How can the EU stop covid transmission and end the pandemic?

By Dr. William Burns PhD MSc

Summary

  • Stopping covid transmission and thereby ending the pandemic appears to have been the goal agreed by the WHO member states in May 2020 (WHA73.1).
  • The EU without doubt brings a new dynamic to this task. Individually, the European states (including UK) lack both the capacity, and in some cases the desire, to do enough.
  • From what I can judge, the next phase for the EU is to strengthen the policy instruments it has developed and weave them into a coherent whole.
  • As highlighted by the interviewees in my report, many policy solutions are imminent at the European level but not implemented.
  • Given an alternative agent for multilateral action in Europe, such as the WHO regional office, is politically unrealistic as far as I know, the EU remains the best bet for ending the pandemic on the continent.

Introduction

Stopping covid transmission and thereby ending the pandemic appears to have been the goal agreed by the WHO member states in May 2020.(1) In this report, I tried to build a picture of whether the EU was capable of delivering that goal. I felt my approach would shed light on the policy measures we could need to end the present pandemic and will need to prevent future pandemics.

We currently have vaccines that appear effective at stopping disease (but perhaps less effective at stopping transmission). It could therefore be argued that no further efforts are required beyond vaccinating everyone. There are obviously going to be operational problems doing that, and vaccine inequity globally, but let us pray universal coverage is eventually achieved.

Will that be enough? We lack the information to answer this question. But we have all heard concerns about waning immunity, vaccine escape mutants, potential chronic infections, and animal reservoirs.(2) What if people continue to sicken and die, even if not in such overwhelming numbers as have done over the past year and a half?

Presumably, there would need to be an expansion in the health system to cope with the increased burden of disease. But it also seems reasonable to expect, whether for humanitarian, economic, or geopolitical reasons, or profit motive for the pharmaceutical industry, that further solutions would be sought. They could involve, for example, a new generation of transmission-blocking vaccines, a drug that guarantees a cure, and/or some other measures that we cannot yet envisage.(3)

An instinct to find solutions is, I think, a point missed by those who argue the virus will become ‘endemic’ and there is nothing we can do about it, because there are obviously people who will be doing something about it. The question, for the purposes of this report, is whether that enterprise would be one mainly for private initiative or whether governments intend to take part.

What are the connections between the current pandemic, and preparation for future pandemics? If we assume major respiratory pandemics occur about every century, based on the 1918 flu, then I guess there is no connection and we should not prepare (or at least we can wait). But expert opinion, as far as I can tell, suggests pandemics are likely to become more frequent.

The G20 report (June 2021) on the covid response stated that if covid became ‘endemic’, ‘responding’ to the current pandemic would ‘blur’ with preparation for the next one (p. 20). Preparation might therefore be an immediate necessity even before the current pandemic has ended and would indeed become intermingled with ending the current pandemic (there is also no law that says another pandemic will not start tomorrow).

When we talk about novel, incurable, infections, the crucial intervention will always be stopping transmission. As far as I am aware, that is the only way to avoid a mass casualty event. Might it also prove to be the crucial intervention for the current pandemic (i.e., the original WHO goal remains the correct one)?

Stopping transmission is, in my view, the most interesting framing from the perspective of science policy. It is a test of bureaucratic power and, it seems to me, a clue as to whether the EU is prepared for the challenges of the decades ahead. Compare the performance of Western countries with the Chinese state, which, due to its organizational capacity, repeatedly knocks down the virus.

I decided to address three aspects of the problem, namely: (1) how the European Commission has understood what went wrong in the initial months of the crisis and the lessons it has drawn so far; (2) foresight; and (3) medical countermeasures. As with my other reports, I used a combination of interviews with scientists and my own reading of publicly-available information. A conclusion follows at the end.(4)

Analysis of the initial EU response

Reflecting back on January and February 2020, it seems, from one perspective, the European Commission did not fully grasp the implications of the Wuhan lockdown. It focused attention instead on offers to support China’s response (and repatriation of EU citizens).

However, the picture of that time is not straightforward. There are also some comments, such as one made by the health commissioner, Stella Kyriakides, on 31 January, that imply senior officials understood the gravity of the situation (see table below).

European Commission covid communications in January and February 2020 (sample)

DateCommentSource
29 JanuaryDuring the latest Health Security Committee, which was held on Tuesday, the Member States reported to us a strong level of preparedness.Stella Kyriakides, Commissioner for Health and Food Safety, speech
29 JanuaryReaching out this morning to [Chinese] PM Li Keqiang to discuss coronavirus and commended efforts of the Chinese government to mitigate and contain the virus. The EU stands ready to provide any assistance needed.Ursula Von der Leyen, Commission President, twitter
31 JanuaryWe need to see a multifaceted, whole-of-government response to the Coronavirus.Kyriakides
24 FebruaryAccording to the information provided by the national authorities [member states], there is a strong overall level of preparedness with countries having response measures in place to provide treatment for the cases in the EU and to mitigate any further transmission within and into the EU.Questions and answers: The EU’s Response to COVID-19
Sources: European Commission Press Corner; twitter.

