Let us give the future another chance [1]

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Alfredo Aguilar

Jun, 2020
MUSIC:

When the toasts and the fireworks celebrating the arrival of 2020 were already over and the news of New Year’s Day arrived, they were boringly similar to the ones of the previous days: joy and tears about Brexit depending of your personal position; fires and droughts in Australia; a Shiite militia attacking the US embassy in Iraq; demonstrations in France by the gilet jaunes; negotiations for a leftist coalition government in Spain; and, of course, the myriad of New Year’s resolutions that were carried over and repeatedly forgotten year after year.

No one was anticipating that the world’s largest catastrophic event since World War II had already started in a popular market in Wuhan. The initial news several weeks later was scarce and contradictory due to the opaque communications policy in China and the rest of the world’s indifference. What followed is well known. Nevertheless, what is shocking was the initial lack of reactions and the indifference and confusion of governments and international organizations: hence the perplexity of most people across the globe.

The forced and prolonged confinement is giving us another opportunity for deep insight regarding a few basic questions that the frantic activity of the pre-pandemic times did not allow us to consider. Some basic, fundamental questions are:

Do we care about global threats and global challenges?

We are learning the hard way that threats or challenges are global. They affect the entirety of the planet, and the problems raised are beyond any individual country’s ability to confront or to solve them. They require a global, coordinated effort to address them in a meaningful way. There is a consensus that the current global challenges affecting the biosphere, the ecological system integrating all living beings and their relationships with the inorganic or non-living matter, may seriously endanger our future conditions of living and of survival as a biological species. The biosphere is an extremely thin and very fragile layer, extending from a few kilometers into the atmosphere to the deep of the oceans. However, most living beings live in a layer of less than three kilometers: two above the sea level and less than one below. We can easily visualize the fragility of the biosphere if we imagine that the Earth is of the size of a watermelon 40 cm in diameter. Then, the biosphere would be about 0.1 mm thick on the surface of the watermelon, thinner than a human hair. Frightening, isn’t it? Therefore, there are good reasons for all to be concerned about global threats and global challenges.

Photo_ Augusto_ watermelon child_ CC BY 4.0

As I was saying, there is consensus in the scientific community about the nature of the global challenges that affect the biosphere and, therefore, humans. These are, namely: climate change, food security (related to, but not the same as, food quality), human demographic increase, preservation of our natural environment, including the oceans and affordable and environmentally friendly energy. To this list we must add another element: new and emerging infectious diseases.

How do we fight global challenges and promote economic and social prosperity?

This question takes me back to my school years, where I struggled in mathematics class, trying to solve problems featuring several equations with several unknowns. With more pain than joy, I finally learnt how to solve them. However, the aforementioned question is far more difficult to answer, as it has several unknowns. What is of more concern is that we do not even know the nature of all these unknowns. Anyhow, no matter its difficulty, finding a viable solution is key to maintaining human civilization as we know it.

In most of our societies there are quite a few homeland saviors with ready-to-use recipes prepared to solve all these problems for us. The caveat behind their pompous promises is that all these solutions have repeatedly failed already, in different continents and at different times. In all cases there have been catastrophic consequences for their populations. Attempting the same approach over and over will lead again to failure. Populist approaches, whatever their political sign, will not bring us any closer to a solution, no matter their number and the noise made by populist supporters. We need to consider three elements to be able to address seriously and efficiently these challenges: [2]

1.  There is a need for a holistic approach which acknowledges that natural resources, and particularly biological ones, are finite.
2.  There is a physical limit to the capacity of the biosphere to produce and renew the world biomass.
3.  The current economic paradigm of unlimited economic growth based on a steadily increasing production of goods is biologically unsustainable and thermodynamically false.

The forced and prolonged confinement is giving us another opportunity for deep insight regarding a few basic questions that the frantic activity of the pre-pandemic times did not allow us to consider.

Until now, efforts to address global challenges have been approached in a haphazard way. Thus, most initiatives developed to fight and to mitigate climate change have been formulated ignoring other challenges, such as the human demographic explosion or the threat of food security. While all efforts made by the United Nations (UN), its agencies and many governments and non-governmental organizations all over the world are extremely useful and must be applauded, it is evident that this sectoral approach will have limited impact should a more holistic approach not be put in place. Two new tools have been recently suggested to conceptually and operationally integrate most challenges derived from global threats; they are bioeconomy and biodiplomacy. [3][4] It is beyond the scope of this article to provide deep insight into these two concepts. However, in the current context, it is important to understand that the bioeconomy is geared to lead the transition from a linear economy, dependent on fossil fuels, to a circular and sustainable bio-based economy, able to operate within the ecological limits and to generate jobs and economic growth. On the other hand, biodiplomacy’s remit lies in the critical need of having a holistic approach for the effective and enduring global management of natural resources of the planet. This approach is a departure from the current economic paradigm of a limitless increase of production, geared towards more inclusive societies, reducing waste, unnecessary production, and consumption of goods. In summary, this would lead towards a circular and sustainable bioeconomy.

