Magic Bullets in the COVID-19 Pandemic
Exploring how “magic bullet” infectious disease mitigation measures have hindered the global response to COVID-19 (written October, 2021).
“Magic bullets” in global health refer to hypothetical cures for diseases that can be delivered or administered and that subsequently, on their own, mitigate the disease’s effects on populations. A single pill or vaccination that would allow individuals to go back to their daily routines without having to worry about a specific pathogen making them sick. In reality, this approach -- established in the 1950’s -- eventually led to a widespread sense of apathy amongst global health professionals when it proved to be ineffective in curbing the impacts of malaria. However, this approach is still visible in the fields of global health and pandemic response and is also visible in the lay population’s understanding of the spread of disease.
During the ongoing COVID-19 pandemic, many medications, as well as vaccines, have been referenced by both professionals and non-professionals in terms reminiscent of the magic bullet approach. Fringe cure-alls began to surface quickly after the pandemic began, preying on the general public’s fear and desire to return to normalcy. This was further fueled by politicians and public figures endorsing potentially dangerous and untested cures, from hydroxychloroquine to ivermectin more recently, as well as pushing the idea that the COVID-19 vaccine alone would return the United States to the way things were pre-pandemic.
The mindset that any one medication on its own could make the pandemic disappear thrived in the conditions set by previous global health crises and widespread uncertainty. Discussions began to center on potential cures for COVID-19, as opposed to mitigation measures and potential legislation to keep populations safe and healthy during a global health crisis. Economic decline further pushed the desire to lift lockdowns and reopen businesses, and two competing voices emerged -- anti-science politicians looking for a magic bullet, often with the goal of returning to a pre-pandemic economy, and public health professionals, looking for a magic bullet after other more long-term mitigation measures were met with hostility. The doubt cast by figures in leadership roles filled the gaps in public health’s pandemic response and allowed many laypersons to see disproven COVID-19 treatments as valid routes for treatment of the disease well after they were proven to be ineffective.
Outside of mask mandates in the United States, after lockdowns were lifted and stimulus payments stopped, vaccines became the primary focus in response to the pandemic, with many hoping that after their rollout, things could, finally, return to the pre-pandemic norm. Even after the vaccines became accessible to most United States citizens, the discussion of the requirements for herd immunity and potential breakthrough infections was overshadowed by a public desire to finally be out of the woods. In reality, United States COVID-19 cases as of October 2021 are comparable to case rates this time last year (The New York Times, 2021), while many of the safety measures deemed necessities last year, such as eviction moratoriums, supplemental unemployment payments, and mandatory shutdowns have been long repealed. Even mandates for indoor masking, one of the earliest mitigation measures recommended by the Centers for Disease Control, are still present in twelve states, three of which only require masking for unvaccinated patrons (Markowitz 2021).
Populations in middle-income countries were hit the hardest -- 75% of the world, per the World Bank (Beaubien 2020). Many who fall into this category were left in a difficult position when businesses shut down and their income disappeared. Even those whose workplaces were not affected by shutdowns had to decide many times between going to work sick and staying home from work for two weeks straight, with or without pay, depending on your position and full-time status for many companies. For someone falling into the middle-income category, this could be between ~1,500 - 5,000 dollars (Davis, 2021) that they may only be receiving a partial amount of, or may even be receiving none at all. This, alongside a culmination of other factors -- namely health-related misinformation and lockdown fatigue, made the public significantly more receptive to a magic bullet against COVID-19.
While priority is often given to the research and development of these “magic bullet” cures in hopes of keeping costs low and producing an easily-delivered solution, it is by no means the most effective approach. Disease management, the alternative to this magic bullet approach, while more time-consuming and initially costly, has proven more effective at controlling diseases and preventing the emergence of novel pathogens. In the early 1990s, as chloroquine and mefloquine began to lose effectiveness against malaria, the World Health Organization began adopting a global health approach, as the failures of the previous magic bullets became clear (Cueto 36). This new approach led to the implementation of primary and preventative care, research, and public health services in hopes to keep case rates low, as opposed to complete eradication of malaria.
In terms of the COVID-19 pandemic in the United States, disease management could look like low-cost and improved primary care so patients are able to manage the chronic conditions that make COVID-19 significantly more deadly, continued eviction moratoriums or free public housing so unhoused individuals are able to quarantine and recover when ill or continued stimulus payments so that workers don’t have to decide between paying their rent and not spreading a novel virus to their coworkers or the patrons of a business. Access to food and public health education, similarly, would act as preemptive mitigation measures that would have helped to quell at least some of the uncertainty felt in the early stages of the pandemic, born from food and toiletry shortages, business closures, and misinformation. Even now, misinformation about what the vaccine is supposed to do is extremely common. Many initially received it as a way of stopping COVID-19 completely, as opposed to managing spread and caseloads, and when breakthrough infections became more well-known, further vaccine skepticism was fueled.
The failures that occurred in managing malaria are still visible in how public health crises are handled today, and the desire for every pathogen to have an opposing and easily delivered cure prevents the lay public from understanding the gravity of these outbreaks, and how involved the process of eradicating a disease can actually be. Many people see the incredible things modern science can do when given adequate time and funding but are not always aware of the level of public and financial support required to get there. It is vital to continue encouraging preemptive disease management over simple response and pushing for long-term effectiveness over short-term relief if the global health community hopes to effectively manage the COVID-19 pandemic as well as any outbreaks or novel diseases in the future.
Sources
Beaubien, Jason. “What 6 of the 7 Countries with the Most Covid-19 Cases Have in Common.” NPR, NPR, 31 July 2020, https://www.npr.org/sections/goatsandsoda/2020/07/31/896879448/the-nations-with-the-most-to-lose-from-covid-19.
The New York Times. “Coronavirus in the U.S.: Latest Map and Case Count.” The New York Times, The New York Times, 3 Mar. 2020, https://www.nytimes.com/interactive/2021/us/covid-cases.html.
Markowitz, Andy. “Does Your State Have a Mask Mandate Due to Coronavirus?” AARP, 2021, https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.html.
Davis, Ben. “What Is a Middle Class Salary?” MVOrganizing, 30 Apr. 2021, https://www.mvorganizing.org/what-is-a-middle-class-salary-in-2020/.
U.S. Census Bureau Quickfacts: United States. 2019, https://www.census.gov/quickfacts/US.
“Covid-19 Provisional Counts - Health Disparities.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Oct. 2021, https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm#RaceHispanicOriginAge.
Samantha Artiga, Latoya Hill, and Oct 2021. “Covid-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes over Time.” KFF, 8 Oct. 2021, https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/.