The member states would appear to have been a big source of misinformation. This could not have helped understanding. They told the Commission that they were prepared (citing comments from the Commission dated 29 January and 24 February). It is not clear what they had prepared for or what they meant by this, but as we subsequently saw, they were not prepared to stop the virus.

It has also to be said, the relevant EU agency, the European CDC (ECDC), made ambiguous statements in its risk assessments as late as February. For example, it talked about ‘considerable uncertainties in assessing the risk of this event, due to lack of detailed epidemiological analyses’ (14 February), and said that ‘the risk associated with COVID-19 infection…is currently considered to be low to moderate’ (23 February).(5)

Obviously, as outsiders, all we have are our own recollections of public statements (and our guesses as to their precise meaning). The Commission did not actually communicate all that much on covid in the first two months of 2020 (I checked the press releases). I feel we are not yet able to understand what was happening inside the Berlaymont.

My goal is therefore not to analyse the response (I lack the required knowledge and understanding) but rather to summarize what the EU subsequently said themselves about what went wrong. Of three reports on this topic that I read, in my view, the two most thoughtful were about ECDC.(6)

The first, commissioned by ECDC and dated November 2020, concluded the agency should place a greater emphasis on ‘the practicality of recommendations for specific contexts’ and ‘tailored communication’ for ‘decision makers without much scientific expertise’.

The European Ombudsman, Emily O’Reilly, also looked into the ECDC response (the investigation ran from 24 July 2020 to 5 February 2021). The ombudsman concluded overall that ‘there is room for the ECDC to improve how it communicates information to the public.’

Both reports emphasised communications in their conclusions. Improvements to communications such as greater emphasis on making direct, less hedged and ambiguous statements might have been helpful. The ombudsman made specific, and highly actionable, recommendations in regard to communications that ought to be implemented.

But I believe deeper issues with the way officials conceived the situation and their role in it were also touched upon in these reports, as captured by the recommendation in the first report that ECDC should in future ‘play a larger role in shaping the European crisis response agenda by providing a more forward-looking perspective’ and undertake ‘early modeling of potential scenarios’.
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The ombudsman report also contained details that, to me, are suggestive of this deeper point. For example, according to testimony given to the ombudsman, the ECDC stated that it ‘could not predict’ in January and mid-February that ‘the virus was already circulating in the community in several countries’.

‘To detect this, member states would have needed huge laboratory capacity to test everyone with COVID-19 compatible symptoms. Unfortunately, there is no way that the diagnostic capacity for a new virus can be scaled up to this level in such a short time frame…Modelling or forecasting was not performed at that time, simply because there was no data to model and no clear epidemiological parameters to use.’

The statement that ECDC ‘could not predict’ the virus was circulating is hard to understand because obviously it was a reasonable prediction that this was the case. By that, I mean, one would always have to assume at the start of a pandemic that the virus was likely to be circulating and, also, that one could not rely on formal methods to make predictions, as the agency itself pointed out.

The ombudsman reported that the ECDC changed from ‘containment’ to a ‘mitigation’ at some point between February and March (date not specified). References like this imply to me a situation under official control. Taking a broader view, this was misleading because the virus was in control, not officials. Covid was, metaphorically, setting the strategy. In that situation, you are either stopping the virus, or you are not.

Information picture

‘Many proposals should be administered by the government, such as sealing off the city from all outside contact of Wuhan; forbidding gathering of more than 100 persons; efficient daily public education of 2019-nCoV precaution; encouraging people to cancel the traditional family gathering during Chinese Lunar New Year and extending the New Year holiday to prevent large-scale spreading.’ – Xu., et al., 31 Jan 2020

The best option, as Chinese experts, namely Prof. Li Lanjuan, realized in January 2020, was to shut down covid transmission. She, and another expert (Prof. Zhong Nanshan) reportedly briefed the Chinese State Council on the crisis on 20 January.

According to an account later given by Prof. Zhong (at a Brookings Institution seminar dated 1 March 2021), the policy goal of the Chinese central government was ‘life supremacy’ (I understand this to mean ‘put lives first’). Decisions such as a lockdown in Wuhan (starting 23 January) followed that principle.

