What if they never develop a vaccine for the Coronavirus?
I pose this question not as a doomsayer. Life is trying enough as it is, right now, without my throwing more muck into this quagmire we’re in. I ask this because if it is a possibility, then we have to imagine our response. In addition to be a writer of speculative fiction (and therefore, someone who trades in what if, day in and day out), I’m also a former aid worker and student of international relations. So I’m pulling all of these interests together to consider what the world may look like.
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The proposition that there will be no medical fix is not far-fetched, not at all. It’s eleven years since SARS; they never developed a vaccine for that. It’s 30 years and 30 million deaths since HIV/AIDS emerged, and there’s no vaccine for that, either (medications have been developed to keep it in abeyance, but that took 20 years). Professor David Isaacs, an expert on infectious diseases, believes developing a vaccine is no certainty, and the more likely outcome is that lockdown measures will be the primary mechanism for fighting the pandemic.
Furthermore, it is not clear that having had the virus gives you immunity. Some scientists hypothesise that immunity could be short lived, lasting only several months (this one of the many reasons we should not listen to the death cultists advocating a ‘herd immunity’ strategy). Worryingly, some preliminary studies have shown this could well be true. We could therefore have multiple waves of the Coronavirus washing around the world.
I pose this question because in Australia – and in many countries – the current plan is a six month plan. Flatten the curve. Okay, great: the early evidence suggests Australia is doing just this. Then what? What happens if we flatten the curve and our healthcare system stays intact? There will not be a vaccine in six months, this we know. In a best-case scenario one will be approved in 18 months, and will get to us in perhaps two years. Again, there may never be one.
Flattening the curve will therefore never be sufficient. We cannot survive in this half-life forever, where many of us are unemployed (I have lost nearly all of my paid work); where most of us are locked down, unable to leave the house except to shop for groceries or exercise. We can get a ticket for the crime of eating a kebab in public, for Christ’s sake.
So, again, what if? How does society move on from this purgatory, and what will the world look like if we do?
There are different timelines open to us. The choices made by our leaders, but also by us as individuals, will determine our path.
The first implication is this: the curve cannot simply be flattened, it must be crushed. The virus has to be eradicated. Some experts have said this impossible, but I predict that parts of Australia – Tasmania, Western Australia, and the Northern Territory – will have zero new infections within three months. A number of experts have called for a short, sharp lockdown, to eliminate the virus. Again, while some say this won’t work, the obvious rejoinder is: why not try? The linked article argues that we can test it for two to three incubation periods (4 – 6 weeks). In the grand scheme of things – the minimum 2 years we’re expected to wait for a vaccine – why not use 2 months to trial a complete lockdown? The worst outcome will be a massive reduction in infections. Another recent Australian study has shown that with a 90% compliance rate to the social distancing measures already enacted, there is a chance we could bring the number of cases to zero. In any case, it appears New Zealand is attempting the elimination route. God I hope they succeed, and show a way through for the rest of us.
Here’s the thing: if it does work, economic, social, and artistic life can begin again. A semblance of our national life will return. We can have a drink with mates, go to the footy, the beach, a concert, a festival. We can send our kids to school. We can hug an old friend.
But that is only within our borders.
If they never develop have vaccine, Australia’s borders will remain closed, potentially for years. International trade would still be possible, with proper biosecurity measures in place. Movement of people between safe zones may also be possible. I can imagine a scenario where New Zealand and many Pacific Islands remain accessible. I can also foresee scenarios where zones within other countries become clear, especially those with advantages of natural terrain – Hawaii, for example. But in a no-vaccine world, Australian borders will allow close to zero movement through them of people, in either direction, to zones still rife with the virus.
This, obviously, will change the way we view the world, and ourselves. We will be more fearful. Think now of how we view strangers, now, in our neighbourhood. When I go outside for my daily exercise, and see someone else on the path, I veer out of their way. I am untrusting, even paranoid about these others. What will this paranoia do writ large, to the psychology of communities and of nations?
The death toll could approach that of the Spanish Flu (50 million). We have seen the impact of the Coronavirus mainly in the wealthy and more powerful countries (Europe, the US, and China). As bad as it has been, the impact in poorer countries will be devastating.
I say this because an advanced economy with a good healthcare system, like Italy, has a mortality rate of 12%. Now, there are some obvious caveats here. The 12% figure coming from Italy assumes everyone who has the virus has been tested. This is not the case. Many will have had mild or no symptoms, bringing the mortality rate down. Italy also has an older, and therefore more vulnerable population.
