What defines a pandemic is the uncontrolled spread of a disease across all continents, causing epidemics in all parts of the world at the same time. For researchers heard by Agência Brasil, covid-19 no longer behaves out of control in most parts of the world, but the decision to downgrade the status of global public health emergency also involves the possibility of keeping resources mobilized to help the poorest countries. Access to vaccines is among the most obvious indicators that the response to the pandemic has been uneven. While countries like Chile, Cuba and Japan applied more than three doses per person, more than 70 countries in the world applied less than one. Worldwide, more than 13.2 billion doses have been applied, with less than 1 billion in the African continent. At the last meeting of the International Health Regulations (IHR – 2005) Emergency Committee on the 2019 Coronavirus Pandemic (COVID-19) at the World Health Organization (WHO), the group’s recommendations were, among others, to focus on vaccination and booster doses, improve data reporting to WHO, and increase the long-term availability of vaccines, diagnostics, and therapies—measures that require support for countries with less robust budgets. The committee recognized that the covid-19 pandemic may be approaching a tipping point, where the disease’s impacts on mortality will remain limited by the large number of people previously infected and immunized. “While eradication of this virus from human and animal hosts is highly unlikely, mitigation of its devastating impact on morbidity and mortality is achievable and should remain a priority goal,” the group said. What is missing for the covid-19 pandemic to end? Marilda Siqueira, from Fiocruz’s IOC Respiratory Virus Laboratory, is optimistic about the current pandemic scenario in Brazil Josué Damacena/Fiocruz/Disclosure /Fiocruz), Marilda Siqueira, believes that the world is experiencing a favorable scenario, and Brazil, an even more favorable scenario, with high vaccination coverage. Added to this is the availability of antivirals developed for the treatment of covid-19 and which are capable of reducing the severity of infections, allowing more patients to be cured. “But this scenario is not homogeneous in all countries. Many countries have a more favorable scenario than others with regard to the capacity of hospital beds, health professionals, and vaccines. When the WHO has not yet declared the end of the pandemic, it has different scenarios in its hands. And for that there are norms and criteria of the international regulation that discuss all the scenarios”, she says. >>> Click here and check out all the articles from Agência Brasil on the three years of the covid-19 pandemic The epidemiologist and professor at the University of Illinois Urbana-Champaign Pedro Hallal says that, at each new general meeting of the World Health Organization, there is an expectation that the decision to end the pandemic will be taken. The researcher says he believes that the health emergency should end soon, but that covid-19 will continue to be a disease that we will live with. “We are approaching the end of the pandemic. And, for those who understand what the term pandemic means, this is even clearer. We are not saying that covid will end, we are saying that we will reach a point where the number of daily deaths will be practically stable, and, thus, it loses the requirement of being out of control, which this is what characterizes an epidemic outbreak. The pandemic is close to the end, but the covid is not ”. Fiocruz Amazônia virologist Felipe Naveca and the president of the Brazilian Society of Infectology, Alberto Chebabo, see the end of the pandemic as a political decision that will also take into account the need to correct inequalities in access to vaccines and epidemiological surveillance instruments, still very scarce in the poorest countries. “We go for it. [fim da pandemia], but it is not an easy decision to make”, argues Naveca. “We have a very unbalanced world. There are countries where the situation is much more controlled, where the health system is stronger and manages to serve the population. And there are other poorer countries, with little progress in vaccination and more fragile health systems. As the WHO thinks of the whole, it is in this sense that the end of the pandemic is still being debated, because when this end is decreed, there is a decrease in these efforts”. President of the Brazilian Society of Infectious Diseases (SBI), Alberto Chebabo – SBI/Disclosure “The WHO does not declare the end of the pandemic much more for the sake of organizing disease control activities”, believes Chebabo. “We have entered a phase where, in most countries in the world, the disease is under control. But we still have a very large inequality in the whole world, and especially in Africa and in smaller countries in Latin America. The coverage is very different, and perhaps because of this, as a strategic matter, to expand the possibility of vaccinating and mobilizing resources, the WHO has not yet declared the end of the public health emergency. But I believe that in the coming weeks we will have a declaration of the end of this pandemic stage”. The vice president of the Brazilian Society of Immunizations, Renato Kfouri, considers that, despite depending on epidemiological data, the end of the pandemic is much more a administrative decree and does not represent an immediate change in people’s lives. Vice-president of the Brazilian Society of Immunizations Renato Kfouri –Photo: Sarah Daltri/SBIM/Disclosure “It is a matter much more of administrative handling of issues. epidemiological moment, yes, but only when transmission issues on the five continents are under control, when vaccines are made available and surveillance resources are structured, will the World Health Organization determine the end”, he says, who