Social distancing and mask wearing were of course known infection control concepts that had been recommended against pandemic disease. But they had to be applied early, citing for example a report published in 2010 by Finkelstein, et al. (part of a US CDC preparedness program).

‘School closings and related top-down social distancing measures are almost useless if done too late. Decision-makers must have an early trigger or else the horse has left the barn…Recommendations generally support use of masks in situations where people are in very close proximity to one another, such as on public transportation and in other crowded areas. In order for the use of masks to be feasible, they need to be made available in adequate supply.’ – Finkelstein, et al., 2010.

In late December and early January, the most extensive public information source on the Wuhan outbreak was the Chinese-language internet.(7) When the Wuhan Municipal Health Commission issued an alert on 31 December 2019, the news was reported in a few European outlets, e.g. Der Spiegel, Deutsche Welle, etc. – but not prominently.

‘There is some important and disturbing information coming out of China right now re: severe pneumonia with similarities to SARS, and etiology currently not yet confirmed…the China CDC & Provincial CDCs are working effectively already, and there is an openness and transparency right now that wasn’t there during the first SARS cases. Also no sign of a wider outbreak yet…let’s hope this is not a novel viral agent, and that it resolves rapidly!’ – Prof. Peter Daszak, 31 December 2019 (via twitter).

The information picture at the start of January 2020 looks complex and, I would guess, was hard to interpret.(8) With the benefit of hindsight, when reviewing some of the media coverage, I can pick out both prescient remarks and also remarks that now seem delusional.

But, at the end of January, by ordering the Wuhan lockdown, the Chinese government would appear to have given a dramatic indication of the need to act.

Chinese efforts suggest the response time for a bureaucracy is, realistically, about one month after the first news of an epidemic emerges in the media. The lack of decisive action from the EU (or anyone) after that point is probably an issue we need to understand (and, hopefully, draw lessons from).

Foresight

“My brother is a physicist at a large hospital and they were well prepared, not in the sense of having a detailed plan but they used scenarios. They imagined what might happen in the longer term future at a time when they had to decide on new equipment,” Prof. Dr. Kerstin Cuhls, Fraunhofer Institute for Systems and Innovation Research ISI, told me in a phone call in July.

“One of the potential threats was an epidemic or pandemic. In the end, the hospital bought new modular equipment for anaesthetics so that they were flexible enough to respond fast to a pandemic. Although, of course the key element missing was staff to run the machines and in care. That is the kind of preparedness for alternative paths into the future we need, not exact plans,” she added.

Prof. Dr. Cuhls is a prominent expert on foresight, a concept that refers to considering alternative futures, e.g. in scenarios, and what they would mean for policy. She studied the EU response to covid and other crises, as well as advising the European Commission and German federal officials. But it seems personal connections often count when it comes to influence!

“Foresight has been around for a long time. It goes in and out of fashion in governments. It gets abolished when people feel safe. Take the German government. It took 30 years of effort to convince the Federal Chancellery to have a foresight group. And in the ministries and agencies, foresight knowledge often gets lost because staff are rotated between tasks.”

“My impression is that initially in the covid crisis, European Commission officials thought the pandemic would be over in a year or less and that everybody may go back to the time before – but too many things changed in-between,” Prof. Dr. Cuhls said.

“In my view, at first policy-makers were just in denial about what was coming because it was so horrible. This is human psychology. Then, after that, they looked at the Ebola epidemic in West Africa and thought covid would end quickly. But covid is different from Ebola.“

“We produced a range of scenarios for the EU ‘world in 2040’ which opened their eyes to the fact that this is not over yet – and with the pandemic, many other things have changed, e.g. in technology, in behaviour and mindsets.”

“With the Commission, I found the most effective format is where you get individuals in each directorate, even the directorates that are not obviously involved in foresight, into joint workshops, not simple meetings. Their experiences spread into the structure this way. Initially we involved participants from the Foresight Correspondence Network in our scenario or Delphi work. Now it is through the Horizon Europe Network.”

“We try to formulate the notions in a positive way and find solutions. Not just look at threats but what we can do about them. We are not powerless.”

“We need to get thinking to shift away from everything being about digital threats. There are obviously other threats like viruses, fire and floods. I just hope lessons are learned from covid for dealing with climate change,” she added.

The Commission has recently put emphasis on what it calls ‘Strategic Foresight’. Prof. Dr. Cuhls was happy that the Commission had a renewed interest in foresight, linked to commissioner Maroš Šefčovič (his interest in the topic pre-dates covid). “But when he is gone, what happens?” she said.

