BNS0027

Written evidence submitted by AnotherDay

Background and introduction

  1. After months of quantitative and qualitative research, the organisation that I work for, AnotherDay, has just finalised a white paper titled, ‘The Vaccine: How the end of one crisis could become the beginning of the next’, which looks at the seismic geopolitical, security, and societal implications of this possible COVID-19 eradication programme. We wanted the paper to be a first look at this important next step in the trajectory of the pandemic - and to help policymakers, journalists, international security professionals and humanitarians talk more confidently about what might come next.
  2. As such, we are submitting the findings of this white paper to the UK Parliament Committee as evidence to address; The main drivers of biosecurity risks to human health in the UK, including from pandemics and emerging infectious diseases and biosecurity risks within overall national security risks.
  3. AnotherDay, is a security, risk and intelligence consultancy, based in London. Our intelligence team has worked very closely with clients both prior to, and throughout the pandemic to provide them with actionable intelligence and crisis management skills to navigate the ever-changing and complex landscape.
  4. Our clients include world leading banks, large multinationals, NGOs, retail outlets, insurance companies, law firms and individuals, and are based/operate around the world.
  5. This white paper is the product of months of data gathering, analysis and expert forecasting on behalf of our intelligence team.

Foreword:

On 27 July 2020, the Director-General of the World Health Organisation (WHO) stated that COVID-19 is easily the most severe global health emergency ever declared under the International Health Regulations (IHR). Believed to have first emerged in China in late 2019, the disease has already led to more than 30 million cases and over a million deaths, with every country on earth affected.

As such, a truly global response is needed – and fast. However, to date, only one infectious disease affecting humans has ever been successfully eradicated globally: the world was declared free from smallpox in May 1980, over two decades after the first eradication programme was initiated.

SARS-CoV-2, the strain of coronavirus responsible for the respiratory illness COVID-19, continues to be an evolving organism. The WHO declared the initial outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020, and a pandemic on 11 March. However, global incidence continues to grow rapidly, new symptoms and side-effects are still emerging, we are starting to see ‘second spikes’ in countries that seemed to have had a solid grip on their outbreaks, and healthcare systems are reaching their limits. Add to this that several months down the line there continue to be a multitude of ‘known unknowns’, ‘unknown unknowns’, and divided opinions on a number of factors including incubation and contagiousness, transmission, symptoms, recovery, immunity, and, critically, potential preventative and reactive treatment options at both country and local levels.

As with other diseases that have driven a global response, the ongoing spread and potential mutation of the SARS-CoV-2 virus must be prevented to not only minimise mortality, morbidity, and disruption of healthcare systems, but also to preserve economies and social development. The answer would seem to be simple: a global eradication programme similar to those implemented for diseases such as smallpox, polio, and yellow fever. And the need for such a programme has never been clearer as we see the current pandemic push numerous countries worldwide into severe recession, compounded further by a range of potential wide-reaching and long-term health, social, and economic welfare consequences. However, this brings about a number of important questions:

                     Is an eradication programme actually achievable on the scale required for COVID-19 and in this age of massive uncontrolled urbanisation and global mobility?

                     If so, what would it need to look like?

                     If so, what are the dynamics and infrastructure needed?

                     How would it be successfully implemented, and protected, in remote and conflict-ridden regions?

                     How quickly can an appropriate global programme be developed and initiated?

                     How long would the campaign take to eradicate COVID-19, if that is indeed possible?

                     And what impact might the programme have on future security risk and political stability?

We begin by analysing the large-scale eradication programmes undertaken for smallpox, polio, and yellow fever, showing that while these have had much success in dramatically reducing or even eliminating disease occurrence, they have also revealed there is no ‘quick win’; eradication is a lengthy and resource-intensive process, requiring a broad range of measures tailored to the individual disease and geographies being targeted, and generating an array of ‘lessons learned’. We then seek to address the questions posed above on the viability of a global eradication campaign for COVID-19, highlighting key comparisons with the nature and context of the other diseases outlined and the implications of these differences. Next, we comment on the potential impact of such a programme on the global security risk and political stability environment going forward, and finally we provide a range of country case studies to demonstrate our observations.

