Structure Polish Academy of Sciences

The year 2020 has just drawn to a close. This is a good time to take stock and to plan for the new year we are now entering. Herein we present hypothetical scenarios for the development of the COVID-19 pandemic in 2021 and beyond. From a scientific point of view, each of them could become a reality, so we should be prepared for them all.

Scenario 1. Poland’s National COVID-19 Vaccination Program will be successfully completed in 2021.

In this scenario, the year 2021 will see a large portion of Poland’s population vaccinated against COVID-19 and we will achieve collective immunity during this year. Even those relatively few individuals who have not been vaccinated (due to serious medical counterindications) will be able to function safely in society. This will be achieved gradually. Through 2021, the number of people immune to COVID-19 will increase month by month, while the risk of healthcare system paralysis will systematically decrease. More and more age groups and occupational groups will return to normal functioning.

The two impeding factors that led to the severe economic slowdown in 2020 – the administrative restrictions and the fear and uncertainty that curbed the normal activity of households and companies – will gradually decline. The Polish economy will slowly begin to wake back up and return to activity. Facing a less uncertain tomorrow, the “postponed demand” of 2020 will be set into motion, becoming the most important growth factor in 2021.

The vaccine will maintain its protective effect for a long time, so in late 2021 and into 2022, COVID-19 cases will be sporadic, occurring mainly among people who come to Poland from countries that have failed to vaccinate the majority of the population. Other EU countries will be similarly successful in fighting the COVID-19 epidemic, thanks to which we will be able to travel freely both within the Schengen area and to those countries outside the EU which, like us, manage to bring the COVID-19 epidemic under control by means of vaccination. 

Scenario 2. Poland’s National COVID-19 Vaccination Program will not be successfully implemented in 2021.

Vaccination against COVID-19 will proceed from the beginning of the year. A sizeable proportion of the Polish population will be afraid of the vaccine and will not want to be vaccinated. There are many reasons for this: fear of the unknown, not always consistent messaging from the authorities, a vocal anti-vaccination movement, and above all the low capital of social trust in Poland. However, as the number of vaccinations grows, we can expect to see growing acceptance of them – the example set by others is crucial here. However, despite the availability of vaccinations, the number of people vaccinated will still be insufficient for collective immunity to be attained. This means that the epidemic in Poland will continue, perhaps slightly less intensely in the summer months and more intensely in the autumn-winter months. Poland will be on the list of high-risk countries – travel to and from Poland will be temporarily restricted or halted.

The social costs of this state of affairs will be vast. As a result of the stress associated with the prolonged pandemic, we will observe an intensification in clinical symptoms of phobia, social anxiety, depression, psychotic disorders and other mental illnesses. There will be an increase in suicides, self-harm, and other individually harmful behaviors such as alcohol and psychoactive substance abuse, as well as socially harmful behaviors such as aggression or violence.

The Polish economy will continue to stagnate. Although the administrative restrictions on economic activity in 2021 will be less painfully felt than in 2020, they will not disappear altogether, because the government will still have to introduce them temporarily. Due to outbreaks of the disease, it will remain significantly difficult to plan economic, educational, or cultural activities. In this scenario, exports will be the main driver of the Polish economy – especially in the event that the COVID-19 epidemic is brought under control in other European countries thanks to vaccination and their economies recover. As a result, foreign demand for Polish products will increase. However, fear and uncertainty will continue to hinder our activity and domestic demand – meaning that aggregate demand in the economy will still be low.

Scenario 3: Resistance to COVID-19, which will be commonly acquired through vaccination in 2021, will disappear after a short time

Most of the population in Poland will be vaccinated in 2021. The incidence of COVID-19 will therefore gradually decrease. However, before the incidence of COVID-19 falls to zero, the immunity acquired through vaccination during this year will start to fade. What will be the consequence of this? The number of patients with COVID-19 will again start to gradually increase as a result. Then, mindful of the mistakes we made when the SARS-CoV-2 virus first appeared in Poland, we will have to act completely differently. How? We will need to carefully monitor the situation, systematically testing a random representative sample of our population, with greater intensity among the most vulnerable groups. To be able to detect an increase in the number of infections early enough, even with a low number of cases, a control-test strategy should be introduced (with at least 300 tests per million people per day). Measures limiting the scope of the epidemic, such as wearing masks, following rules of hygiene, and maintaining appropriate distancing, will still have to be promoted. It will be crucial to isolate people who have had contact with infected people. Local outbreaks will require a rapid and decisive response, including travel restrictions, targeted testing, and local economic closures to quickly reduce the numbers of new cases.