“Also, I am not in favor of the term ‘Strategic’. There is foresight and there is strategy. We can present scenarios, assumptions about different futures. But we do not predict. And it is the policy-makers’ job to create a strategy based on visions or aims. I think sometimes the officials expect foresight advisers to make decisions for them. When we decline to do it, officials get disappointed. This is a problem.”

“We definitely need better training. I teach in a masters course in futures research at the Freie Universität Berlin. But this kind of course is not common. I also teach at the Federal Academy for Security Policy (BAKS). We get German civil servants as participants to do practical foresight, and we network across ministries and agencies. It is not so much teaching but rather an interactive learning session for all of us. This is a very good initiative.”

Prof. Dr. Cuhls was a member of the European Commission expert group on Strategic Foresight for R&I Policy in Horizon 2020 (active 2015-2016). One of the recommendations of their report was to establish ‘a…think tank, with a small group of independent professionals specialised in foresight and strategy development at its core…to act as a liaison with national foresight providers, citizens and stakeholders’ (p. 17).(9)

There are many public research institutions and university departments that undertake foresight activities in Europe. While acknowledging it would be incredibly difficult from a legal perspective, many people I have spoken with (not just associated with this report) suggested these institutions could be mobilized through a framework advisory contract with the Commission.

“I would be in full support of any initiative that brought the foresight capabilities and capacities in/of the EU Member States to the European level,” another informant with knowledge of the topic told me.

“They could create some stable framework that would allow for a continued and preferably sustainably-financed integration of national and EU foresight activities. At the moment, there is a growing multitude of actors, usually connected only by individual events such as conferences or research contracts lasting 2-3 years.”

“The EU Joint Research Center, which is already developing its own capacity, could work perfectly as the centre of gravity for any stable (and open) framework aimed at integrating member state foresight capabilities. Preferably this would be financed for the duration of the multiannual financial framework (until 2027),” the informant added.

Returning, once more, to the start of the pandemic, social distancing and wearing face masks by the public had been stock concepts in pandemic planning for years. Indeed, they would seem to be the only possible countermeasures when faced with a new respiratory agent (drugs and vaccines take time to develop).

But pandemic preparations, particularly after SARS, had also shown that the majority of Europeans probably did not know how to behave (unlike in East Asia). In 2006, concerns were expressed about the willingness of the French public to wear a face mask outside to protect others during a pandemic.(10)

Therefore, it was in a sense obvious that Europe was not prepared as well as it might have been. As everyone now knows, the opportunity was missed particularly in the years before covid but perhaps also in the first months of 2020 to instil life-saving behavior patterns.

Worse than this, in the early stages of the pandemic, citizens were even discouraged from wearing masks. ECDC, it seems thinking only of factory-made medical masks, stated that they were in short supply. Yet, famously, even common household materials like tea cloths tied around the mouth and nose could have been useful.(11)

“Citizens are crucial partners in foresight. We need people involved,” Prof. Dr. Cuhls said.

She noted how Japanese schools regularly teach pupils about what to do in a disaster. This means, for example, knowing to get under a table in an earthquake (school buildings are also reinforced to survive earthquakes). Even though every situation is different, people have at least some basic training they can rely upon.

“People in Europe feel too safe. I don’t mean we scare people but we need people to be regularly reminded and informed how to react in unclear situations. People don’t know how to help others in an accident.”

“Recently, for example, we told people to leave homes due to the flooding. But they didn’t. And they are, tragically, dead. This is an example of citizens not grasping the magnitude of the threat and what they can do to protect themselves.”

Schools have evidently been long known as one of the main action points in preparedness for respiratory pandemics (although little was done until the current pandemic). This observation refers to physical measures to minimize transmission like supply of masks/ventilation (classroom design) and medical countermeasures like pediatric vaccines. But, just as Japanese children prepare for earthquakes, we should surely also teach children the skills and mindset needed to beat a pandemic or react in case of fire or other disasters (this is an opportunity for EU funding).

It seems, from the conversations I had, that foresight cannot only be an exercise for officials (although that would have been very useful). It has to be a whole-of-society activity (sometimes termed inclusive foresight).

Foresight would probably take different forms according to the audience but could draw on a common underlying framework.(12) It potentially gives the space for experts, as well as citizens, to imagine the future, the challenges they might face, and the agency to protect themselves and others.

Medical countermeasures

Vaccines have been the headline R&D interventions against covid. There is an idea that governments played an important role in shepherding the development process. It is however hard for an ordinary member of the public to obtain exact details.(13)

Two main vaccines thus far used in Europe owe their origins to technology incubated in the biotechnology sphere, namely, BioNTech SE (Germany) and Vaccitech (UK). However, the crucial interventions in terms of getting vaccines into use were development and manufacturing. For BioNtech, this was with Fosun Pharma and Pfizer. Vaccitech (via the University of Oxford) initially sought partnership with Merck but subsequently shifted to AstraZeneca.

