Essay: A Strategy for the Long Fight Against COVID-19

The Forever Virus Global herd immunity is now unreachable. How should governments' strategy in the fight against COVID-19 change in response? Foreign Affairs

It is time to say it out loud: the virus behind the COVID-19 pandemic is not going away. SARS-CoV-2 cannot be eradicated, since it is already growing in more than a dozen different animal species. Among humans, global herd immunity, once promoted as a singular solution, is unreachable.

Most countries simply don’t have enough vaccines to go around, and even in the lucky few with an ample supply, too many people are refusing to get the shot. As a result, the world will not reach the point where enough people are immune to stop the virus’s spread before the emergence of dangerous variants—ones that are more transmissible, vaccine resistant, and even able to evade current diagnostic tests. Such supervariants could bring the world back to square one. It might be 2020 all over again.

Rather than die out, the virus will likely ping-pong back and forth across the globe for years to come. Some of yesterday’s success stories are now vulnerable to serious outbreaks. Many of these are places that kept the pandemic at bay through tight border controls and excellent testing, tracing, and isolation but have been unable to acquire good vaccines. Witness Taiwan and Vietnam, which experienced impressively few deaths until May 2021, when, owing to a lack of vaccination, they faced a reversal of fortune. But even countries that have vaccinated large proportions of their populations will be vulnerable to outbreaks caused by certain variants. That is what appears to have happened in several hot spots in Chile, Mongolia, the Seychelles, and the United Kingdom.

The virus is here to stay. The question is, What do we need to do to ensure that we are, too?

Conquering a pandemic is not only about money and resources; it is also about ideas and strategy. In 1854, at a time when germ theory had yet to take hold, the physician John Snow stopped a cholera epidemic in London by tracing its source to an infected well; after he persuaded community leaders to remove the handle from the well’s pump, the outbreak ended.

In the 1970s, smallpox was rampant in Africa and India. The epidemiologist William Foege, working in a hospital in Nigeria, recognized that the small amount of vaccine he had been allocated was not enough to inoculate everyone. So he pioneered a new way of using vaccines, focusing not on volunteers or the well-connected but on the people most at risk of getting the disease next. By the end of the decade, thanks to this strategy—first called “surveillance and containment” and later “ring vaccination”—smallpox had been eradicated. It is a twenty-first-century version of this strategy, along with faster mass vaccination, that could help make COVID-19 history.

For this pandemic, epidemiology also has tools to return the world to a state of relative normalcy, to allow us to live with SARS-CoV-2 as we learned to deal with other diseases, such as influenza and measles. The key lies in treating vaccines as transferable resources that can be rapidly deployed where they are needed most: to hot spots where infection rates are high and vaccine supplies are low. The United States, flush with vaccines, is well positioned to lead this effort, using a modernized version of the strategy employed to control smallpox.

Meanwhile, governments should exploit new technologies to get better at identifying and containing outbreaks. That means embracing exposure notification systems to alert people to their possible infection. And it means enhancing capabilities to sequence viral genomes, so that researchers can rapidly determine which variant is where and which vaccines work best against each. All this needs to happen as quickly as possible. The slower countries vaccinate people most at risk of spreading the disease, the more variants will emerge. ...