Despite the loss of immunity, however, we will not be completely defenseless – we will still have a vaccine against COVID-19, allowing us to launch a booster vaccination program. From the economic perspective, on the other hand, we already know the optimal policy to adopt in pandemic conditions. Research has shown that restrictions impede economic activity to a lesser extent than the uncontrolled spread of a pandemic. Economic restrictions should therefore be short-term, decisive and introduced at an early stage. In this scenario, we will also be expectantly awaiting the creation of an effective, safe and easy-to-take oral medicine that can be used both in treatment and for post-exposure prevention at home.

Scenario 4: In 2021, a variety of SARS-CoV-2 will emerge which will not be fought by the immune responses caused by the COVID-19 vaccine

Another scenario involving renewed increases in the numbers of patients could result from the emergence of variants of the SARS-CoV-2 virus that are resistant to the vaccine. However, our immune system is equipped with a whole range of defense mechanisms and ways of remembering the threat, so before we face the threat of going back to square one, we will have plenty of time to develop a new variant of the vaccine, provided that we spot new variants early enough through monitoring. In addition, we already have a new methodology for the rapid development and modification of the vaccine in response to emerging mutations. In addition, it can be expected that the virus itself will also change over time, growing less virulent, to eventually become a relatively harmless pathogen similar to seasonal coronaviruses.

Scenario 5: In the coming years, perhaps even in 2021, we will be attacked by a completely new pathogen

Not all viruses dangerous to humans have already been discovered; many diseases have not yet been revealed and many others are dormant. Some viruses, such as those causing avian flu, MERS (Middle East Respiratory Syndrome), hemorrhagic fevers, or encephalitis-causing flaviviruses, continue to occur among humans. Fortunately, so far they are relatively poorly transmitted from human to human. However, research has shown that over time they could also take on a pandemic character. Due to the rapidly warming climate, the West Nile, Dengue, O’NyongNyong, and Usutu viruses have already been reported in Europe. If another new disease manifests itself before the COVID-19 epidemic is suppressed, we will simultaneously have to fight on two fronts, against two completely different pathogens – and what is more, again without a vaccine for the new pathogen.

To be able to emerge victorious from future pandemics, the Polish economy needs two great investments: in healthcare and in anti-epidemic protection. Hospitals have to be ready to rapidly take in large numbers of patients with a new unknown pandemic disease, irrespective of its route of transmission, and epidemiological services need to be able to efficiently detect and eliminate outbreaks      .

Conclusions

All the above scenarios are possible from the scientific standpoint and none of them can be ruled out. Therefore, we should draw the following conclusions from the year 2020, which will make it much easier for us to face developments in each of the scenarios presented above.

Number one: efficient institutions. We need to prepare ourselves institutionally for new epidemic threats. Poland should have a multidisciplinary expert institution (a National Health Organization) monitoring the global epidemic situation, closely cooperating with organizations such as the WHO (World Health Organization) or ECDC (European Centre for Disease Prevention and Control). It may be expedient for such national institutions to be established in all the EU countries, because without good and close international cooperation it is impossible to cope with serious challenges that by their nature stretch across national borders. By effectively coordinating the purchase of vaccines, the EU has shown that it is well-suited for this type of activity. When the imminent danger of an epidemic is announced, previously developed procedures (domestic testing and monitoring) and resources needed to fight the epidemic should be set into motion. For this to be done, it is necessary to significantly modernize, train and subsidize the sanitary and epidemiological services and implement a uniform, transparent, and reliable system of collecting data on epidemic threats and on vaccination procedures. Doctors specialized in infectious diseases also have a great role to play here – a specialization that is currently highly underappreciated in Poland. Specialists should also be active from the very beginning, educating the public about the approaching threat and preparing the information campaign. Taiwan, for example, was thus prepared for the COVID-19 epidemic and it suffered very few fatalities in 2020, while continually maintaining its economy open.

Number two: science. We need to bolster science in Poland and public trust in it. It is fearful to think of how the COVID-19 pandemic would have gone without science – how many victims there would have been, how great the material and civilizational losses would have been in Poland and worldwide. Only by taking scientific knowledge into account are we able to act rationally in the face of such a threat.

Number three: cooperation and responsibility. Coping with an epidemiological threat requires all of us to cooperate and behave responsibly. This attitude should manifest itself, for example, in widespread vaccinations against COVID-19 in 2021. This is the only way to avoid unnecessary human and economic casualties.

About the team

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary.

Other members of the team are:

Dr. Aneta Afelt (University of Warsaw)

Prof. Małgorzata Kossowska (Jagiellonian University)

Prof. Radosław Owczuk, MD (Medical University of Gdańsk)

Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)

Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)

Dr. Magdalena Rosińska, MD (National Institute for Public Health – National Hygiene Institute, Warsaw)

Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology)

Dr. Tomasz Smiatacz, MD (Medical University of Gdańsk)