The world has passed another grim milestone in the course of the COVID-19 pandemic, with total deaths from COVID-19 infections in 2021 surpassing the total in 2020.
This pandemic is still out of control in many places around the world — 65 percent of COVID-19 deaths in the middle of June were in India, Brazil, Colombia and Argentina. New variants continue to emerge with the potential of evading the protection offered by the hard-won advances of the past six months.
There are many lessons we have learned — and have yet to learn — from the COVID-19 pandemic. Science can have a transformative power when it is unleashed, but it requires sufficient funding. Yet even then, a scientific breakthrough is not enough. The power of science and the tools it produces must be made available to all on an equitable basis if we are to truly benefit from them.
The fact that COVID-19, which did not exist less than two years ago, now has a host of safe and effective vaccine options is nothing short of stunning. Fortunately, the dire potential of a COVID-19 pandemic was recognized and the needed support to fund the development of potent vaccines materialized — to the tune of $10.5 billion from the U.S. alone — and the resulting scientific breakthroughs have happened. But what we are now witnessing is the need not only for scientific advances but also the limitations to their utility if not accompanied by equal advances in the areas of global, equitable access and social justice.
We live in a highly interconnected world that depends on transnational exchange. The spirit of global collaboration that has brought about many of the scientific tools that could diagnose, treat and prevent COVID-19 are a testament to that fact. However, the benefits of this interconnectivity can only be fully realized if the fruits of scientific progress are made available regardless of geography and social class.
Unfortunately, these are not new lessons. As witnessed many times in the past, when the crisis du jour is overcome, the lessons learned are either quickly forgotten or ignored. Our history of responding to previous disease outbreaks offers helpful context for our current moment.
For example, we saw great urgency in 2014 and 2015 when the Ebola virus ravaged West Africa. Experimental vaccines had already been developed for Ebola but funding for the final stages of clinical testing had not been available for more than a decade. However, once a dozen or so cases — out of a total of over 26,000 — were treated outside of the West African region, most countries in North America and Europe went on high alert, the clinical trial process was fast-tracked, and a vaccine was approved for experimental use that arguably helped quell the outbreak. Unfortunately, in the halls of government, especially in high-income countries, pandemic preparedness for future pandemics was shelved fairly quickly.
Looking at the longstanding tuberculosis (TB) pandemic, with mortality numbers much closer to COVID-19 than Ebola (TB kills about 1.5 million people annually), the sense of urgency is difficult to find. TB is an ancient disease that most typically attacks the lungs and is transmitted person-to-person through the air, similar to COVID-19. It has not been consigned to the dustheap of the Victorian-era as many in high-income countries may assume. In fact, TB had been the deadliest global infectious disease prior to COVID-19, and unfortunately will most likely retake that grim mantle when — hopefully — COVID-19 vaccination efforts are globally successful.
The armamentarium for preventing TB includes only a single, minimally effective, century-old vaccine. Only four medicines to treat TB infections, including one developed by my organization, have been approved by stringent regulatory authorities in the last 40 years even as deadly, drug-resistant strains of the disease infect half a million people annually.. In comparison, we have had four Emergency Use Authorizations from the U.S. Food and Drug Administration for COVID-19 therapy in less than a year.
As Winston Churchill rephrased George Santayana’s thought, “those who fail to learn from history are condemned to repeat it.” We must not only learn from the ongoing COVID-19 tragedy to prevent future pandemics, but also to effectively attack those that are rampant across the globe today.
Mel Spigelman, MD, is the president and CEO of TB Alliance, a nonprofit organization dedicated to the discovery, development and delivery of better, faster-acting and affordable tuberculosis drugs.