We cannot prevent new pandemics, nor other global challenges such as climate change, food security and others. Notwithstanding the above, we can, and we must act now to diminish, adapt, and mitigate their impact. All global challenges are intertwined and must be addressed in an efficient way. The Club of Rome has recently published a study addressing these issues. Their main message is to build more rational and sustainable societies by generating a new social catharsis, with new values deviating from the mirage of unlimited economic growth. [5]

How much time do we have to react?

Procrastination is the preferred attitude of many, but it may be a disaster for society and for mankind. There are always solid reasons for leaving for tomorrow what should have been done yesterday. However, the COVID-19 pandemic has tragically evidenced the consequences of delaying important decisions. I wonder where those «experts» and «visionaries» are those who now, with arrogance and an air of superiority, said that COVID-19 was nothing but severe flu, that there was nothing to worry about: that panic was more dangerous than the virus, that the mortality rate had been severely inflated and, besides, that the flu also kills hundreds of thousands every year – so why make all this fuss? At the time of their «predictions,» the infection was out of control in China and extended to other countries, and the Ro [6] was between two and three. Everyone with a minimum knowledge of microbiology knew that, by then, the epidemic was already unstoppable. All these visionaries with their crystal balls have faded away, along with their tarot cards reading the future. At that time, some governments punished the scientists and doctors that crudely described the reality and who dared to say that the «king was naked.» Other government leaders chose to surround themselves only by experts ready to provide the advice the government wanted to hear. Finally, a large majority simply did not pay any attention until it was too late. For many politicians, COVID-19 was a nuisance interfering in the «grandeur» of their actions to go down in history. At the end, globally, reactions were late, hesitant, uncoordinated, and often with contradictory initiatives with respect to other countries. When this pandemic is over, epidemiologists will be able to write an «Atlas of avoidable deaths by COVID-19,» with the hope that future leaders may be more diligent than the current ones. Compared with the so-called «Spanish flu» of 1918, science and medicine have made tremendous progress in all domains since those times. Yet, when we compare the reactions of public authorities to the pandemic then and now, one can hardly see any significant differences. [7] Hence, the relevance of the question: What is needed for our governments to be concerned and proactive, and not just reactive, to future epidemics? The science and the technology are out there, but the political eagerness and leadership to deal with the pandemic is sadly missing. These leaders are not the ones capable of addressing the complexity and the strategic thinking required to lead initiatives towards mitigating the effects of the global challenges. One must agree with Greta Thunberg when she addressed the world leaders at the UN Climate Action Summit in 2019 and rebuked: «How dare you!» while they engaged in long circumlocutions, without making any decisions on the issue of climate change.

In dealing with global threats of the biosphere, it is necessary to have on the one side a Cartesian approach, and on the other hand, an understanding that the ecosystems forming the biosphere are the sum of all its components and of the multiple interactions among them. Only with this bifocal approach will future leaders and their societies be able to address the global challenges in a meaningful way. There is no other way. History will analyze with the perspective of time how we were able to face the COVID-19 pandemic and the remaining global challenges. Let us hope that history books will mention how in the 21st century, global and effective measures were taken to avoid irreversible damages to mankind. Ensuring this is now our duty to future generations.

The world needs more science

Human history is based on a successive series of certitudes, undisputed truths, and dogmas that time, wars, or oblivion fade away regularly over the course of time. These certitudes started with the conception of the natural world, and the supposed supremacy of man over all other living and inanimate objects in the universe. Nowadays, our knowledge of the natural world has dramatically increased. Thanks to the work of many scientists in the last few centuries, we know today that Homo sapiens is just one species among several millions of other species cohabitating the planet. [8] We also know that all existing living beings are descended from one unique common ancestor, the Last Universal Common Ancestor (LUCA), which originated around 4,000 million years ago. In a certain way, we can legitimately say that all living beings around us are to a certain degree our close or distant relatives.

There is a clear singularity in Homo sapiens when compared with the rest of living beings. It has a unique ability of developing a brain capable of abstract reasoning. Our ancestors were able to harness the fire, develop weapons to hunt animals, invent agriculture, and develop large and complex societies. Over time, humanity has reached an extraordinary understanding of the natural world, the structure and composition of the universe, the nature of life and the universality of the genetic code. Philosophers, writers and musicians, have provided mankind a legacy of compositions, pieces of theatre, novels and new abstract conceptions of the mind and of the world.