Known official interventions in this process include advanced procurement of doses, factory upgrades funded by taxpayers, and rapid regulatory approval. The public, in terms of clinical trial participants, were also deployed, and should not be forgotten as a key part of the mix.

Behind these headlines, of course, there has been a lot of other R&D, but its exact scale is harder to define (it has received less publicity). There has been a degree of self-organization by some scientists during the pandemic. This has been in such diverse areas as medical countermeasures, epidemiology, and even public-facing roles or holding the governments to account. Overall, large amounts of new knowledge have been created about covid. Some of that knowledge (an unknown amount) has been converted into solutions (or might have application to other crises).(14)

It seems the key lesson from the vaccines has been that you get results from investing relatively large sums of taxpayer funding in well-known pharmaceutical and biotech firms, who own, or are developing, relevant technology and can scale it up fast. This is, of course, very obvious.

The possibility that mRNA technology, and the chimpanzee adenovirus used by AstraZeneca (originally developed for MERS), were potential options for a vaccine was not I think obscure knowledge among experts even before the pandemic hit. Nor was the fact that the biotech sector would prove a good hunting ground for leads.(15) In other words, there was luck and hard work, but it was possible to put these projects together from existing components.

In other areas of R&D, the situation might look different. Given its relative lack of visibility, and the fact there seems now to be so much covid R&D that no one can understand it all, it is much more difficult to say. Different combinations of policy instruments, and different experts, may be required to identify potential leads and progress them rapidly towards application.

A curative drug is an obvious intervention. Prof. Bruno Villoutreix, research director, Inserm, and University of Paris, has been a vocal critic of what he sees as a lack of official action on this topic. With a colleague, Dr. Natesh Singh, he published an opinion article dated April 2021 that gave an excoriating critique, mirroring comments in a highly critical, but little known, report on the French research ministry from the government auditor.(16)

“As far as I can tell public capacity is focused on doing clinical trials for big pharma. It relies on the actual discoveries coming from somewhere else. The question is if we want to actually discover drugs. I am not sure we do,” he told me by phone.

“A problem is that the principal investigator-based system does not work for this. You need teams to develop drugs. There is a lot of discussion between clinicians at the moment on covid drug discovery. But we need to bring chemistry, computer science and biophysics into the planning process. We are not doing that.”

Prof. Villoutreix points to UK analysis by Tralau-Stewart, et al., (2014) and Shanks, et al. (2015), which he believes has applicability to the entire continent.(17)

“The barriers are well known as are the potential solutions. People have been talking about this for almost a decade. There is capacity in the member states. This should not be so difficult. The problem is that nothing happens.”

IP issues typically get in the way of more structured collaboration between public and private sectors. But it seems opportunities are being missed.

“I think we could learn something from the Academic Drug Discovery Consortium in the USA. It is not a perfect example but it is a start. It provides a single means for everyone to communicate with one another. The European Commission could try to lead a conversation about this topic in the member states.”

“I would say at the moment we have activity going on but it is Brownian motion. Lots of duplication. Lots of investigation of leads that are obviously completely useless. The chloroquine scandal is one example. It is a tragic joke.”

Hydroxychloroquine has not been a great advert for academic drug discovery. Without doubt, preposterous or even dangerous pronouncements on covid have discredited several scientists around the world who would otherwise have remained obscure. The pharmaceutical industry has also had its scandals in the past. It would be unfair to judge the whole enterprise by the actions of a few.

Given we will probably need a mix of countermeasures, there is reason to be optimistic about what is gradually emerging from the private sector, including next generation vaccines and potentially curative drugs.

A public R&D system primed to help deliver medical countermeasures could bring benefits in any pandemic response, particularly if it relates to foresight on future threats.

Calls for reform in a report sponsored by the European Federation of Pharmaceutical Industries and Associations (EFPIA), however, seem excessive on this point. The trade body is connecting covid to an industry wish-list for restructuring EU competitiveness policies. To the contrary, I think relatively modest and even improvised improvements in overall performance would be worthwhile and might even be enough.

But, work is obviously still needed, and it will require experts in a diverse range of topics (not just medical experts), because the potential industries and areas of science required are large.(18)

The European Commission, at the least, intends to develop an understanding of the global pipeline of covid therapeutics, with completion of that work by mid-2022 culminating in an ‘interactive mapping platform’.(19) This is important because it will allow it to assess if the private sector is up to the challenge.

