future is one in which we fail to change our moral benchmarks, and end up measuring the danger of COVID-21 by the standards of 2020. If wealthy countries with early access to vaccines abandon continued, global coronavirus-vaccination efforts as their cases fall or when the disease becomes milder for them, a still-severe disease could haunt the world indefinitely—and lead to rebounds everywhere.

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