Editor’s Note: Syra Madad, an infectious disease epidemiologist and communication scientist, is the senior director of the system-wide Special Pathogens Program at NYC Health + Hospitals and a fellow at the Belfer Center for Science and International Affairs. She tweets @syramadad. The views expressed in this comment are her own. See more views on CNN.
My family was first infected with Covid-19 in April 2020 — a terrifying and terrifying experience at a time when the pandemic was mounting in New York and there was no vaccine or effective treatment.
When most of us got re-infected in January this year, I was disappointed, given that we are up to date with vaccinations and generally wear masks in high-risk areas. But re-infection is the norm for many and we have recovered this second time. While I still deal with a chronic cough and runny nose, it’s more of a nuisance than anything else.
Our second experience was a far cry from the first — thanks to the availability of vaccines and other therapeutic substances.
But many of the antibody drugs are no longer effective because of the rapid evolution of the virus and its many subvariants. The US government desperately needs to continue investing in more Covid treatments to keep up with the evolving nature of the virus.
The Biden administration has already announced its intention to end the public health emergency declaration for Covid-19 on May 11, after more than three years. The national crisis peaked in early 2021, with more than 4,000 deaths a day from Covid-19 (subsequent waves, like the one caused by Omicron, were also incredibly deadly). Now, the latest figures from the US Centers for Disease Control and Prevention show that there are fewer than 2,300 deaths per week. This decline is due, in part, to vaccines, therapeutic drugs, and more immunity in our communities.
But the virus that causes Covid-19 has not disappeared. Based on the CDC’s weekly number, Covid-19 is still killing an average of about 327 Americans each day. By comparison, lung cancer causes more than 350 deaths each day in this country — the highest death toll of any type of cancer, according to the American Cancer Society. Huge efforts are still being made to educate the public about lung cancer prevention, screening and treatment. And the research, as well as the search for a better treatment, has not stopped. So why should we accept anything less for Covid-19?
The reality is that the rapid evolution of Covid-19 and its secondary progeny has severely limited our arsenal of effective therapeutics, especially for the immunocompromised.
In the past two years, the US Food and Drug Administration has withdrawn approval of five antibody therapies because subvariants of Omicron have rendered them ineffective.
In November, with a new subline of Omicron taking off, the FDA revoked the emergency use license for the antibody therapy bebtelovimab, a drug used to treat mild to moderate Covid-19 in adult and pediatric patients.
Fast forward two months and Omicron’s rapidly growing XBB subclass began to dominate US Covid cases in January. The FDA has revoked the emergency use license of Evusheld, a long-acting antibody combination used to prevent Covid-19 in immunocompromised individuals who do not have an adequate immune response to the Covid-19 vaccination and in those for whom vaccination is not recommended.
What remains for those not hospitalized but at high risk of serious illness from Covid-19 are antiviral drugs such as Paxlovid, Remdesivir and Molnupiravir as well as convalescent plasma for some patients, all of which have their own limitations. Fortunately, some drug companies have said they will continue to research and evaluate other antibody therapy candidates.
But the search for other and more effective treatments is only part of the challenge. The need for more effective Covid-19 vaccines that prevent transmission is another.
We must continue to invest in better vaccines, especially as studies show that some people who have recovered from Covid-19 are at increased risk of developing cardiovascular complications up to a year later. It is one of many other documented long-term effects of the disease on brain, kidney and lung health. Added to the dilemma is the increased risk of re-infections. A study has shown that repeatedly catching Covid-19 increases the likelihood that a person will experience new and sometimes lasting health problems.
Not to mention there’s still the risk of lingering Covid, a catch-all term for a huge number of new, returning or ongoing health problems people experience after infection. Although it is still difficult to estimate how many people continue to experience prolonged Covid, a 2022 survey by the US Census Bureau found that approximately 16 million working-age Americans (ages 18 to 65) have prolonged Covid, and of those, 2 to 4 million are unemployed as a result.
Don’t get me wrong, our current vaccines save lives and serve the purpose of preventing serious outcomes caused by Covid-19. More than 671 million doses of Covid-19 vaccines have been administered in the United States as of December 2021, according to the CDC. That’s about 80% of the US population getting at least one dose, a monumental public health achievement.
A new analysis from the Commonwealth Fund found that since Covid-19 vaccines became available, vaccination has prevented more than 18 million hospitalizations and prevented more than 3 million deaths in the US. The vaccination program “saved the US more than $1 trillion in medical costs and preserved hospital resources, kept children in school and allowed businesses and other activities to open,” it said. Covid-19 vaccines even help reduce the risk of long-term Covid, according to a study. But we need to step up our vaccine game.
The last Congress did not fund vaccines or next-generation therapy for Covid-19, and it seems unlikely that our current Congress will either. But we desperately need an Operation Warp Speed 2.0 as we continue to experience the evolution of this virus, which has eroded the protective wall of immunity we’ve built over the past few years. Stopping funding now would be foolish.
The good thing is that we are not starting from scratch. Places like the Center for Infectious Disease Research and Policy, which recently unveiled a roadmap for advancing better vaccines for Covid-19, are doing good work. But funding and political commitment are essential — not just scientific expertise and resources.
As I reflect on the last three years of the pandemic, it wasn’t the failure of science or technology that held us back. Instead, scientific breakthroughs meant we had two life-saving Covid-19 vaccines at our disposal, about a year after the new coronavirus first appeared. What hurt us most was the failure of our imagination.
It is wishful thinking to assume that the virus that causes Covid-19 is done with us. To sit back and be complacent while the virus continues to mutate, potentially leading to newer and more severe variants, would be a huge mistake.