Policy makers and politicians should listen to independent panels of scientists to develop evidence-based policy decisions. Science and empirical reasoning should be further added to the curricula of schools, as science education is one of the most powerful tools to understand the world, enabling citizens to make informed decisions.

Those of us who are lucky enough to live in the developed world, do not often realize that at the beginning of the 19th century, no country had a life expectancy of more than 40 years. Nowadays, most people in the world can expect to live as long as those in the richest countries in 1950. The UN estimates a global average life expectancy of 72.6 years for 2019. Globally, life expectancy has increased more than 30 years in the last two centuries. This enormous progress in human history has been largely due to contributions from technological developments, in particular to the availability of drinking water and urban sanitation as well as scientific progress that has led to the introduction of hygienic standards, the discovery of antibiotics and the development of vaccines. This incredible progress achieved over the last two centuries should not hide the persistent global inequalities in health that we see today, and should be an encouragement to realize what is possible and doable.

Despite this amazing scientific and technological progress, there is a puzzling mystery in human evolution. Contrary to science and technology, where advances rise on the shoulders of the preceding generations of scientists and engineers, other areas such as political ideologies, economic theories, and social sciences (among others) seem to evolve in a different manner. Scientific and technological advances proceed in a linear way. Every generation built their experience on the accumulation of knowledge obtained over past generations. Thus, in the 18th century, the Industrial Revolution started with the invention of steam engines and railways run by steam locomotives, which were replaced towards the middle of the 20th century by machines powered by diesel and later by electricity. The scientific and technological advances do not go backwards. Nowadays, no one attempts to produce a commercial steam machine, or a galena radio, or travel by mule. There have been obscurantist periods in history where the prevailing power of absolutist regimes and religions banned and punished any scientific endeavor. Apart from this, science and technology, once established, are universally accepted and adopted.

It is not my intention to discuss here the applications, nor the uses or misuses, of scientific and technological advances in different periods of history. This matter merits a separate article. It is also beyond the remit of this article to address the implications of the different methodological approaches used in the natural and social sciences. This is simply to point out the amazing fact that among the educated members of our societies, no one questions, irrespective of their political ideology, religion, or country of origin: Newton’s Law of Universal Gravitation, Einstein’s Theory of Relativity, the structure of DNA and the universality of the genetic code, or that the «pi» (π) and «e» (e) numbers are mathematical constants.

I would like to illustrate the basic foundations of international scientific collaboration with a hypothetical example geared towards the search for a vaccine for the current pandemic. Let us consider that a Chinese scientist in Shanghai may have sequenced the genome of SARS-CoV-2, the virus that causes the COVID-19 disease, and sends the sequence to a colleague in Montreal, who may look for possible unique sequences involved in human cell infection. The Canadian scientist may well communicate these results to another colleague in Heidelberg to study the proteins or peptides coded by these sequences (the idea being to identify possible hints for a potential vaccine). Again, these results with the proteins and peptides could have crossed the English Channel to a spin-off company in Cambridge to develop a variety of potential antibodies, with the idea of neutralizing the proteins or peptides coded by the virus and, hence, its pathogenicity. But this is not the end, far from it: from Cambridge, a number of samples of the developed antibodies could have been sent back to Shanghai, but also posted to New Delhi, Mexico City, Berlin, Atlanta, Saint Petersburg, Cape Town, Boston, Alexandria, Madrid, Lyon, and many other cities across the globe to test its efficacy in culture cells, animal models and, and only if the results are positive, humans in many hospitals across the world. And, again, if the results of this long chain of international scientific collaboration prove positive, the candidate vaccine goes to the main regulatory authorities: the European Medicines Agencies (EMA), the U.S. Food and Drug Administration (FDA) and some other regulatory agencies scattered around the world. Provided the regulatory bodies are in agreement, the vaccine would then be produced on a large scale by pharmaceutical companies. Eventually, the vaccine would be delivered to pharmacies and patients.

Photo_ woodleywonderworks_ Science on a Sphere_ CC BY 4.0

This is how science works. Each of these steps is complex; results need to be verified, checked again, falsified and scrutinized, following Popper’s terminology, before they are published in scientific journals following strict peer review systems. The entire scientific process is painstaking, often viewed by politicians and some societal sectors as slow and with uncertainties. However, history shows that those countries that have steadily invested more in science and in technology have higher standards of living, health, education, and democracy than those that choose not to do so. Sometimes, the political establishment in power have tried to repress or to bend the science and the scientists that contradict their ideology. This often has catastrophic consequences, not only for scientists, but also for societies at large. In science there are no shortcuts, nor absolute certitudes, but gradual and steady advances in the world of the unknown. Scientific progress is based on the veracity and reproducibility of results. Once scientific results are published in academic journals, they form part of the common human heritage.