We’ve also been rigorous in avoiding the question of whether a vaccine is even possible

to develop. Clearly the availability (or not) of a COVID-19 immunisation will create its own monumental social, economic, and political effects. For the purposes of this research, though, we’ve focussed on how the actions, infrastructure, and decisions associated with a global eradication programme specifically will redefine our world, create new conflicts, or inflame existing ones. As with any seismic shift in human history, it may also create specific spaces in which there’s the potential for a new peace rather than a new war.

Sophocles once opined that nothing vast enters the life of mortals without a curse: there’s no doubt that a global eradication campaign is critically important to move beyond the COVID-19 pandemic, but policymakers and thinkers need to begin identifying the potential risks associated with such a gargantuan effort – which eventually may have to reach all seven billion humans on the planet – so that these risks can be effectively mitigated and controlled.

So far, most public discourse has focussed on if and when a vaccine will arrive – we have therefore put together this white paper to help begin a conversation between international security professionals, the wider private sector, humanitarians, policymakers, and journalists on how we should start preparing for a world that could be fundamentally altered by the decisions, infrastructure, and conflicts over immunisation. From empty streets in London, to vibrant and teeming streets in Dhaka, to isolated fishing communities in the Canadian Arctic, we’ve tried to assess and explore the implications of what might come next – the implications, of The Vaccine.

Key findings:

(a)   What we can learn from previous eradication campaigns

be particularly true if The Vaccine only leads to an effective immune response for a few months.

 

(b)   Societal resistance to vaccination

 

(c) The terrorist-disease nexus

 

(d)   Potential flashpoints of The Vaccine

Fig 1.1:

Fig 1.2:


 

Fig 1.3:

 

Conclusion:

a)      In our rush to exit the current crisis, we can’t ignore the risk of creating an entirely new one

Exhibiting bias toward a current situation is an intrinsic part of the human condition: Joseph Banks, the botanist on Captain James Cook’s expedition to Australia in 1770, recorded in his diary that he was baffled that local indigenous fishermen completely ignored their - at the time, entirely alien - sail ship. Cook’s arrival would lead to a tectonic shift in the fortunes and futures of up to two million of Australia’s inhabitants, but at the time local people were more concerned with survival than the appearance of something so alien that it could barely be perceived.

This isn’t entirely dissimilar to the situation in which we find ourselves in late 2020. The pandemic has created a kind of cognitive hangover: we’re trying, and failing, to envisage an end to the crisis while still trying to process its extensive, and still accumulating, impacts. Conflating ‘The Vaccine’ with ‘The End’ is a very straightforward way for us to cope with an uncertainty which might last into the middle of the decade, because through this conflation we create our own mental off-ramp. The Vaccine exists - at some unknown time in the future, requiring some unknown level of effort, exerted by people who aren’t us - and that’s enough to be comforting.

Like the fishermen on the coast of what would eventually be known as Queensland, this obsession with dealing with the problems of the present keeps the difficulties, risks, and opportunities of The Vaccine blurry in our minds’ eye. It’s definitely now the time to bring it into sharp focus, and accept that any COVID-19 eradication programme would be one of the largest and most complex undertakings in human history. It will dwarf previous public health interventions, and would attempt to achieve widespread global immunity in a few short years - a fraction of the two to three decades of consistent surveillance and inoculation required to (almost) banish smallpox and wild poliovirus.

Difficult doesn’t mean impossible. But, it will require a clear multinational strategy which brings together over 200 disparate and conflicting national initiatives, many of which will lack infrastructure, funding, and know-how. It will need to be achieved in regions which are impassable, in societies which are already fractured, and in states which aren’t safe, stable, or secure. This might also need to be achieved in very short order; unless The Vaccine can provide lifelong immunity, coronavirus anywhere is coronavirus everywhere.

