Topic: “The COVID-19 Pandemic during a Historical Turning Point and the Need for the Convergence of Knowledge”
Hitoshi Oshitani (Professor from the Department of Virology, Tohoku University Graduate School of Medicine)
　It has been almost three years since the WHO declared a Public Health Emergency of International Concern (PHEIC) for COVID-19 in January 2020. The pandemic will likely continue indefinitely, with unforeseen challenges perhaps lurking on the horizon. The issue has become increasingly complex and must be examined from a variety of perspectives.

　The risk of emerging infectious diseases, such as COVID-19, has increased with the evolution of civilizations. The possibility of emerging infectious diseases becoming a serious threat in the 21st century has been pointed out since the late 1980s. However, the international community has downplayed these risks and promoted globalization. As a result, the risk of pandemics due to emerging infectious diseases is higher now than at any other point in the history of humankind.

　The international outbreak of SARS after a reported case in 2003 in Guangdong, China shocked the world. This, combined with the highly pathogenic avian influenza virus (H5N1) epidemic that followed soon after, heightened the sense of urgency towards emerging infectious disease pandemics. This led to the WHO revising the International Health Regulations. In Japan, the inadequacy of infectious disease crisis management has been thoroughly critiqued. However, despite inadequate preparation and a weak public health infrastructure both globally and domestically, we in Japan confronted the COVID-19 pandemic.

　After COVID-19 was first reported by the WHO on January 5, 2020, the disease rapidly spread across the world. Delayed PHEIC declaration, due to political considerations by the WHO and the delay in the international community's response were major factors for the global spread. In particular, lack of risk awareness delayed initial responses in Western countries, leading to increased deaths in the early stages of the pandemic. In addition, the emergence of mutant strains, including the European strain (D614G), made COVID-19 difficult to control and led to the pandemic. In Japan, COVID-19 cases were successfully contained during the first wave of the pandemic because of early case detection and efforts of public health centers. However, the virus circulated and spread in highly populated metropolitan areas which later led to a nationwide epidemic.

　Initially, it was hoped that the problem would be solved by the rapid development of drugs. Indeed, vaccine provision—especially mRNA vaccines—has contributed greatly to the reduction of COVID-19 deaths. However, only a few vaccines and therapeutics were approved, and the vaccine effectiveness has diminished over time. Furthermore, the emergence of mutant strains with low vaccine efficacy emerged one after another. Pharmaceuticals have not been able to solve those issues altogether.

　Currently, there are more than 6.6 million deaths worldwide due to COVID-19, but the actual number of deaths in each country is estimated to be far higher than reported. The number of daily COVID-19 deaths in Japan currently exceeds 400. Furthermore, the number of excess mortalities in Japan has drastically increased from last year. Additionally, medical emergencies, such as emergency transport difficulties, have occurred in Japan and many other countries.

　Despite these circumstances, there is currently a global "Back to Normal" movement which aims to return society to the way it was before the COVID-19 pandemic. Even if the COVID-19 pandemic is resolved, new pandemics, including influenza pandemics, are likely to occur. Given this possibility, it is crucial to consider whether we really should return to "normal"—a lifestyle that has always been vulnerable to emerging infectious diseases.