If you promise, you have to deliver

Abstract

COVID‐19 highlighted the importance of science and scientists to produce vaccines, cures and diagnostics. But scientists need to be careful not to overpromise on what they can deliver.

The COVID pandemic has changed many things, and it becomes hard to remember the way we lived before China reported the first cases of a viral pneumonia in January. When news came from Italy that the disease had arrived there, it was no longer a distant problem confined to Asia. A football game in Bergamo and after‐skiing parties in Austria caused new outbreaks all over Europe and COVID‐19 became a tsunami. Tsunami is a large tidal wave, caused by an underwater earthquake or volcanic eruption, that progresses inexorably over long distances. Appropriate. Nobody had information on how bad it was or how far it would penetrate into the community. Ministers and reporters asked questions: Was there sufficient personal protection equipment (PPE) available? Were there enough respirators, ICUs, and hospital staff to take care of the sick? A diagnostic test was available, but were there enough laboratories, reagents, and trained personnel to perform the large number of tests needed to contain the virus? And that list became longer as time went by.

Most countries reacted by reducing social contacts and dusted off any plans for such an emergency. I was in Ireland, and the seriousness of the situation became clear when pubs and churches closed. Some countries were more insouciant. The UK, the United States, and Sweden thought this was a “fake wolf call” and decided to protect their economies instead of the population. Brazil and some other macho‐led countries followed suit. A big experiment was under way: Which was the right road to follow? Hindsight tells us that the more the rapid restrictions were put in place, the better the health outcome, while the economies of all countries have been hit massively.

We also realized that there is an army of people, mostly in low‐paying jobs, who are essential for keeping society functioning during a lockdown: hospital staff and cleaners, truck drivers, supermarket staff, or postmen. Equally important for the front‐line workers was importing essential items such as face masks and PPEs from low‐cost countries. At a time when putting up shutters was a primary response, we needed to keep the door open to people and imports. But I fear that society’s sudden appreciation of essential low‐wage services in food production and distribution or hospitals may be quickly forgotten once we move back to where we used to be.

Society had another realization: Research and researchers are needed. “Give me a cure” and “Give me a vaccine” were the challenges for the global scientific community, to which they rose. Some researchers quickly became media stars and oracles who guide political decisions. They need to be careful though to avoid exuberant promises and to spend as much time explaining that finding a cure, vaccine, or rapid diagnostic test is hard and slow work and that the outcome is likely not perfect (Gannon, 2007).

It is thus useful to look at the mismatch between what was promised and what has come to fruition so far. While waiting for the Godot of a vaccine, many have been looking for alternative and effective treatments. Most citizens understand a “treatment” as the equivalent of a paracetamol when a cold or headache interrupts their life. Initially, they were led to believe that there was a pill on a shelf somewhere and that some researchers would eventually find it. Any drug that had anti‐inflammatory or anti‐viral properties was tested. Viral inhibitors, ACE inhibitors, anti‐malarials, vitamin D, and Chinese herbal medicines all had their virtues touted and given promising advance notice on TV. Rigor was not a requirement for papers published in haste by clinicians on the front line. Getting information out while there was total ignorance of the pathology wrought by the virus was important for the professionals, but it caused confusion among the public. A cure reported on the news yesterday became a failure today. A case in point is hydroxychloroquine whose popularity ebbed after the confusion of retractions (Gannon, 2020). After peristaltic gyrations, treatments have been found with specific benefits but the meaning of the word “treatment” has changed. It is now something that saves lives in hospitals but does not stop the infection in its tracks at the first sneeze. For most of the public, though it may seem that what was delivered did not match the promise.

The discussions about a vaccine came early and, again, the public was brought to believe that COVID would be over once a vaccine is available. It will be interesting to see how that plays out. The global research response has been unprecedented, and there are as many vaccine trials as horses in the Derby or Melbourne Cup. The four leaders that are galloping through the final trial phases show promising results, and Russia, at the time of writing, claims they have finished ahead of the others. In addition to about 20 vaccine candidates in clinical trials, there are almost 200 ready to get into the parade ring. If any vaccine is proven to be effective, who will be first to get the magic shield of protection? Will it work on people of all ages? Will there be a significant sub‐set of people who suffer a bad reaction from the jab? Will it be a question of the depth of the national or personal wallet? How long will it take to make billions of shots available? Some countries have not waited for the “All Clear” message and have pre‐purchased multiple candidate vaccines. But is the public, sustained by the promise of THE VACCINE, ready to understand that the chances are not very high of making a 100% effective vaccine with no side effects? Will the public wonder again why there is a difference between the perfection that was promised and the reality that is delivered?

We now know that the tsunami passes from one country to the next. There is the calm after the storm, and people come out of their lockdowns and get back to their normal lives. The voices arguing against restrictive decisions become louder. Slowly, with the hubris of survivors, the lessons learned are forgotten and the cautious behaviors that were adopted are abandoned. Soon, social distancing seems like a fad out of fashion and masks have become the symbol of the side a person is on in the discussion between protective measures to keep the health system functioning and the need to get the economy back on its feet. Nevertheless, COVID has not gone away. Countries that basked in self‐congratulations at flattening the curve now find that it re‐appears in work or play areas where the hygiene guidelines on noticeboards have faded. Changes away from caution allowed the virus to start a second resurgence, and wave after wave now hits countries where it was thought to be under control. Borders, which seemed theoretical or passé in a globalized economy, are again patrolled by the army and police. Governments reenact lockdowns and closures. Masks become ubiquitous. We now have a much better understanding of how to surf the waves and social measures are of greatest importance. We know that we will be “dumped” into a churning surf if we do not get the balance right.

Any easy wins from re‐purposing drugs have already been harvested. Novel drugs will eventually emerge, but their arrival is likely years down the road rather than months. The official view is that a vaccine and/or an aspirin‐type pill will be the solution. Researchers who support those lines, without caveats, are in danger of a significant backlash if they do not deliver; this is not a grant application. On a regular basis, one hears claims that “we have a great new drug in development. If we could get funding it would cure Covid”. While appreciating optimism and enthusiasm, the research community has to face the facts and say loudly that, at present, we are left with social distancing and hygiene as our surfboard until effective products that have passed all the safety tests become available.

This means adopting the new depersonalized lifestyle, which creates many problems. Mental health issues become more widespread, living in close quarters can increase the risk of domestic violence, loss of income and jobs hurt people, and whole industries suffer from lack of customers. Life loses its sparkle. Those who were infected are known now to have a significantly increased risk of longer‐term health problems—it is a nasty virus. In the end, we have to be fatalistic and accept that we have to live in this uncomfortable life for as long as the virus circulates. The optimistic view is that it will mutate and lose its pathogenicity. However, there is no evidence yet that this virus will oblige. The interim observation is that mortality rates are declining as clinicians have learned how better to treat viral pneumonia. The waves will have to be surfed for some time with the exhilaration of being upright when the front has passed being matched by the need to prepare for the next one. And more stormy weather is still on the horizon. Research will have to react to the inevitable setbacks it will face and get back on their chosen surfboard. Scientists have the opportunity to ensure that society finally sees the special contribution they make. Politicians will need to concede that the people in the white coats are essential to save lives and the economy. However, this is dependent on not over‐promising on timelines or performance and in delivering products that align with the expectations of the public.

Conflict of interest

The author declares that he has no conflict of interest.

EMBO Reports (2020) 21: e51827