A Q&A with WHO’s Maria Van Kerkhove on Covid — and fatigue over the pandemic

Maria Van Kerkhove gets it. Truly, she knows you’re over Covid.

The World Health Organization’s technical lead for Covid-19, Van Kerkhove understands that the world is struggling with a lot right now. Devastating flooding in Pakistan, famine in the Horn of Africa, war in Ukraine, monkeypox around the globe — there are too many demands for our attention and concern, for philanthropic and government funding. Plus, everyone just wants Covid to be in the rear-view mirror.

But 1 million people around the world have died from Covid so far this year, and at this point about 15,000 deaths a week are being added to that toll.

Forgetting about Covid isn’t the answer, she insists. Right-sizing our response to it is.

STAT talked to Van Kerkhove this week about where things stand with the pandemic. There was no talk of restrictions, or more of the dreaded Covid lockdowns. There was talk of the impossible-to-keep-straight names of the various Omicron subvariants.

This transcript of the conversation was edited for length and clarity.

You’re concerned about the fact that no one wants to talk about Covid anymore?

We’re in this situation with this virus where it’s still circulating pretty rampantly. We’re in a much better position globally to deal with it. But the world just so badly wants it to be over that I don’t think we’re optimizing our response. Nearly 15,000 people globally are dying every week; a million people died this year alone up to the end of August. So how do we communicate the threat of a virus that people so desperately want to behave in a predictable manner yet is not behaving with enough predictability where we could plan out the next six months to a year?

Omicron obviously is dominant, worldwide. BA.5 is the subvariant that is dominant. But there’s at least two dozen subvariants of BA.5 that we are tracking. BA.4 is decreasing, but BA.4.6 is increasing in some countries. It’s complicated. We can’t describe it in one-off sentences. We can’t describe the risk as succinctly as we would like, with the exception that this virus is still killing a large number of people.

So how do we get the messaging right? To say: Live your life. Live it responsibly, be safe, and by being safe, we mean get all the vaccine doses that are recommended for you, fight like hell for vaccine equity in countries that don’t have it yet. Wear a mask when you’re inside, or when you’re traveling, as much as you can. Just think about your daily activities and take some decisions based on your own risk.

We’re not talking about extreme measures anymore. We’re talking about simple measures that individuals can take. And at a government level, how do we clearly state that dealing with Covid, responding to Covid, is pandemic preparedness? It is an investment in every system that is needed for dealing with infectious diseases, the known and the unknown threats.

Has the WHO enlisted the help of anthropologists? Are you trying to get guidance from experts who think about how to get people to change behaviors and accept information they don’t want to hear?

Absolutely. We talk to behavioral scientists. We talk to social scientists. We talk to anthropologists. We have a behavioral insights group. We have a social science technical advisory group. And a lot of what we hear are the challenges that we face, with trust at an all-time low around the world for various reasons, with so many populations facing existential threats and conflicts, including war and displacement from floods and drought.

What we’re trying to do is right-size this response. Bang the drum to get governments to focus on what needs to be done for Covid to end the emergency everywhere. But Covid is not the only threat that faces people and governments. We are seeing countries dismantle pandemic systems like defunding surveillance, shutting labs down, firing work staff. And that is a mistake. That is short-sighted because that workforce and those systems can be used for other threats that that country faces. Covid. Monkeypox. Influenza. RSV. Polio.

So it’s much easier to pivot existing systems than to have to set them up each time a new threat emerges?

That’s right. This start and stop, this stalling out is what we want to prevent. The argument I’m trying to make is what we’re doing for Covid is for all of these diseases. There are specificities, obviously, but if you have a strong and an agile surveillance system in place, you adapt it. You utilize your event-based surveillance, your sentinel surveillance, your wastewater surveillance — whatever you have at your disposal. You utilize your lab capacity. You look at your diagnostic algorithms and say, OK, what are the threats that my population faces? And what do we need to be testing for?

You increase your vaccination coverage for Covid and all of the other vaccines, the diseases that we have vaccines for, which strengthens outreach, which strengthens relationships with communities. You tackle misinformation. I think that is something we will have to do forever. So all of these elements of the Covid response are important for everything else.

Before the 2009 flu pandemic there was a lot of time and money spent on pandemic planning, but the H1N1 pandemic was mild and after the fact, no one wanted to talk about pandemic planning anymore. Now with Covid, we’ve been through a major event, and no one wants to talk about pandemic planning anymore, or spend any money on it. It feels like the wrong lessons are being ingrained. Why isn’t this teaching us that these threats are coming at a faster pace?

I think it’s the trauma. I honestly think it’s like when you have a traumatic event on your body and you have your surgery, you have your cast, you have your rehabilitation, and then you forget about the pain.

In an event like this, you’ve got every sector focused on this because they need it to end. To save people’s lives. To get economies back on track. To get health systems back in place, get kids back in school. To go back to normal.

What we are not seeing right now is our countries use that trauma that they had with Covid to build longer-term systems. It’s not a one-off. It’s not an event like a flood, or like an earthquake. This is such a long-term thing that we have to just deal with. But we can. We’re evolving into dealing with Covid and flu and RSV. We’re evolving to deal with polio being detected in wastewater and monkeypox. We have to adapt.

Our funders should see this, and governments should see this as really focusing on economies. Healthy people contribute to economies. People who die do not.

When you’re talking about right-sizing things, there’s a lot of surveillance infrastructure for flu and RSV. Are there attempts to take advantage of those synergies?

Yes, there is a lot that is actually happening in that space. Because what we want to do is to have this integrated respiratory disease management which covers surveillance aspects. Utilizing the different systems that are in place. We need flu surveillance with SARS-CoV-2, with RSV.

There are different objectives of surveillance systems. So we want to utilize the different components — wastewater surveillance, seroprevalence, enhanced outbreak investigation-type surveillance in particular populations, in health facilities, in long-term living facilities, in immunocompromised patients. And the same thing with viral sequencing.

Surveillance is a concept that shouldn’t be pathogen-specific. It’s about the integration of this for diseases. And there’s a lot that’s happening very positively in that space. It just needs to be nourished. It needs to be financially sustained. We need the workforce that’s in place to do that. I see a lot of positive things that are happening in countries. We just have to keep pushing on this.

Last question: The variant naming thing. It was such a relief when the WHO came up with the system of naming variants by the letters of the Greek alphabet. But now we’re back in the same mess again, with strings of letters and numbers for the names of Omicron’s subvariants and sub-subvariants. Are we just stuck with this?

No, we’re not.

The scientific names — the Pango names, Nextstrain — won’t change. The Greek lettering system was for communication purposes where we describe something that’s “sufficiently different” than the last variant. What we’re looking at — and there is quite some active debate on this — is whether the subvariants are sufficiently different to be given a different name. The question that we’re looking at is whether the possibility to cause additional waves of illness should be a criteria to characterize it as something different.

We’re not going to go back and name BA.1, BA.2, BA.5 by different Greek letters. That’s not the point of that naming system. But if, for argument’s sake, BA.2.75 or BA.6 or BA.7 — because there will be more — is sufficiently different, where we have enough immune escape, where we expect to see an additional substantial wave, we’ll use that Greek system.