The broader problem with the mortality rate is that no-one agrees on what it is. There is furious debate among scientists. The prestigious The Lancet published a paper that estimates a mortality rate of 5.7% in symptomatic patients. The Chief Medical Officer of the UK believes it closer to about 1%, if asymptomatic cases are considered.
But the primary problem with predictions on mortality rates, as I see it, is that they are predicated on the quality of a nation’s healthcare system, and the capacity of that country to ‘lock down’ its inhabitants. Thus the correct question, for much of the world, is this: what is the mortality rate when there are no functioning hospitals, and no ability to lockdown? Italy has a high mortality rate, but it has been confined to a small part of the population. It 
has the infrastructure to keep people in their homes, safe.
But what if this is not possible? Take a tweet from an Indian doctor that went viral last week:
“Social distancing is a privilege,” wrote Dr Jagadish J Hiremath. “It means you live in a house large enough to practise it. Hand washing is a privilege too. It means you have access to running water. Hand sanitisers are a privilege. It means you have money to buy them. Lockdowns are a privilege. It means you can afford to be at home. Most of the ways to ward the corona off are accessible only to the affluent.”
I find myself wary of contemporary conversations about privilege, as they primarily involve the educated and wealthy elite yelling at each other online. But the doctor’s use of the word here is apposite. The ability to practice social distancing is a privilege. One-sixth of the urban population of India – a number that reaches into the hundreds of millions – live in slums, without a clean water supply. Globally, approximately 2 billion people do not have access to safe drinking water.
Let’s take Bangladesh, with high population density, weak governance, and a precarious health system. While the 
population of Bangladesh and most other poor countries tend to be far younger on average (the median is 27.8 in Bangladesh, 47.3 in Japan), and therefore more resilient to the disease, there also large swathes of the population that have compromised immune systems. If we take the one million Rohingya refugees in camps currently in Bangladesh, for example, malnutrition is widespread. 40,000 people pack each square kilometre, in these camps. Nearby Bangladeshi communities, already resentful of the presence of these refugees, could turn to violence if they fear the virus will spread to them.
This will be replicated in many parts of the world. Porous borders, weak healthcare systems, ensuing civil strife, and even conflicts between nations. More: wealthy nations won’t be able to help. Equipment, yes; human resources: no. Those vital personnel sent by advanced economies at times of crisis – I was one of these personnel, in a former career – to help rebuild or to heal, will not be coming. Thus, a scenario where the mortality rate is as bad as Italy, but applied to most of the population, is absolutely possible.
When this is over, the death toll from Covid-19 and associated conflicts will number more than 50 million.
The world will change
My view, as someone who has travelled extensively, lived and worked through Southeast Asia, and as a student of international relations, is unsurprising: things will fall apart, the centre will not hold. Nations will become more insular. This will have both good and bad implications for Australia. On the positive side, manufacturing in key industries – such as healthcare – will be brought back to Australia as a matter of national security. Rightly so. Yet this insularity will breed distrust and fear of the outside world.
Elsewhere, conflicts will flare. As argued above, those fleeing the virus will come to cities and nations that will have every right to refuse refuge. It will get ugly. Global systems and the international rules-based order – the UN, the World Trade Organisation, the World Bank – will be undermined, perhaps fatally.
China, the cause of all this, will benefit. They lied about the virus, persecuted heroic doctors who blew the whistle, and called ‘racist’ any country that instituted travel bans on China. But they will come out of this ahead. Already they are turning it into a propaganda victory, offering medical aid around the world, including to Europe. The US, already teetering as a global power, will be further weakened. Its poor governance structures exposed, its erratic leadership compounding the crisis.
As I said at the start, I am not prophesying all of this as a certainty. I am simply putting it forward as a possibility. One we must prepare for. Whether a vaccine is found in 18 months, or never, this much is clear: Australia’s borders will be closed for one to two years – as will the borders of most of the world. If we accept this as likely, Australia – and other countries and cities with comparable geographic advantages – should consider dedicating themselves to eliminating the virus. While life may never be the same again, at least, in this way, it will still be life. We have the chance to sustain our fundamental need for human connection; to work, to play, to feel the sun on our faces on a pristine beach, to embrace an old friend, to yell at the referee at the footy.
Australia now has genuine choice to make; that we even have one is a privilege.
