The world is seeing the effect of COVID-19 and multiple re-immergence in different variant forms around the globe. This has been met by unequal responses in many countries which has led to different outcomes and has impacted the populations in North America, Europe, Asia, Latin America, Africa and Australia . Because of the gravity of the situation, extraordinary progress was made to secure some vaccines inspite of short clinical trials. Pfizer-BioNTech, Oxford Astra Zeneca, Bharat Biotech Covaxin, Gamaleya Sputnik V, Sinovac, Johnson & Johnson are being used or will be used shortly for the mass vaccination programme. However, because of delay in the vaccination cover due to various reasons and the evolving SARS-COV-2 variants, instead of bringing the crisis to a close we might be witnessing a new phase of the pandemic.

Although, we are having good responses to the treatment of COVID-19 with a variety of pharmaceutical agents at our disposal and supportive measures, the burden of hope is still largely dependent on mass vaccination and creation of herd immunity. However, the problem here is unless a rapid vaccination scheme achieves a high population coverage and offer a reasonably long lasting protection, then it might not end the pandemic anytime soon.

Many goverments are faced with the behaviour of it’s citizens, where a large number of the population are fully aware and do understand that wearing face masks, maintaining social distancing and hand hygiene are very important to prevent the horizontal transmission of the virus, a significant number either do not understand the way the viral transmission occurs or ignore it entirely due to various reasons and undo the very process of the preventive actions. Added to this is the mutation and the formation of more SARS-COV-2 variants leading to rapid transmission and very likely less effectiveness of the vaccines in use.

There is always a risk that misinformation and disinformation along with vaccine hesitancy could compromise the global response if an international effort is not mounted simultaneously instead of many countries taking the nationalist approach to the vaccine delivery and immunisation programs. Although, we might not be able to eradicate it totally because of animal reservoirs including some domestic animals, non-optimal vaccine coverage and unpredictable degrees of immunological protection, but an containment can be assured globally if the correct epidemiological and public health strategies are formed and implemented

We also need to look at the potency of each type of vaccine available to us including it’s efficacy against the variants which are emerging in different parts of the world. There is a common belief that once vaccinated ,the person can not carry the virus and infect another person. This can happen through the viral shedding mechanism and especially if it is a variant. There is also theoretically a concern of viral escape as more and more mutants starts circulating among the population or animals. Some virologists are predicting that these mutants could be more virulent than the current one but there is no hard evidence yet. There is this pessimistic scenario, where these re-emerging variants will have the ability to escape vaccine immunity which might lead to high income countries to respond by rapidly manufacturing the adapted vaccines for multiple rounds of reimmunisation with the idea of achieving a national control while rest of the world struggles to achieve a similar parity following repeated onslaughts by the mutant waves and the current available vaccines not being sufficient in mounting an effective response against these circulating variants. This will lead to frequent outbreaks even in the high income countries and to achieve some degree of normality will not be possible.Therefore,unless a global strategy is adapted for all countries working in tandem to scale up preventive healthcare efforts,this will remain a constant threat to re-emerge again even in places where it been satisfactorily contained.

A panel of global experts, like that of the interim COVID-19 working group of the International Science Council(ISC) in conjunction with the WHO and the UN should deal with this pandemic in a robust fashion with all the options it has at at it’s disposal in a global manner ,if we were to contain this virus and it’s variant in good time. This would also carry a message of optism to all countries fighting this deadly virus.

-Prof(Dr), Dilip Mahapatra

-Clinical Director, Lugh Medical Centre, College Height’s, Dundalk, Co.Louth, Ireland .