But there is not, as far as I am aware (based on the organigram), a cross-cutting unit within the Commission RTD (research directorate) responsible for gathering and analysing information on R&D relevant to crises. Activities, where they are occurring, will be split by topic. The only potential point of convergence in the bureaucracy is the apex (director-general). The apex would not have bandwidth for all the detail.(20)

RTD could at least start to integrate crises (including the current one) into its routine planning and appraisal activities of funding for both research and training, and see what conversations, if any, can be had with research ministries in the member states on these topics.

Last September, the Commission President, Ursula von der Leyen, launched plans to create the Health Emergency Preparedness and Response Authority (HERA) that would identify potential medical countermeasures and support their development.

HERA planning is ongoing. Differing visions of the authority appear to be circulating (in the most recent published information, it is recorded that HERA will be an ‘internal Commission structure’).(21) As far as I can tell, HERA will not have its own budget but use the budget of existing programs. An ‘increase in staff is envisaged’ in ‘crisis time’ when a ‘redeployment of human resources between Commission services and…the European Medicines Agency/ECDC may be necessary’.(22)

Given the Commission arguably has insufficient staffing to handle the crisis (or anything) as it is, and in light of reported structural changes in such key directorates as RTD, this proposal to operate within the current budget/staffing envelope might not improve the situation immediately.

In such a case I guess the Commission would try to mobilize the national scientific institutions to support it. But it has often been unable to do that on any scale in the past for various legal, political, and organizational reasons. HERA is not well-known in the scientific community and has not gained much comment from scientists so far.

HERA proposals are due in Q4. This means it would have taken more than a year to get from the initial idea to a proposal. I guess that HERA, assuming it becomes operational in 2022, is unlikely to become a serious threat to infectious diseases until 2023.

American perspectives

The US Biomedical Advanced Research and Development Authority (BARDA), founded 2006, was one early inspiration for HERA. Action by BARDA is the reason why a covid vaccine was developed quickly, according to comments by Dr. Marie-Paule Kieny, Director of Research, Inserm, in December 2020.

I asked a leading expert on American infectious disease policy, Prof. Gigi Kwik Gronvall, Johns Hopkins University, for her opinion on BARDA and Operation Warp Speed (OWS).

“We certainly don’t know all the details. At the moment the US Government Office for Accountability (GAO) seems to be taking the lead assembling some of the facts,” Prof. Gronvall said, citing a GAO report dated February 2021.

“Experience from within BARDA in terms of contract negotiation might have been brought into play with the vaccines. I mean, there are only so many people with that experience in the federal government. But this must have been a secretary-level decision not something down to BARDA leadership.”

“In the past, BARDA definitely played a role in supporting small firms in developing medical countermeasures. But not the big pharma companies. They don’t need the money.”

“What the covid crisis seems to have shown us is that the millions of dollars BARDA spent getting FDA authorization for certain medical countermeasures was perhaps unnecessary. We delivered the vaccines with only an emergency use authorization. We didn’t need the full authorization. So perhaps there is something to learn there about where best to spend the money.”

Prof. Daniel Gross, Duke University, and Prof. Bhaven Sampat, Columbia University, wrote an interesting paper comparing American government R&D responses to covid with those in WW2. The paper does not argue that WW2 is exactly like the current crisis, but uses the comparison as a way to understand governmental actions.

“What is striking in the covid pandemic is that the USA had no central agency weaving the response together. In principle Anthony Fauci or another public leader could have been the Vannevar Bush of 2020, but no such leader was ever appointed. To me that is an important difference: we lacked a person or agency with the staff, funds, and authority to coordinate a broad-based government response,” Prof. Gross said in a phone call to me.

Vannevar Bush led US government research operations during WW2. His name is shorthand for a systemic vision of how taxpayers funded science that dominated American policy in the years after WW2.

If we were to look for an equivalent figure today in the Brussels bureaucracy, perhaps it could be Ursula von der Leyen (appropriately enough, a physician by training).

“Our research system has been very productive. Funding basic research that provides a platform for a pandemic response is important. But having institutions that can pivot to crisis problems or grand challenges like climate change is also vital, and we do not have a robust set of institutions for doing so,” Prof. Gross added.

In a crisis, how can you weave together the existing public research system, designed to generate new knowledge on lots of topics, to deliver the specific result you want? The answer to that question does not seem obvious.

Conclusion

The above is a very incomplete picture of a complicated situation. I only briefly touched on a small number of areas that I personally found interesting.

However, based on the limited material I read, the EU brings a new dynamic to the covid crisis. Individually, the European states (including UK) lack both the capacity, and in some cases, the desire, to do enough.(23)

Despite a slow start, the European Commission managed to improvise a range of policy instruments, such as advanced purchase agreements, loans, regulatory interventions, research grants, science advisory services, information exchange platforms, and so on.