So are governments and organisations already mobilising, strategising and preparing for this gargantuan public health effort? Well, not exactly. The GAVI COVAX initiative, raising funding and commitments from states to ensure that the world’s poorest won’t be waiting at the back of the line for their dose, is an excellent start. It’s also likely not enough. We need to accept that the pandemic, so far at least, has not led to the same push for and reinforcement of pragmatic multilateralism that was seen after the last bout of wanton economic vandalism during the Second World War. Broadly speaking, most national governments have turned inwards and have reduced their capacity to engage on overseas issues in a meaningful, non-tokenistic, way.

A clear, well-designed and multilateral eradication strategy isn’t a nice to have - this is a long process at the best of times, let alone in the middle of a global pandemic where the WHO is struggling with international suspicion, and relationships between permanent UN Security Council members are at a very low ebb. Planning needs to start now for us to have any chance of pursuing an end to COVID-19 without destablising entire regions in the process.

b)     As with any significant event in human history, The Vaccine will have far-reaching effects

This doesn’t mean it shouldn’t happen - it must happen. From barmen in New York City to stallholders in Nairobi, the end of the pandemic would herald a return to an economic normality which dictates the health, success, and education of billions of people. The UN has already warned that lockdowns in 2020 have pushed up to 500 million people back into poverty, erasing the equivalent of 10 years’ of poverty eradication work. A ‘new normal’ of avoiding human contact only works for those who are already economically and socially stable.

This inevitability doesn’t, however, relinquish responsibility for making sure that any eradication campaign is deployed in a way which mitigates risks as far as possible: a rush to vaccinate hundreds of millions of people without this planning is not just likely to exacerbate its worst impacts, it’s probably also doomed to failure. Understanding and visualising the effects of reaching and inoculating almost every human on the planet in a short period of time helps us to begin assessing what can be done proactively to reduce the risks associated with such an effort.

Very few countries have emerged from the opening act of the pandemic with greater stability; in many ways, the political and economic atmosphere hasn’t been this febrile in most people’s living memory. This is also the atmosphere in which we’ll endeavour to do something which has never previously been attempted. Most previous disease eradication programmes have been conducted by technocrats, in slow time, and with little fanfare: in some ways, this is really what made them so successful. Public health responses to COVID-19 have already been marred by politicisation, disinformation, geopolitical tension, and incompetence. The next challenge will be to make sure that The Vaccine is not condemned to a similar fate.

c)      The Vaccine could either slow or accelerate the move away from a unipolar world - that choice now belongs to the United States

In many ways, the trajectory of the current crisis correlates closely with the relationship between the United States and China. The pandemic has brought into sharp focus an entirely new set of geopolitical considerations which may not have appeared until well into the 2020s: many firms are now reassessing their supply chain exposures to both superpowers in an environment where regulation and legislation have taken the place of gunboats and summits. The institution of the National Security Law in Hong Kong while world powers were distracted by COVID-19, or new US legislation governing the use of American machinery overseas to manufacture Huawei semiconductors, exemplifies an entirely new battle over intellectual property, technology, and economic interdependence. Although the pandemic isn’t the cause of this tension, it’s certainly the accelerant.

Since the collapse of the Soviet Union, the United States has been the sole guarantor of international security. This unipolar world, with a single set of ‘rules’ for prosperity managed and promulgated by organisations such as the International Monetary Fund and World Bank, appears to be giving way to one in which competing sets of norms now need to coexist. Even before COVID-19, the arena of overseas financial aid was becoming increasingly competitive - why promise reform and anti-corruption drives for IMF assistance when Belt & Road initiatives would be just as lucrative without the same strictures? The actions of the United States in the coming years, particularly with regard to their support to the developing world to achieve comprehensive immunisation, will play a huge role in shaping the perceptions of national capitals towards or away from an American order which seems to be slowly evaporating.

They will also have competition. It’s not far-fetched to imagine a scenario in which Chinese and American-made vaccines are both available, and the efficacy of both is untested or comparable: if the US decides to embargo export of this vaccine under an ‘America First’ policy and China does not, how does this shift relationships with important economies of the future such as Nigeria, Brazil and Indonesia? This ‘vaccine diplomacy’ will become as important, if not more so, than the ‘infrastructure diplomacy’ which both the United States and China have pursued aggressively for many years. Had the pandemic struck 20 years ago, it’s likely that the US would have played the leading role in planning for, funding and executing eradication on almost every continent. If that role becomes vacant, the question of who steps in to fill the gap becomes a serious one which could define geopolitical influence for many years.

