The arrival of several vaccines against the coronavirus is cause for celebration in the face of a pandemic that has killed millions across the globe, but health officials and experts are warning that wholly eradicating the virus is not likely an achievable goal.
Instead, the SARS-CoV-2 virus and the disease it causes, COVID-19, are likely here to stay, a new and perpetual threat to human health that hums in the background of our everyday lives.
“This virus may become just another endemic virus in our communities, and this virus may never go away,” Mike Ryan, director of the World Health Organization’s emergencies program, said in May, just months after the pandemic began. “I think it is important that we be realistic, and I don’t think anyone can predict when or if this disease will disappear.”
More than 106 million people across the world have tested positive for the coronavirus, according to data from the Johns Hopkins University Center for Systems Science and Engineering, including 27 million in the United States. More than 2.3 million people across the world, and nearly half a million in the U.S., have died.
Even the vaccines, which have shown a tremendous degree of efficacy against the virus, are not likely to result in its erasure. The vaccines will save millions of lives as they become more widespread, but there will always be some people who either lack access to or refuse to accept shots.
New mutations that have emerged in Britain, South Africa and Brazil have showed evidence that the virus can adapt to even the best defenses. South Africa over the weekend paused the rollout of one vaccine, created by AstraZeneca, after a study showed it was less effective in preventing mild or moderate symptoms.
Those mutations raise the prospect that some form of the coronavirus may emerge that can evade existing vaccines. Appearing on NBC’s “Meet The Press” on Sunday, Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said scientists are already working to adapt the existing vaccines.
“If [the new strains] do become dominant we may need to upgrade the vaccine. That’s exactly the direction we’re going right now,” Fauci said.
But the unchecked spread of the virus has given it virtually limitless potential to morph into something new, and evolutionary pressures give it the incentive to adapt itself.
“We surely will be living with this virus in different forms perhaps for a long time to come,” said Peggy Hamburg, chairwoman of the board of the American Association for the Advancement of Science and a former commissioner of the Food and Drug Administration.
The likelihood that the virus will never truly go away is putting renewed focus on treatments for the disease, development of which has lagged behind the vaccines. Physicians treat some patients who become very ill with corticosteroids, or with the antiviral drug remdesivir. Virtually every patient admitted to the hospital is given blood thinners to prevent clots.
But developing more and better treatments has become a key priority for the pharmaceutical industry.
“Eradicating a disease like this is not the right goal. Controlling it and becoming better at treating it is far more doable, and worth the cost,” said Abraar Karan, a public health expert at Harvard Medical School and Brigham & Women’s Hospital in Boston. “Many diseases run into issues around true eradication and it doesn’t end up making sense to try and completely stop them because it often becomes exceedingly unlikely.”
Some experts said the annual development of an influenza vaccine — which scientists base on observations about which strain is likely to become dominant in a given year — represents a likely blueprint for the future of COVID-19.
“As our population gains immunity, and if we get into a cycle of annual vaccination like flu, based on the circulating strains in the global south and what ends circulation in March the virus season prior, it will really only be kids and immunosuppressed [people] that are at higher risk,” said Christine Petersen, an epidemiologist at the University of Iowa. “We will probably get some better, more targeted antivirals too to then help these groups have better outcomes if they do get sick.”
Non-pharmacological interventions — social distancing and mask use, in particular — have already saved millions of people from infection, both from the coronavirus and from other transmissible diseases. The number of confirmed influenza cases reported in the United States this year is a sliver of what is typical for a given period; in the last week, just 25 people in the entire United States tested positive for a flu virus, according to weekly data compiled by the Centers for Disease Control and Prevention.
Public health experts said even if the coronavirus becomes a regular threat to human health, Americans should continue taking every possible measure to protect themselves.
“The more we can control and limit the spread now, the better off we’ll be going forward,” Hamburg said.