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Issues such as perception of vulnerability, frustration and fatigue with restrictions all affect how people behave.
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COVID-19: What happens next?

As we have seen, the COVID-19 pandemic is extraordinarily dynamic, taking dramatic turns for better or for worse each week. The interconnectedness of today’s world means that what happens in one country can quickly impact others.

Some believe the outcome of the pandemic will now unfold as a race between vaccinations and new variants. However, there are other factors that will impact how the pandemic progresses.

This article lays out a number of these key factors. By working with our sector specialists and health professionals, we can use these factors to better anticipate the associated challenges and opportunities where we live and work, to manage risks and optimise operations.

Bringing an understanding of these risk factors into design and planning will make our communities more resilient, not only to the threat of COVID-19 but to future infectious disease threats too.

Vaccines

Vaccines are our best weapon to beat the pandemic, after being developed in record time and proving more successful than expected in clinical trials and real-world observational studies. However, there are still significant obstacles. As we’ve seen in the first few months of the global vaccine roll-out, there are vast disparities in vaccine availability. Some countries with low vaccination coverage are experiencing large surges in infections. Even countries with reasonable vaccination coverage will struggle to vaccinate all adults due to vaccine hesitancy, with many people unwilling to be vaccinated due to fears of various risks, whether real or imagined. Inconsistent government support for certain vaccines adds to these fears. The duration of protection and ability to stop transmission are still not fully understood, but vaccines will likely require periodic booster doses tailored to new circulating variants.

New variants

All viruses mutate; it is part of their evolution. There are thousands of variations of the virus that causes COVID-19 but most of these involve minor, inconsequential mutations. However, in some countries, highly transmissible new variants are tearing through populations faster than they can be vaccinated, with devastating consequences. Variants of concern may affect transmissibility, vaccine or treatment efficacy, protection against re-infection, or even severity of disease. Countries experiencing large outbreaks are the most likely places for new variants to arise, simply due to probability. If a variant were to emerge that significantly reduces vaccine efficacy or evades immunity from previous infection, this could set back global progress towards ending the pandemic.

Politics

Political leaders are influenced by multiple factors and their priorities differ for a variety of reasons. This is reflected in how they do or don’t apply public health guidance or restrictions. Other dynamic considerations include upcoming elections, political or economic pressures from businesses or constituents, and geopolitical tensions or diplomatic trends, where national interests may conflict with international interests. Early in the pandemic we saw imbalances in the global personal protective equipment (PPE) supply; now there’s a similar situation with vaccines, with many countries prioritising the entirety of their adult population over a more strategic and equitable global distribution that would protect the highest-risk individuals in every country.

Economics

In addition to the loss of human life, COVID-19 has devastated economies in many countries. Cost-benefit analyses have influenced decision-making around imposing restrictions. The benefits of some interventions are simpler to demonstrate, where a modest investment yields high returns for the prevention of transmission, such as compulsory wearing of masks. In other cases, the analysis is more complex where broader economic activity is affected, for example the closing of hospitality venues. The ability of governments to offer subsidies or benefit packages impacts the population, and a lack of economic support can lead to greater inequalities. As some countries achieve low infection rates and higher vaccine coverage, there is significant pressure from affected sectors to loosen restrictions.

Health system capacity

It is important for governments to prevent the saturation or collapse of healthcare systems and to protect health workers’ mental and physical health to sustain a working health system for the future. When the health system nears capacity, more restrictions are generally put in place to protect existing services. The focus on COVID-19 has also displaced other needs like cancer screening and elective surgeries, which will be a continued burden on population health.

Research

There are many questions that, once answered, will contribute greatly to improving COVID-19 outcomes. This includes research on new treatments, a better understanding of ‘long COVID’, and the science of severe disease. Once these topics are better understood, we will be able to better manage COVID-19 cases and prevent severe illness and death – reducing uncertainty, fear, and the need for restrictions.

Human behaviour

Issues such as perception of vulnerability, frustration and fatigue with restrictions, worsening mental health, exposure to misinformation, or financial pressures all affect how people behave. Despite restrictions and measures to reduce infection risk, some may not comply; others may even resist returning to activities as it takes time to regain confidence. Behaviour can be influenced with effective communication strategies involving trusted community leaders, consistent messaging, transparency and accessible language or visuals.

Geography

The impact of the above factors varies substantially around the world, so must be viewed in the local context. Furthermore, geographical influences such as border restrictions (and their effectiveness) and the movements of people within countries affect the spread of the virus. For example, countries with long and porous land borders are especially vulnerable to changes in the circumstances of neighbouring countries. Geography can also affect the ease or difficulty of reaching hospitals, vaccinating rural populations, and carrying out surveillance.

Dr Anthony Huszar

Mott MacDonald global health security lead

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