Ten lessons from the first two years of COVID-19

Two years ago today, the World Health Organization (WHO) declared that COVID-19 was a pandemic. Since then, more than six million lives around the world have been lost to the disease, and daily life has been upended in countless ways. Some countries are now regaining a degree of normality, though the threat of another variant-induced wave of disease remains. On this second anniversary, we reflect on ten things the world has learned through the course of the pandemic.

1. Infectious diseases are a whole-of-society issue. One in every 1,300 people alive in 2019 has died from infection with SARS-CoV-2, but when we look back on COVID-19 in the future, the direct health impact may not be what we remember most. Indirect effects on health, as a result of delayed routine and preventive care, overstressed healthcare systems, and the increased mental-health burden, may eventually seem more significant. Children—especially those from low-income families—suffered significant harm during prolonged school closures. And the economic harm and dislocation that the pandemic caused have decreased the quality of life for people around the world.
2. The vaccine development paradigm has been transformed for emergencies and, potentially, for more. Two years on, it is easy to forget how remarkable the development of COVID-19 vaccines was. Moving in just 326 days from a genomic sequence to the authorization of a COVID-19 vaccine by a stringent regulatory authority shattered all previous records. In addition, biomedical science delivered multiple vaccines with high efficacy against severe COVID-19 and a strong overall safety profile. The bar has risen, and there is now serious discussion of what it will take to cut the time from sequence to authorization to just 100 days for the next emerging threat.
3. Conversely, weaknesses in vaccine manufacturing and equitable distribution will require systemic change. Despite the successes of vaccine R&D, there have been persistent inequalities in access to its fruits. Allocation is an important question. So is manufacturing. Significantly increasing global vaccine-manufacturing capacity for emergencies would help ensure rapid access to future vaccines for the greatest number of people. The location of capacity also matters. Low-income regions are planning to develop their own local capacity so that they depend less on global agreements and long supply chains during the next infectious-disease crisis.
4. Trust is one of the most delicate but critical requirements for an effective pandemic response. Before the pandemic, it might have been assumed that safe vaccines offering high levels of protection against a frequently fatal and society-altering disease would be in high demand. In some countries, they have been, but in others vaccine skepticism has limited demand.¹“Estimates of vaccine hesitancy for COVID-19,” Centers for Disease Control and Prevention, cdc.org. In this pandemic, like so much else, success in public health has depended on both the public’s trust in government and in a shared social contract among citizens. The same principles apply to companies deciding on their policies for the return to in-person work. Trust is hard to manufacture during a crisis. Building confidence in specific areas—including biomedical science—can be especially important.
5. Agility and speed will be the new basis for differentiation. The pandemic has consistently defied expectations; our response to it has evolved through multiple chapters as new information and tools became available. Emerging evidence—on such topics as the benefits of masking, the chance of repeat infection, the risk of new variants, the difficulty of achieving herd immunity, and the benefits of boosters—has required policy and behavioral changes. Countries, businesses, and other stakeholders have had to balance the benefits of incorporating new evidence into their response plans against the confusion and frustration that frequent changes can cause. Our research shows that agility and strong communications have allowed some companies to respond more effectively to the crisis than others.
6. Government policy matters—but individual behavior sometimes matters more. This dynamic played out in a couple of ways, starting with lockdowns and mask mandates in early 2020. These were largely effective, but their effectiveness varied, depending on how seriously people took the rules and the ways in which people mixed. Later that year, when several manufacturers announced vaccines within a span of several weeks, hopes soared that countries could reach herd immunity quickly. That dream was no match for the realities of vaccine hesitancy. Around the world, a significant part of the population declined to take the vaccine. That may have helped SARS-CoV-2 to mutate and spread.
7. Schools are the true fulcrum for the functioning of society. We always knew this in an abstract way. But the pandemic brought it home. While school shutdowns were clearly necessary, they have put “a generation of kids at risk,”²“Resetting education: lessons from Sesame Street on helping a generation at risk,” World Economic Forum, October 2, 2020, weforum.org. wrecked the mental health of many people,³“Mental health toll of pandemic ‘devastating’ – WHO,” Inquirer, October 5, 2020, inquirer.net. and upended households around the world. Online learning proved to be “a poor substitute” for classrooms; kids still haven’t caught up with the lost learning. Lower-income students are further behind than others. The stress has not only been incredibly difficult for children and their parents and teachers but also boiled over into political activism in many places, defining elections in some.
8. Work will never be the same. The pandemic’s first year proved three things: our old definition of essential workers was inadequate; the numbers and kinds of workers we need are profoundly different now; and most knowledge workers can do the job from home. In the second year of the pandemic, people across the income spectrum internalized those lessons. Millions quit—especially women—and people who kept their jobs are questioning the old assumptions. Employees and employers see the world differently. That disconnect is having lots of effects. For one thing, it’s sharpening a labor shortage that had been slowly brewing. It is also causing owners and occupiers of real estate to rethink the role of the office.
9. Economic stimulus works, but only in concert with strong public-health measures. In early 2020, there was a public debate on the trade-off between protecting people from the virus and protecting the economy. At that time, we suggested that this framework was off the mark—there is no trade-off. Two years on, the facts are clear: no country kept its economy moving well without controlling the spread of the virus as well. The inverse is also true: countries that struggled to control the virus suffered worse economic outcomes. The size of the fiscal-stimulus package did not matter much. The ability to solve simultaneously for both problems, the virus and the economy, did.
10. Whether we experience these problems again will depend on the investments and institutions we establish now. In addition to the lives lost, the current pandemic has cost the global economy an estimated $16 trillion. Our article “Not the last pandemic” describes how new investments of $5 per person a year globally for disease surveillance, “always on” response systems, disease prevention, the preparation of hospitals, and R&D can help the global community respond more effectively to the next major infectious-disease threat. The global community, including the G7 and G20, has now begun to describe the potential architecture of a future system. Countries are dedicating new resources to the topic. Finding ways to track preparedness and to ensure that new funding is well spent will be critical. Clearly, the world understands that it must be more prepared for the next crisis.

If there’s one theme throughout these ten lessons, it is the need for humility. Many of our orthodoxies from past decades have been upended, and the need to continually learn has never been clearer, so that we can continue to adapt to today’s crisis and prevent the next one.