Policy makers and politicians should listen to independent panels of scientists to develop evidence-based policy decisions. Science and empirical reasoning should be further added to the curricula of schools, as science education is one of the most powerful tools to understand the world, enabling citizens to make informed decisions.

Is the bottle half full or half empty?

There are several examples of human endeavors that have spanned beyond the lifespan of humans themselves. City walls, castles and cathedrals are the most familiar examples. But besides these, human nature wants a work to be completed as soon as possible, once conceived and started. This is particularly true of politicians, whose horizons, with some exceptions, do not go beyond their term of office. Long-term planning is one of the most outstanding characteristics not only of politicians, but also of humans in general. Biological species have extremely limited capability to learn from past experiences and plan accordingly. Homo sapiens have developed an extraordinary intellect, able to conceive awesome musical compositions, complex philosophical and mathematical concepts, and even abstruse physical theories, but they have not advanced much in developing what psychologist Martin Seligman has termed Homo prospectus. Paradoxically, the fact is that humans are extremely poor at long-range planning. Our notorious inability as a species to significantly affect the long-term is blatantly evident. There are man-made crises of population growth or climate change, not to mention the wars and crises that result. The reason we are so poor at long-range planning might well lie in the relatively short time of our evolution as a human species. In purely biological terms, long-term planning is not one of the main drivers of human evolution. However, due to the threat of global challenges, such as a new pandemic, climate change, food security, population increase, water scarcity, preservation of natural ecosystems, ecological limits of the biosphere, and availability of cheap and clean energy, among others, our survival as a species largely depends on developing globally accepted strategies that are conceptually evolutionary, geared at dealing with these challenges and that those future generations might confront.

Recent history has shown that, despite our apparent lack of proficiency in developing long-term planning as a biological species, when there is a widely and commonly agreed will, such efforts result in tremendous rewards. I will explain this with three examples:

The first one is the complete eradication of smallpox, which is considered the greatest achievement in international public health. The endeavor started in 1959, when the World Health Organization (WHO) initiated a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from lack of funds, personnel, and commitment from countries, as well as a shortage of vaccine donations. The Intensified Eradication Program began in 1967 with a promise of renewed efforts. This time, laboratories in many countries where smallpox outbursts occurred regularly were able to produce more, higher quality freeze-dried vaccines. Several other factors also played a critical role in the success of the intensified efforts, such as the establishment of a surveillance system to detect and investigate cases, mass vaccination campaigns, and finally, political support. The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977). In 1980, the 33rd World Health Assembly officially declared the world free of this disease. Smallpox has been so far the only human disease ever eradicated.

Global or regional institutions, such as the United Nations, their agencies, the European Union and others, should develop a number of
«bio-diplomatic missions» on health, agriculture, food security and climate change, geared to develop and act in the interests of the human population overall; they should not be undone by legitimate, yet narrow interests of any single national or regional priority.

The second success story, still unfinished, is the polio eradication program initiated by the World Health Organization in 1988, which has also been one of the greatest success stories in global health. The vaccine has reduced polio incidence by 99.9%. More than 16 million people have been saved from paralysis or death thanks to vaccination efforts. At its peak in the middle of the 20th century, polio killed half a million people every year, primarily children. In 1988, there were more than 125 polio-endemic countries. Now there are only three: Nigeria, Pakistan, and Afghanistan, where ongoing political conflicts have made eradication efforts difficult. One part of the problem is indeed, a political one; the second part, however, is scientific. The complete banishment of polio requires the enhancement of the existing oral vaccine, as in very few cases, the current oral vaccine «reverts» and triggers the disease instead of protecting against it. The Polio Eradication Initiative is the largest-ever internationally coordinated public health effort in history, and is led by national governments with five partners: WHO, Rotary International, the U.S. Centre for Disease Control and Prevention (CDC), UNICEF and the Bill & Melinda Gates Foundation, demonstrating positive synergistic collaboration between governments, public institutions and private initiatives. This is a clear-cut example of the need for science, political will and global initiatives to go hand in hand, supporting each other in order to achieve global endeavors.

The last example of a success story is the Millennium Development Goals (MDGs) of the UN, which were set up in 2000 to shape a broad vision to fight poverty, particularly in developing countries. That vision remained the overarching development framework for the world until 2015. The end of the MDGs period was one of the few occasions in the last years that mankind has had a good reason to celebrate. Thanks to concerted global, regional, national, and local efforts, the MDGs have saved the lives of millions and improved living conditions for many more. The results demonstrate that, with targeted interventions, sound strategies, strong and close collaborations between science and health carers, adequate resources, and political will, even the poorest countries can make dramatic and unprecedented progress. The MDGs have demonstrated uneven achievements and shortfalls in some areas, but we know now that even gigantic tasks like the ones just mentioned can be a success if there is a will, clear objectives, and measurable targets.

