Defeating death from COVID: Here’s a comprehensive strategy

In its first nine months in office, the Biden administration has made impressive and significant progress regarding the nation’s COVID-19 crisis. With bipartisan congressional support, it has passed another economic relief measure; encouraged and in some cases mandated vaccinations; tracked the spread of the Delta variant and encouraged safe practices, including a necessary if unpalatable return to mask wearing in many settings; authorized booster shots for some parts of the population; and made pledges of money, as well as actual vaccines, to developing countries.

All of this is welcome — but only a good start. We are still not taking COVID-19 seriously enough as a country, or broader international community. This virus is potent, adaptable and dangerous. U.S. COVID death rates of 1,500 or more a day, even if gradually declining now, should be far fewer — and we should aim to have them approach zero within a year. On the current path, by contrast, things could stay bad or even get worse, as they have in several Eastern European countries. 

Now is the moment to act. The politics of COVID will not allow the Biden administration much time for necessary course correction. At this point, the major remedial and additional measures we recommend can be presented not as an acknowledgement of failure but as a necessary package, given the severity of the Delta variant and the unwillingness of many Americans to be vaccinated this year. In addition, the growing availability of vaccines, and the formal safety approvals for booster shots, as well as immunization of the young, create policy opportunities that were not available before. 

But if the Biden administration does not act soon, it will have squandered this crucial moment — and the next mutation of the coronavirus could make us all wonder why we did not seize the opportunity to attack the virus across multiple fronts when we had the chance. 

As one of us (Haseltine) has outlined in a new paper, a new and expanded strategy against COVID-19 is required along four main lines of effort. Packaged into legislation, they might have a combined annual cost in the general range of $10 billion a year for the next few years — a fraction of the trillions of dollars that this virus has cost the nation and the world in suppressed economic activity and lives lost:

Improve and expand vaccines. The current generation of vaccines against COVID using recombinant RNA technology is remarkable. But we still do not have enough vaccine in the manufacturing pipeline — and we should be aiming to develop better vaccines against a virus that seems likely to become endemic in the population for years to come. The current vaccines lose effectiveness after a number of months, meaning that all who can should get boosters. Existing vaccines also fail to prevent those who are vaccinated, but nonetheless infected, from being contagious. We need to understand this virus better and should resource a concerted research effort. We also need more vaccine production capacity at home and abroad, subsidized by the government if need be.

Better antivirals. Antivirals are a needed complement to vaccines. But the current antivirals in late-stage development target only two areas of the virus: the polymerase and the protease. This echoes the initial situation for our last great pandemic, HIV/AIDS. We learned then that such a narrow view is not enough. We should take full advantage of the numerous drug targets — more than 16 by our estimation — that could lead to new types of antiviral drugs. These drugs can and should be given to those who contract the disease (whether vaccinated or not) and to those at particular risk of contracting it because of exposure to contagious individuals or weakened immune systems. Again, research is necessary — we need antivirals that are safe, cheap and, ideally, in pill form.

Reinvigorated public health measures. While social distancing and indoor mask wearing are important, we need to recommit to ideas that were popular last year in the United States — and that have proved effective in China and some other countries — but that have waned here of late. In particular, beyond much more testing, we need to build that army of 100,000 contact-tracers that once was envisioned (though with luck, the size of that public health force can decline in 2022 or 2023, as progress is made), and to increase financial incentives for self-isolation. It may be possible eventually to replace the two-week isolation for those exposed with prophylactic antivirals.

A global strategy. For all the welcome U.S. donations to the COVAX fund, and promises to share vaccines, the Biden administration and other donors have only mapped out a plan to provide about half the 20 billion or so doses of vaccine that will be needed to inoculate the world. Developing countries must do better at building their own manufacturing capacity, but for now, there is little substitute for an expanded Western effort on this front.  China’s and India’s vaccines can help some but are not nearly as good as the Pfizer and Moderna shots.

Given the course we are on now, America likely will hit the terrible figure of 1 million COVID deaths — more fatalities than this nation has suffered in all its wars combined since the Revolution — sometime in 2022. It need not be that way.

William Haseltine is the president and chair of Access Health International. Michael O’Hanlon is a senior fellow at the Brookings Institution, where Haseltine is also a trustee.