The actions of pharmaceutical companies will also play a role. Intellectual property protection is at the heart of medical research and development, and provides the reassurance needed to private firms that spending billions of dollars on treatments which are likely to fail is a worthwhile endeavour which will eventually generate future profits. Does that reasoning still hold for a coronavirus vaccine? A patent-free drug could enable production to be ramped up at the national level far more quickly than could ever be achieved by a single well-meaning organisation, and the nationality of the pharmaceutical companies which eventually reach the milestone of having an approved vaccine could play a key role in whether releasing it on an ‘open source’ basis could even be possible.

The final geopolitical consideration will be the timeline, and prioritisation, of vaccine distribution. In 1972, a pilgrim returning from Iraq to Kosovo (then part of the Socialist Federal Republic of Yugoslavia) came down with smallpox: the country subsequently vaccinated 18 million people in 10 days using military roadblocks. The action of inoculation is not what takes the time, it’s the supply chain of providing enough doses and maintaining their efficacy. Should the developing world see countries like France, the United Kingdom, and China blocking vaccine exports to guarantee the safety of their own populations, the potential long-term strategic impacts could be very significant. If The Vaccine provides limited protection and requires almost constant top ups (say every four months, particularly for frontline health workers), this becomes a very realistic scenario.

d)     Eradication done badly could add fuel to the fire of existing conflicts, or create entirely new ones

Taking a specific example makes it easier to understand how The Vaccine presents significant risks in areas of armed conflict. In the Taliban-held Korengal Valley, Afghanistan, who has the right to carry out vaccinations? The same logic applies to vast swathes of the Earth’s land surface which are de facto under the control of non-state armed groups. National governments have a difficult choice: do they attempt to exert their sovereignty through military operations, creating space for vaccination, or hand over the tools of immunisation to groups with which they’ve been fighting for years, or even decades? The third option is equally unthinkable - withholding potentially lifesaving drugs from the civilian populace to avoid the casualties of a military campaign, or the political embarassment of acquiescing to the territorial claims of secessionist or terrorist actors. In 2012, it was estimated that up to 200 million people fell into the category of ‘conflict-affected residents’ who are subject to the whims of rebel organisations.

We’ve also outlined in this paper how terrorist groups, particularly those that hold territory, have weaponised previous vaccination campaigns: preventing inoculation teams from carrying out their jobs can prove to the populace, or other political actors, that they are a force to be reckoned with and can create public health crises which weak governments find it hard to respond to effectively. Groups such as the Pakistani Taliban, Boko Haram and Al Shabaab have all pursued this strategy repeatedly and are likely to do so again. The Pakistan example is instructive: at least 101 vaccinators have been assassinated, alongside many of their military and police escorts, since 2012. International organisations and their national donors need to begin considering how vaccinators will be protected in these situations and many others.

This also begins a self-fulfilling prophecy. As vaccinators find it difficult to access conflict-affected areas, weak national governments attempt to facilitate eradication campaigns by force - in so doing, local populations associate vaccination with military operations, increasing the percentage of residents who refuse to be treated. Even worse, some governments may also see an opportunity to use vaccination as a cover for intelligence gathering in areas which are usually inaccessible: although most agree that the politicisation of these types of campaigns must be avoided, for some the temptation is likely to just be too great. These trade-offs, and how they’re navigated, will determine how long the coronavirus is able to continue to circulate in the absence of any kind of herd immunity.

Oppressed or discriminated-against minorities are also unlikely to hold enough trust in national governments to accept an intensive vaccination campaign without violence: the Rohingya in Myanmar, for example, have suffered at the hands of the regime’s military for almost a decade. The prospect of the same national government taking steps to bring immunisation to villages that they have previously attempted to eradicate is problematic at best. This problem isn’t just confined to intra-state conflicts: does Armenia have the right to lead the eradication campaign in Nagorno-Karabakh, or does Azerbaijan? The same question could apply to dozens of frozen conflicts across the former Soviet Union, Africa and Asia.