Global or regional institutions, such as the United Nations, their agencies, the European Union and others, should develop a number of «bio-diplomatic missions» on health, agriculture, food security and climate change, geared to develop and act in the interests of the human population overall; they should not be undone by legitimate, yet narrow interests of any single national or regional priority.

Will we learn or will we continue to conduct business as usual?

Pandemics brutally remind us that whatever social, political, religious or economic differences we may have, we are a single biological species: Homo sapiens. However, one sometimes wonders whether the name of the species sapiens was the most appropriate one. Wars throughout history, political and religious persecutions, dictatorships of different color, nazism, fascism and communism have provoked at least as many deaths as all pandemics throughout history. In the 20th century, mankind had created international organizations such as the United Nations, the European Union, and many others to discuss and prevent armed conflicts. With all their limitations, these organizations have repeatedly proved their efficacy and their utility. We cannot completely prevent the emergence or the impact of future pandemics. Notwithstanding, with long-term, forward thinking and planning, we could largely diminish the emergence of new ones and, above all, mitigate their deleterious effects. We have the science and technology to address and to confront such threats. What is needed is political will and long-term vision beyond the boundaries of political parties or terms of office.

The scenario enacted by most leaders of the world in this pandemic crisis has been appalling. Societies need empowered citizens rather than centralized political control. Citizens should feel they are part of the solution, and their increasing participation in policy decisions should be promoted and encouraged. This can only be obtained with highly developed democracies, with empowered citizens and visionary leaders able to combine short-term tactics with long-term strategies. Social insight and catharsis are desperately needed to examine the factors that have led to this situation, but there is no point in a social «self-flagellation.» It is important to remember, once again, that an imperfect democratic society is always preferable to an efficient dictatorship. The times of such dictatorships or the modern version of «paternalistic governments» are over. What is needed, again, is that the job of a politician is understood as one of a civil servant, and that it becomes a desirable and socially recognized profession. For that, we need to bring to the attention of policy makers that political decisions, along with consideration of other elements, must be based on evidence-based science. Governments should not be tempted to twist or bias scientific advice. In turn, scientists should be required to provide scientific advice to governments or policymakers that reflects on the consensus of scientific knowledge at that moment, indicating all possible uncertainties, and including different options and their putative consequences, whenever this is feasible.

It is striking how children are required to study historic dates of wars, and names of forgotten kings or obscure political rulers. However, they are hardly taught anything about pandemics or «global epidemics,» the current terminology preferred by WHO. They are not told about the most recent ones: SARS [9] and MERS, [10] nor about the «big ones»: the so-called Spanish Flu that took place from 1918 to 1920, killing 20 to 100 million, or the Black Death, also known as «The Plague,» which reportedly killed between 75 and 200 million people between 1331 and 1353.

It is very evident that societies and politicians never forgot the lessons from past epidemics, due to the simple reason that they never learnt them in the first place. A post-pandemic society needs to abandon the current illusion and comfort of certitudes. There are not certitudes in social life, nor in science. History shows that science, and therefore society, progresses when it departs from trodden paths. A lack of initiative and imagination, added to a fear of intellectual challenges and an accommodative position, have led us to where we are now. The need for change will not come from political systems, which on many occasions have proven to be a failure. People with new ideas, particularly young people willing to set new bearings in our societies, must be given the chance to forge unbeaten paths and set new bearings. The future also belongs to them.

It is indispensable to trigger broad social dialogues in order to agree on a new basis for the relocation of production chains, and to agree on a fair balance between an autarchic and a globalized society.

The end of political dogmas: «The age of certitudes is over» [11]

Certitudes provide comfort, assurance, and the positive feeling of belonging to a group surrounded by like-minded people. Doubts, incertitude, and questions generate uneasiness, mistrust and fear. Politicians love certitudes. Regardless of whether they are based on solid ground, or are just wishful thinking, certitudes are the common language of politicians, irrespective of their political spectrum. Even when Winston Churchill became Prime Minister in 1940 and said, «I have nothing to offer but blood, toil, tears and sweat,» he was providing a certitude that sadly proved itself right, although he was also showing unparalleled leadership and charisma. On the contrary, doubts, prudence and caution are the way scientists achieve their results, because they know that no matter how solid scientific results may be, they are all provisional until a new theory, data or hypothesis generates new results on which is built science progress from generation to generation.

