“People will come to recognise that wearing face masks reduces all respiratory infections and there may be a greater willingness to wear them each winter as they did in Asia after SARS in 2002,” he says.
But while mask-wearing may be a nice and polite thing to do, Peter Openshaw, professor of experimental medicine at Imperial College, London is sceptical about future uptake. “Over time, Covid will bed down by changing its nature, and with people accumulating lots of immunity it will become one of the winter viruses,” he explains. “Without the urgency, I’d be surprised if people will be prepared to wear masks.”
We won’t need to use a vaccine passport
All the experts agree that vaccine passports to get into big events such as cup finals or concerts are a political issue, rather than a health-based one and are mainly a nudge for people to get boosted or vaccinated and to negatively impact anti-vaxxers.
“If vaccines don’t prevent transmission, the reason for having vaccine passports is to stop severe disease and hospital admissions,” says Tim Spector, professor of genetic epidemiology at King’s College London and founder of the Zoe app. “For a while, I think proof of some sort will be required although that’s more likely to be a recent negative test or antibody test or proof of repeated infections – rather than just proof of having the vaccine.”
But Openshaw reckons it won’t be long before certification won’t be necessary. “If it becomes like other coronaviruses over time, they will just be a temporary measure while we have a high hospitalisation and mortality rate,” he says. “We don’t have vaccine passports for influenza, which has been a significant threat for many years.”
Covid will wane as immunity builds
According to Paul Hunter, professor in medicine at the University of East Anglia, our grandchildren’s grandchildren will be catching SARS-CoV-2 – the coronavirus that causes Covid. “This isn’t the first time a virus of this kind has appeared,” he explains. “It’s been hypothesised that the Russian flu, which emerged in 1889, wasn’t actually influenza, but was caused by another coronavirus, OC43. The Russian flu pandemic caused four or five waves of disease over the following five years with many deaths, after which it seemed to disappear. OC43, the potential cause, still circulates today, though rarely causes severe disease and it’s either asymptomatic or appears as a common cold.”
Hunter claims that in the UK and other countries with high vaccine coverage and also high numbers of past cases, most people will have some form of immunity to the virus. “In England, for example, it’s estimated that at the beginning of September over 94 per cent of the adult population had Covid antibodies,” he says. “And as more people’s immunity is boosted over time by natural reinfections or booster immunisations, we can expect an increasing proportion of new infections to be asymptomatic or, at worst, cause mild illness. The virus will remain with us, but the disease will become part of our history.”
Dr Elly Gaunt, group leader at the Roslin Institute at the University of Edinburgh, where she investigates the genetic coding strategies of viruses, agrees: “There were lots of similarities between OC43 and this virus – around 10 per cent of people even had persistent symptoms, just like we have now with long Covid,” she says. “We expect the virus to adapt – just like it has done with omicron – but a build-up of exposures to it will increase the backdrop of immunity and the virus will get less clinically severe. That’s what we can predict over the next five to 10 years.”
McKee, however, warns it is wrong to suggest that microorganisms inevitably evolve to become milder. “The plague or smallpox did not get milder and there is no intrinsic property of viruses that make them become less dangerous over time,” he says. “If they decline it’s more usually to do with changes in immunity including vaccines and exposure.”
We’ll still need an annual jab
Chief medical officer Chris Witty has already predicted the development of a “universal jab” that protects against all variants which should be ready at some point in mid-2023 as well as the arrival of several new antiviral drugs, which should do the “heavy lifting” for the NHS.
This upcoming redesign of the vaccine comes as no surprise to McKee, who asserts that variants like omicron may make it necessary but warns there is “a small danger the immune system might not recognise a new vaccine in those immune to the earlier variant.”