This was quite impressive. There has been criticism of the Commission, particularly on vaccine procurement, but what that criticism rarely recognizes is the EU is not a state and every problem it faces is unique because it is, itself, unique as a political entity.

From what I can judge, the next phase for the EU is to strengthen the instruments it has developed and weave them into a coherent whole. As highlighted above, many policy solutions are imminent.

Given an alternative agent for multilateral action in Europe, such as the WHO regional office, is politically unrealistic as far as I know (and G7/G20, etc. are conferences not delivery mechanisms), there is not much else to bring into play.

I would like to thank the experts who gave their advice and comments. However, opinions expressed in this report remain my own and should not be construed as representing the views of others, except where clearly attributed.

(1) Resolution 73.1 of the World Health Assembly (19 May 2020) called for efforts to ‘contain and control the COVID-19 pandemic’ and ‘extensive immunization against COVID-19…in preventing, containing and stopping transmission in order to bring the pandemic to an end’. The WHO COVID-19 Strategic Preparedness and Response Plan 2021, dated 21 February 2021, referred to ’goal: end the COVID-19 pandemic’ with ‘suppress transmission’ as a ‘strategic objective’ (p. 10). It also noted a desire to ‘eliminate transmission’ (p. 14). The WHO report on implementation of 73.1, dated 21 May 2021, did not draw attention to the obvious backsliding from the resolution. But it reiterated the need for ‘controlling transmission in every country and context’ with a view to ‘ending the pandemic’ and that ‘transmission must be suppressed’ (p. 20). Authors of the more recent G20 High Level Independent Panel report (June 2021), linked of course to the G20 rather than the WHO, also proposed to vaccinate the majority of the people on the planet. But they anticipated this action might not be enough, and the virus could become ‘endemic’.
(2) My impression is that some European politicians and their electorates believe the crisis is already over. I guess time will tell. No one can predict the future. But I found the following opinion article informative (although I am not sure how, on p. 502, the authors could attribute likelihood to different future scenarios): Telenti, et al., 2021, After the pandemic: perspectives on the future trajectory of COVID-19, in: Nature. Varnai and Simmonds, 2021, The scientific, technological and societal conditions for the end of the COVID-19 crisis, is also informative. My reading, specifically on the issues of chronic infection and animal reservoirs, respectively: Simmonds, et al., 2021, Understanding the outcomes of COVID-19 – does the current model of an acute respiratory infection really fit? in: Journal of General Virology and Michelitsch, et al., 2021, SARS-CoV-2 in animals: From potential hosts to animal models, in: Advances in Virus Research.
(3) Aspects of the history of malaria, smallpox and HIV/AIDS might offer interesting insights on how the official and scientific responses to infection get shaped, particularly in regard to shifting notions of eradication (malaria and smallpox), the importance of R&D, and the role of activism (HIV/AIDS). On these points, I found the following informative: Bhattacharya, 2008, The World Health Organization and global smallpox eradication, in: Journal of Epidemiology and Community Health; Epstein, 2000, Democracy, expertise, and AIDS treatment activism, in: Science, Technology, and Democracy; Fenner, et al., 1988, Smallpox and its Eradication (pp. 478-479); Reinhardt, 2015, How smallpox became a ‘suitable candidate for global eradication’ in: Ageless Arts: the Journal of the Southern Association for the History of Medicine and Science; Litsios, 2020, The World Health Organization’s changing goals and expectations concerning malaria, 1948-2019, in: História, Ciências, Saúde-Manguinhos.
(4) Please note this is obviously not even close to a complete picture. A lot of elements are missing. It is also important to note the initial European response was mainly the responsibility of the national governments (and also regional governments in countries where power is devolved). This apparently changed as the crisis progressed with the ‘EU’, ‘Brussels’ or ‘federal’ authorities taking, or wanting to take, a more prominent role. To clarify, in this report, I am analyzing aspects of the ‘Brussels’ response, i.e. European Commission and the EU agencies, not the responses of the member state governments, nor the interrelations between different levels of governance.
(5) Italy began its first regional lockdown in late February (Codogno). But it was only on 2 March that the ECDC began to make clearer remarks about the danger (‘risk…moderate to high’). This was a shift from February. On 12 March ECDC finally made an unambiguous statement about the ‘need for immediate targeted action’. However, the agency continued to recommend against the use of face masks by the public until 8 April.
