Q&A with our President: COVID-19 two years on

Two years since the start of the COVID-19 pandemic our President, Professor Dame Anne Johnson PMedSci, takes a look back at what we have learnt in the UK and globally, and ahead to the what the future may hold. 

Where has the Academy made the most impact during the pandemic?

I believe that our two multidisciplinary expert group reports which looked ahead at winter 2020-21 and 2021-22 respectively were major contributions, bringing together COVID-19 research evidence for policy and public communication. These were put together at speed at the request of our Fellow and the Government’s Chief Scientific Advisor, Professor Sir Patrick Vallance FMedSci.

Both reports, and the influence they had, together with the extraordinary multidisciplinary work of our Fellows and wider community throughout the pandemic, have showed the Academy at its best as a dynamic, responsive, and impactful organisation. We worked alongside public and patient representatives in the development of both reports, using their lived experiences to inform discussions, and help shape our recommendations.  

Supporting researchers has been more crucial than ever, with COVID-19 exposing gaps in the research funding system, and interrupting research. I am pleased about the work that the Academy has done to mitigate impacts, including launching a COVID-19 career support space and using extenuating circumstances data to consider grant applications and extensions.  

What has the pandemic taught us?

We have learnt about the power of science and the importance of the public health response but also of the uncertainties that we face. A few reflections on lessons learnt thus far:

    • The last two years have demonstrated unprecedented capability from the scientific community to work across disciplines to provide life-saving vaccines and therapeutics, and guide behavioural interventions. Ground-breaking surveillance, genomics and data analytics have helped us understand the evolving pandemic like never before. To capitalise on our scientific talent, we now need to invest in scaling up sustainable clinical research infrastructure and capacity which can deliver proven interventions at speed, with proportionate and agile governance.
    • With science hitting the headlines like never before, conveying uncertainty and unknowns became an increasingly important part of science communication, a skill which I and my peers had to hone. We need to continue to prioritise speaking clearly, openly, and honestly about science. I hope that scientists talking about what we know, what we don’t know, and what we need to find out will give the media and the public more insight into how science works and build upon this dialogue.
    • The public have played a huge role in controlling the spread of COVID-19, often at great personal sacrifice. The pandemic has underscored the extent of national and global health inequities. We need to place the public at the heart of public health (the clue is in the name!), finding better ways of engaging with, and supporting, individuals and communities. 
    • One of the hardest lessons learnt is humility in the face of forces of nature: COVID-19 has emerged in an ecological niche which humanity has played a part in creating. High population density, high rates of social mixing, global travel, proximity of human and animal environments, and inequalities in access to vaccines and healthcare have all played a part.
What might happen next, and why is it hard to predict?

In the UK we may be moving into a phase where the combination of immunity arising from natural infection and vaccination is building population immunity to severe disease, although less so to infection. This may in turn mean that COVID-19 becomes another of the endemic respiratory infections.

There is still great uncertainty as to what will happen next with the virus, and we may yet see a new variant which causes more severe disease. Many millions globally have yet to receive even one dose of vaccine. Therefore, we must be realistic about the limits of what we know and our effectiveness in delivering the solutions we have.

What advice would you give people now, and for the coming months?

First and foremost, we have strong evidence of the impacts of vaccination on reducing illness and death, so continuing with the vaccine rollouts locally and globally is essential.

We need to understand how we can live with the virus while recognising the specific circumstances where additional measures may be needed. This includes assessing how we limit risk to ourselves personally, and to those around us, especially those who may be more vulnerable.

Respiratory hygiene measures, such as wearing a face mask when appropriate, staying at home when sick and good ventilation may have their place in the long run. Just as we improved hygiene in hospitals to help reduce the spread of MRSA in the last decade, we need to think how to build better resilience against respiratory infections in settings like hospitals, care homes, and local communities.

What do we need to do globally to tackle the pandemic?

We urgently need to address vaccine equity, and how to use vaccines most effectively, getting jabs to the people who need them most around the world – just as in the noughties we addressed access to antiretrovirals for HIV. There is a lot of work we need to do as an international community to build resilience to virus spread and to improve treatment, as well as working to develop the next generation of vaccines.

This is a big job for the World Health Organization and for governments internationally. The G7 pandemic preparedness plan, the work being done by the Coalition for Epidemic Preparedness Innovations and COVAX are all important, but we need to examine why we haven't done better on international access to vaccines, and on international collaboration for pandemic preparedness in the future.

How has the pandemic impacted on our overall health?

The pandemic has highlighted the enormous pressures on our health systems, persistent and widening health inequalities, and the relationship between social determinants of health and COVID-19 outcomes. This is a wakeup call to address the evidence base and deliver practical actions, to tackle underlying health determinants, and access to education, prevention, and care, to reduce inequities. We need to focus on key public health challenges such as the obesity epidemic and the risks of poor mental health, both highlighted by COVID-19.

The pandemic has had both direct and indirect effects on health. We will continue to see the impacts on mental and physical health as a result of COVID-19 measures and delayed access to care. The Academy has focussed on increasing the profile of mental health research since the beginning of the pandemic, working closely with patients and the public to better understand the impacts and response to the virus has had on our day-to-day lives. 

Only in the coming months and years will we understand the full impact on our overall health, such as delayed cancer diagnosis and the impact of missed education and enforced isolation on a generation of children.

Do you think we are prepared to deal with future health crises?

We were not as prepared for an event like this as we thought – our disinvestment in public health and diagnostic capability came at a big cost – and much needs to be done nationally and internationally for future pandemic preparedness.

If, and when, this pandemic subsides it will be challenging to keep up the momentum of investing in resilient systems for the future. We are constantly seeing new and emerging infections in human societies. The growth of urban populations, climate change, environmental degradation and international travel are all factors which make further pandemics in the future more likely. We must think about plans to mitigate future pandemics, not just in terms of medical interventions, but also in improving built and natural environments and mitigating exposure though human-animal interactions which are likely to shape the risk of future outbreaks.

In conclusion

The Academy has been collecting and sharing learnings from the pandemic. We will continue to do so, contributing to the ever-growing evidence on the virus and its wider impacts, as they evolve, and as we find new ways to respond and adapt. We have come a long way: multidisciplinary science, vaccines, and the efforts of the public have saved many millions of lives.

I hope that we can learn from our experiences and build better global resilience for the future not only to COVID-19 and other infections, but to the many other public health challenges ahead of us.

Visit our COVID-19 information hub for a detailed look at the Academy’s past and present work around the pandemic.

For a more thorough look at the Academy’s impacts during the pandemic see our Review of the Academy of Medical Sciences through the pandemic.

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