Since the beginning of the COVID-19 pandemic, society has behaved passively, acting as perplexed spectators in the ongoing cacophony between these two different ways of thinking and communicating. The difference is seemingly small, but it has profound implications: Scientists are people that love studying nature. They know a lot about a small territory of knowledge. They know that despite how much they know, there is much more that they themselves do not know, but which they know others know. However, the most important difference is that scientists are very prudent by nature, because they know that there is a huge universe of knowledge that they not only do not know, but also, they know that nobody knows. Hence, their prudence in arriving at assertions. On the contrary, politicians know few things and defend them with profound assertiveness. Depending on their political orientation, politicians know different things that, nevertheless, are defended with equal enthusiasm as their political adversaries do with the opposite. But they share one feature in common: what they know constitutes their universe of knowledge and certitude. They know that there are many things that they do not know, but most of them refuse categorically to know what they do not know, in case the new knowledge could wobble the foundations of their ideas and convictions. Doubt is a mortal sin for a politician. However, if accompanied by a rational approach, doubts may save a society.

Defending and fighting against COVID-19

It is hard to believe that man set foot on the moon more than 50 years ago, and despite that, our strategies today to defend ourselves from viral infections have hardly changed. Luckily, the situation with bacterial infections has experienced terrific progress, thanks to the discovery of a large number of antibiotics. This progress is shadowed by the steady increase of antibiotic resistance in many bacterial strains generated by the massive use and, often, abuse of antibiotics. Despite the fact that bacteria and viruses are both microscopic, the differences are humongous: bacteria are autonomous organisms, capable of replicating themselves, whilst viruses are necessarily parasitic. They need another organism (bacteria, plant, animal or human cell) to hijack the host cell mechanisms, to be able to replicate and propagate. To give a rough idea of the size of the tiny dimension of a virus, I would like to note that the size of a blood cell ranges from 6 to 8 µm, [12] while the lower limit of vision of human sight is about 0.1 mm. A bacterium ranges from 1to5 µm, and the smallpox virus, one of the largest, between 250 and 400 nm. SARS-CoV-2, the virus that causes COVID-19, has a size of 0.125 µm or 125 nm in diameter. Roughly, a human blood cell is about 50 times bigger than the COVID-19 virus. It may seem counterintuitive, but viruses, despite their tiny size, are terribly difficult to combat, and the main reason lies in their molecular simplicity and their frequent high mutation rate. It is exceedingly difficult to find molecular targets specific for the virus not found in humans. Like in any armed conflict, in the combat against COVID-19, what is needed are parallel strategies of defense and of attack.

The first line of defense is obviously to minimize exposure to the virus. This has failed catastrophically with COVID-19. Not only has the barrier between bats (which seem the natural reservoir of the virus) and humans been broken in the Wuhan market. but it has also extended all over the world, with currently over five million people infected, and over three hundred thousand deaths.

The second line of defence is to prevent the virus from entering in contact with human mucous membranes. For that purpose, skin is a good barrier. Implementing certain basic hygiene practices, and wearing masks, may also contribute in diminishing the transmission rate. However, once a small droplet of saliva from an infected person enters into contact with nose mucosa or the mouth of another person, there is a pretty good chance that this person becomes infected and contagious (albeit a significant proportion of 25% – 50% of the infected cases are asymptomatic or with mild symptoms).

It is indispensable to trigger broad social dialogues in order to agree on a new basis for the relocation of production chains, and to agree on a fair balance between an autarchic and a globalized society.

When an infected person needs medical care, doctors decide the specific protocol to follow, depending on age, pre-existing medical conditions, prognosis, evolution of the disease, etc. Concerning how to combat the virus itself, doctors have two main options: on the one hand, antiviruses, or medicines aimed to kill or to stop the propagation of the virus like antibiotics do with bacteria; [13] on the other hand, there are vaccines. Some critically ill patients could receive infusions of antibody-rich plasma from other patients who have had the disease and recovered. The concept is an old one, and it is called «passive antibody therapy,» because antibody-rich plasma is transferred from someone who has successfully recovered from an infection, to a patient suffering from the same disease. This technique was extensively used in the pre-antibiotics era.

When the defense becomes an attack [14]

a.  The search for new antivirals

COVID-19 is a new disease. In the absence of a vaccine, doctors confronted with patients affected by COVID-19 are using the therapeutic arsenal available to combat the related virus. The most important ones are antiviruses. They are the equivalent for viruses that antibiotics are for bacterial infections. However, the number of antiviruses and their specificity and efficacy are significantly lower than their equivalent antibiotics. Also, some of them may have serious secondary effects. In the absence of a vaccine, however, they are the first ammunition to fight COVID-19. The most frequently used antiviruses at the beginning of the pandemic included: Remdesivir, a drug that was developed to block infection with related coronaviruses and even Ebola; and Lopinavir/ritonavir, a drug combination used against viruses like HIV. These antivirals act by blocking key viral proteins called «proteases.» Chloroquine and hydroxychloroquine are currently used to treat malaria and the autoimmune disease lupus. They also seem to block viruses from entering cells, and as such prevent infection.