(6) In June 2021, the Commission itself published a report analyzing the covid response. It concluded, accurately, by stating that the EU and its member states were not ready for the pandemic and that ‘preparedness and planning were exposed as being under-funded and under-developed’. However, it lacked analysis of the actions taken at the start of the pandemic (unlike the reports on ECDC).
(7) For a timeline of Chinese media coverage, see: Congressional-Executive Commission on China, 2020, Domestic Chinese media coverage of the covid-19 outbreak, in: Annual Report 2020, pp. 49-51.
(8) Previous work by the Commission published in its own science for policy handbook (not on covid) pointed to the issue of ‘information overflow’ in a crisis, citing, De Groeve, 2020, Knowledge-based crisis and emergency management, in: Science for Policy Handbook (p. 184).
(9) The European Commission recently issued a €13m tender for an ‘IT platform…for intelligence gathering and analysis’ including ‘anticipatory threat assessments, consequence management and medical countermeasure requirements’ for a range of threats (biological, chemical, radiological, etc.). Hopefully this program will eventually incorporate the ideas from Prof. Dr. Cuhls and others concerning foresight.
(10) Gautier, et al., 2006, Enquête Nicolle 2006: Connaissances, attitudes et comportements face au risque infectieux (pp. 178-179).
(11) There has been sarcastic coverage in the Dutch media on the tea cloths (targeting the inadequacy of the Dutch government response). The original paper: van der Sande, et al., 2008, Professional and home-made face masks reduce exposure to respiratory infections among the general population, in: PLOS One. It is an interesting example of how citizens could have improvised a response to the pandemic by repurposing a common household item. The study is not unique. Studies on masks (and improvised masks) were a feature of pandemic preparedness in the years after SARS.
(12) I have no expertise on this matter. But I believe the EU has talked since before the pandemic about reflecting on the future and how to prepare for it. One part seems to be a renewed emphasis on strategic foresight, which is possibly chefsache, or at least an activity for experts. The second part is the Conference on the Future of Europe which I believe is intended to engage citizens. The two initiatives appear to be in separate silos and lack a shared framework for discussion. For example, why does Joint Research Center foresight use 14 global megatrends while the Conference on the Future of Europe uses four themes?
(13) For Europe, the most informative account I read was: Aghion, et al., 2020, How to strengthen European industries’ leadership in vaccine research and innovation, in: VoxEU. Bown and Bollyky, 2021, How COVID-19 vaccine supply chains emerged in the midst of a pandemic, Working Paper21-12, Peterson Institute for International Economics, is useful. It shows that governments had only a very limited picture of vaccine supply chains (p. 42).
(14) The WHO Coordinated Global Research Roadmap potentially offers a picture of global R&D activities. But the roadmap has not been updated since early last year!
(15) BioNTech, a firm founded in 2008 in Mainz (Germany), in which half the shares are reportedly owned by the billionaire investors Thomas and Andreas Strüngmann. Other major investors appear to be Temasek Holdings (Singapore government), Pfizer, and Fosun Pharma. The company had previously partnered with Pfizer to develop an influenza vaccine. The technology, mRNA, was on the radar for vaccine development. The firm received €50m from the EIB in December 2019 (unrelated to covid – cancer treatments).
(16) Gallié and Ott, 2021, Mécanismes de coordination des acteurs et des démarches en matière de recherche liée à la Covid-19, IGESR
(17) Please also note projects such as the European Lead Factory and EU-OPEN-SCREEN.
(18) GloPID-R is a relevant initiative, see, e.g., Norton, et al., 2020, Preparing for a pandemic: highlighting themes for research funding and practice – perspectives from the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), in: BMC Medicine. But I suspect it has limited reach outside a relatively small group of committed public health experts (based on the members listed on its website).
(19) COM(2021) 355 final/2, 6 May 2021 (p. 5).
(20). Prof. Dr. Cuhls, cited in the previous section, notes as relevant a recent call from the Millennium Project for a new ‘UN Office to Coordinate Global Research to Prevent Human Extinction’.
(21) Meeting of the High-level Group on the Health Emergency Preparedness and Response Authority (HERA) and HERA Incubator, Summary Report, 19 July 2021 (p. 2). Meeting minutes and other documents are available under HERA HLG (E03770) in the Register of Commission Expert Groups.
(22) Meeting of the High-level Group on the Health Emergency Preparedness and Response Authority (HERA) and HERA Incubator, Summary Report, 19 July 2021 (pp. 2 & 4).
(23) In a subsequent report, I hope to look at how an R&D response to a range of crises (not just covid) might be woven together across EU, member states, and the private sector. This report will look at the legal frameworks, as well as the various policy instruments. I hope to complete the work in 2022 (but given this is a voluntary, unpaid, activity, no guarantees as to timing…)