Equally, the prospect for The Vaccine could create the space for subject-specific dialogue between conflict actors that have never previously engaged: with the right international support, these individual discussions could lead to more wide-ranging peace talks. This is a good example of how public health initiatives can pose both risks and opportunities.

e)      We also can’t ignore the potential for social fracturing at home should The Vaccine become a political ‘wedge issue’

With surveys suggesting that vaccine refusal in developed countries is already hovering around 30% even before one has been developed, there is absolutely no room for complacency on the part of national public health agencies - and private organisations. Although some officials have already suggested that a vaccine would likely be reserved for high-risk demographics, if immunisation is to be the ‘off-ramp’ from the current crisis then the planning assumption is that an eradication campaign needs to target 67%-80% of the population. If this threshold isn’t reached, the coronavirus will continue to circulate and economies and societies will continue to suffer.

Potential refusals increasing from their current indicated level could end The Vaccine before it’s even started, underlining the importance of public trust building long before a viable drug becomes readily available. As it stands, there’s significant room for this refusal rate to fluctuate wildly: social media and conspiracy theories seem to hold an outsized influence on suspicion of immunisation, and a popular viral post or video questioning the safety, motivation, or efficacy of The Vaccine could push refusal rates beyond the herd immunity threshold placing entire societies more at risk than in other countries. This is going to be a particular problem for the United States, United Kingdom, France, Russia, and eastern Europe.

If politicisation of the eradication campaign undermines public trust, and the prospect of being immunised becomes a ‘wedge issue’, all bets are off. For the first time, a political issue would be directly connected to the health of every person in society: this is likely to exacerbate societal fracturing, particularly when coupled with social media recommendation engines. These engines, which recommend posts, videos, or groups to look at next, amplify content which has higher engagement rates - these engagement rates themselves are usually associated with content which elicits emotions like fear, paranoia, distrust, or hate. If these engines create a feedback loop of popularity for fringe conspiracy theories concerning The Vaccine, it may start a runaway chain reaction of misinformation eroding public trust which could take years to effectively combat. Social media companies need to take the lead in managing the public discourse.

If a significant proportion of the population refuse vaccination, obstructing an ultimate goal of protecting everyone in a country through herd immunity (and therefore eventually eradicating the virus), what steps would governments begin to take? Organisations also have a lot to think about here. Those who refuse vaccination may, at best, be prevented from taking part in normal social or economic activities: at the most extreme end of the spectrum, they may eventually fall foul of mandatory immunisation laws. All of these extraordinary measures could lead to even further societal fracturing at a time of inherent instability.

This may also have the effect of physically separating groups of society based on their willingness to be vaccinated: should a private organisation refuse access to their offices to a person that hasn’t provided a vaccination certificate? Would this open the company up to liability? If this decision-making process is extrapolated at scale across society, in the worst case these groups with differing views could be physically separated - a drastic escalation from being digitally distanced in separate dialogue chambers on social media.

This can also play out on the international stage. Some countries, particularly in Asia, report potential vaccination refusal rates of less than 10%: they would naturally reach herd immunity levels far more quickly than nations with refusal rates closer to 30% or 40%. The gradual lifting of travel and economic restrictions, then, would probably favour states with lower vaccination refusal rates. This would have myriad real-world effects, from companies losing business to overseas competitors who have greater freedom of movement, to political backlashes by individuals who see citizens with different passports being able to travel more freely than they can. This entire question will depend heavily on the global immunisation strategy.

f)       The final risk sits outside the scope of this paper - whether eradication is even possible

We’ve seen the world change profoundly in the last 12 months: to imagine that it’s not capable of changing again is naive. There’s no guarantee that The Vaccine will ever arrive, or that eradication will ever be possible, but organisations should be preparing for the seismic shifts that it would bring all the same. Insurers should consider how it will affect losses, companies must assess how they’d respond to the social fracturing created by individual decisions, and humanitarians and governments need to begin preparing for the upheaval associated with the vaccination process. The Vaccine isn’t just the end of the current crisis - it could become one of its own.

19 October 2020