The medical literature indicates that the panoply of existing antiviruses is limited in fighting the virus. However, in many cases they allow for gaining time, and prevent or diminish the severity of infections. Laboratories all over the world are in a race to develop new, more efficient, and more specific antiviruses than current ones. In the meantime, at least 27 clinical trials of different antivirus treatments are now underway. It is important to note that antiviruses are given to patients infected when the viruses are still present in the body of the affected person. To protect a population against future infections of the virus, the answer is a vaccine.

b.  The race for a vaccine

It is beyond the remit of this article to outline the process of vaccine development. In an earlier section of this article, I have presented a hypothetical example of the complexity and multistep processes necessary in the search for a vaccine. Here, I just present an outline of current efforts aimed at the development of a successful vaccine against COVID-19.

Soon after the first epidemic cases were observed in China and nearby countries, a race began to develop a vaccine, well before the epidemic became a pandemic. The amount of background knowledge is immense. Therefore, it is critically important to have a steady support of basic and mission-oriented research. This has allowed for the WHO to develop 8 candidate vaccines in clinical trials and another 110 in preclinical evaluations by 15 May 2020. [15] This unprecedented, terrific speed in the search for new vaccines did not happen by chance, but thanks to the huge accumulation of scientific results from previous epidemics (SARS, avian flu, MERS, Ebola, seasonal flu and AIDS, among others), and by the steady efforts of a large community of scientists working in different laboratories across the world. Some of the current approaches being used to develop a vaccine against COVID-19 are based on similar strategies that worked against the SARS outbreak from 2002 to 2004. It is interesting to note that SARS-CoV-2 and SARS share 79% of their genomes; this similarity is misleading, however, as the human genome shares 99% similarity to that of chimpanzees, our closest living relatives, and 98% with gorillas. Among humans, the similarity is 99.9%. Yet, it is the unique DNA, its expression, and its interactions with the environment, the epigenetic, which establishes the difference between individuals and between species. As a consequence, a word of caution and prudence is needed regarding sensationalist news that announces a vaccine being developed in an unrealistically short time. As I said before, there are no shortcuts in science.

Often, the problem with science is a lack of funds that prevents progress, although on certain occasions, the problem is intrinsic to the nature of the object of study. Let us illustrate this with concrete examples in vaccine developments.

Smallpox and polio vaccines, just to mention these two, have saved the lives of millions of people. It has been estimated that since the year 2000, vaccines have saved more than 20 million people, prevented 500 million infections, and saved 350 billion U.S. dollars. Perhaps these figures will cause us to have a different perspective the next time we cross paths with a doctor, a nurse, or a scientist. Not everything is rosy, however. It is well documented that 32 million people have died from AIDS-related illnesses since the start of the epidemic. Notwithstanding, the number of deaths has been significantly reduced, thanks to access to antiretroviral therapy. Sadly, despite colossal intellectual, economic, and logistical efforts, there is still not a vaccine, and there may never be. Malaria presents a similar situation, with 219 million cases of malaria per year, and nearly half a million deaths yearly. So far, there is not a reliable and efficient vaccine. In both cases, the reasons are different, but lie in the molecular biology of the infective agent. In these two cases, current approaches include prevention: antivirals in the case of AIDS, and antiparasitics in the case of malaria.

We do not yet know the outcome of the current race for a vaccine against COVID-19, but in spite of the criticisms that efforts have not been united in the search for a single vaccine model, the approach of «multiple working hypothesis» seems advisable on this occasion, as it is unlikely that placing more funds or manpower into just one model would increase the chances of success. Many of those candidate vaccines will succumb during this race. The critical thing is that there will be at least one candidate vaccine that arrives at the finish line. Then, a global effort will be needed to produce billions of doses of this vaccine. The challenges are monumental, and of an unprecedented nature. This will not be achieved without a new attitude enhancing the synergies between scientists, health professionals, policy makers, social and economic actors, and joint public and private initiatives. No one should be discarded due to old-fashioned prejudices. The coming months and the coming years will be decisive in understanding what our chances are in allowing for a better future.

Concluding remarks [16] 

If one must project the future based on the experience of the recent past, then, the History of the 20th century leaves us with mixed feelings: We remember with horror the two World Wars and many more regional wars scattered all over the planet and of the Century, the rise of military pushes and dictatorships in Latin America, Africa and Asia. But also, we welcomed the consolidation of old democracies as well as the rapid increase of incipient ones in many countries, following military regimes. We have also been witnessing the dramatic increase of the standards of living in many countries but concomitantly, increase of the inequalities between different regions of the globe. Science and technologies have made major breakthroughs saving the lives of hundreds of millions and enhancing the life of billions of people. Nevertheless, our duty in the 21st Century is to pay more attention to ensure more inclusive societies leaving no one behind of the benefits of science, health, and technology.