emphasizes that covid-19 has still provoked epidemic and regional peaks in Brazil, but that an endemic behavior is “the natural way.” What are the threats of new pandemics? world increasingly connected by international travel and commercial transactions between countries, the ability of respiratory viruses such as SARS-CoV-2 to rapidly spread remains a challenge for health authorities and scientists. Felipe Naveca points out that the coronavirus has already demonstrated that it is a threat that is here to stay, after having caused three relevant public health emergencies in less than 20 years. In 2002 and 2012, the SARS and MERS coronaviruses caused epidemics that reached several countries in East Asia and the Middle East, which had already drawn the attention of the scientific community to the need to prepare for the next outbreak, which began in 2019, with the SARS-CoV-2. “In a list of possible threats of a new pandemic, the coronavirus would certainly be among them, as well as the Influenza. There is no way for us to think that it will not happen, because history shows us that it has happened a few times”, says Naveca. “This was the third emergency event of a coronavirus of great medical importance in less than 20 years. The chance of another happening is great. Nobody believes that it will be in the very near future, but, impossible, it is not.” Naveca believes that the technological advances brought about by investments in genetic sequencing and new vaccine technologies in the covid-19 pandemic will play an important role in humanity’s response to possible new health emergencies. “We are going to experience another pandemic. If it is going to be on the same scale, I hope not. But new challenges will arise”, believes the researcher. “These new vaccine strategies are more easily adapted structures for new lineages and new coronaviruses. If a new variant of concern appears that changes the scenario, it would not happen overnight, but the entire framework of information that already exists will be used and it will be possible to make an emergency vaccine much faster. All this progress counts in our favor “. The covid-19 pandemic, decreed 3 years ago, left capitals around the world completely empty. In the photo, St. Peter’s Square, in Rome – GUGLIELMO MANGIAPANE The president of the Brazilian Society of Infectious Diseases agrees that coronaviruses are a threat that needs to be under constant surveillance, just like Influenza, which caused pandemics in 1918 and 2009 and has again caused concern for the spread of the H5N1 strain, which causes avian flu. “These are viruses that are here to stay and can cause new pandemics. Even this one, SARS-CoV-2, with new variants, can cause new increases in cases and new clinical manifestations that are still unknown to us”, says Chebabo. “Both Influenza and coronaviruses infect other species, and therefore cannot be eliminated like viruses that only infect humans, such as measles or poliovirus. , are respiratory viruses, which makes their transmission easier, without the need for a vector. No intimate contact is necessary, just close contact”. Epidemiologist Pedro Hallal recalls that the history of public health records that events with the dimension of the covid-19 pandemic are rare and happen only once a generation. But smaller epidemic outbreaks may be more frequent. “I think we are going to have epidemic outbreaks, perhaps more frequent than we normally had, and perhaps caused by the coronavirus itself.” Despite the optimism, he sees that human actions that cause ecosystem imbalance and climate change contribute to humanity running more risks of experiencing new global public health emergencies. Zoonotic viruses like the coronavirus, which can jump to humans, gain more opportunities when these animals are displaced from their natural habitats. “If we keep making so many mistakes on the environmental agenda, maybe we increase the risk of having a new pandemic in our generation. But, in general, I think the probability is not very high.” Marilda Siqueira also sees climate change as part of the problems that potentiate the threats of new pandemics. But she adds that all human-environment interaction needs to be included in this discussion. A global public health emergency was declared on March 11, 2020. In the photo, South Korean soldiers disinfect the international airport in Daegu, at the beginning of the pandemic – KIM KYUNG-HOON/copyright “There is also our interaction with the other species through deforestation, and what we prepare to eat and survive, and the way we prepare it”, she says, who advocates encouraging more surveillance research with a unique health perspective, which also takes animal health into account . “In nature, we have animal reservoirs that have continuously circulating viruses, including coronaviruses. And also the Influenza virus, present in several species of migratory birds that cross continents, and some mammals. If we don’t have, within a single health concept, investment in this animal-human interaction, we’re going to have more problems.” The virologist believes that advances in the various fields of science involved in combating the pandemic, as well as the training of international networks of researchers, strengthen humanity’s capacity to respond to the next health emergencies. However, for this, it is also necessary for governments and societies to discuss what worked and what went wrong during the covid-19 crisis, so that the lessons are learned. “We know that we are going to have new pandemics. We don’t know if it will be tomorrow, ten years from now or 100 years from now. The lessons learned are very important for preparing for new pandemics or epidemics, such as dengue with which we have been living for decades, or that of chikungunya, which is in countries neighboring Brazil and may return”.
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