There are two characteristics of mankind that allow us to look at the future with a moderate optimism. They are innovation and resilience. Thanks to innovation, humans have been able to build our civilization and our societies and thanks to resilience, they have had eagerness and courage to recover from periodic and catastrophic events. I am convinced that we as humans will recover from this pandemic. The human and economic losses will be colossal, but we will be able to rise from this crisis. It may take years, perhaps a decade or more. But we shall overcome this pandemic as species. Hopefully, humbler, accepting that we do not have all the responses and with a new globally accepted social deal acknowledging that global threats require global solutions.

My hesitations come on whether we would be able to learn something from this experience. If we have been taken totally unprepared, uncoordinated and with late responses in a devastating pandemic, how we are going to react towards the already existing global threats to our planet? My hopes for a rational, coordinated, and decisive actions on the current political class is far less than mitigated. My hopes lie mostly on the young people. On their audacity and innovative approaches to find their own bearing in the remaining of the 21st Century, navigating by uncharted scientific, socio-political, and economic territories. Nothing is guaranteed in this journey. New paradigms are needed. There is no such a thing as returning to «business as usual». When I try to imagine the kind of responses that they would develop to challenge the new pandemics to come and to the increasingly threatening Global Challenges, my thoughts go with Bob Dylan in his song «Blowin’ in the wind»:

«The answer, my friend, is blowin’ in the wind. The answer is blowin’ in the wind.»

[1]  To Lucía and Irene, they are part of the future

[2]  Aguilar A. & Patermann, C. (2020, in press). Biodiplomacy, the new frontier for bioeconomy. New Biotechnology.

[3]  Aguilar, A., Twardowski, T. & Wohlgemuth, R. (2019). Bioeconomy for sustainable development. Biotechnology Journal. 1800638. DOI: 10.1002/biot.201800638.

[4]  Aguilar, A. (2018). Bioeconomía y sociedad [Bioeconomy and society]. In Aguilar, A., Ramón, D. & Egea F.J. (Eds.). (Vol. 31, pp. 15-36): Mediterráneo económico. Cajamar.

[5]  Ulrich von Weizsäker, E., Wijkman, A. (2018). Capitalism, short-termism, Population and the Destruction of the Planet. Club of Rome. Springer.

[6]  R0 is the number of cases, on average, an infected person will cause during their infectious period. if R0 is less than 1, the disease will die out in a population, because on average an infectious person will transmit to fewer than one other susceptible person. If R0 is greater than 1, the disease will spread.

[7]  Spinney, L. (2017). Pale Rider: The Spanish Flu of 1918 and How it Changed the World. Jonathan Cape.

[8]  It is estimated that the number of Earth’s current species range from 2 million to 2 billion of which about 1.74 million have been scientifically reported and over 80% percent have not yet been described. Of those, most of them are bacteria, viruses, and other microscopic living beings. More than 99% of all species that ever lived on Earth are estimated to be extinct.

[9]  Severe Acute Respiratory Syndrome

[10]  Middle East Respiratory Syndrome

[11]  Statement pronounced at the last Octagon meeting «The era of (in)security: urgent matters and self-defeating prophecies.» Madrid, 22-24 November 2019. https://commonactionforum.net/octagon2019/

[12]  1 millimeter (mm) = 1000 micrometers (µm) = 1000 000, or 106 nanometers (nm)

[13]  It is important to remember that antibiotics are not effective against viruses and should not be used in viral infections unless prescribed by a medical doctor to treat a simultaneous bacterial infection or as a prophylactic measure in certain medical conditions. Antibiotics and antivirals should not be used without the formal prescription of a medical doctor.

[14]  This section aims to provide the reader with a succinct overview of some of the therapeutic approaches being used by the medical profession against COVID-19. It does not pretend to be exhaustive or up to date. This information does not replace the professional advice of a qualified medical doctor and is included to provide the reader with a taste of the huge difficulties that doctors are confronted with in dealing with a new disease such as COVID-19.

[15]  World Health Organization. Draft landscape of COVID-19 candidate vaccines. https://www.who.int/who-documents-detail/draft-landscape-of-covid-19-candidate-vaccines

[16]  I would like to thank Rosario Peláez López, Dr. Diana Aguilar Peláez (M.D.), Dr. Vanessa Campo Ruiz (M.D.) and Dr. Eduardo Aguilar Peláez for their advice, fruitful discussions, and critical reading of the manuscript.

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