What to expect in 2021

It has been one of the most difficult seasons for Kenya and the rest of the world. A sick world and crushing economies, 2020 was bad in many fronts from health to social services sector.

When the first cases of Covid-19 were reported, subsequent lockdowns and restrictions meant limited movement of people as well as goods. The actions were meant to put Covid-19 in check.

But, Covid-19 has still infected almost 80 million people worldwide and killed more than 1.7 million in just one year. The world completely changed, from social interactions to the way people work, with more working virtually to avoid getting and transmitting Sars-Cov-2, the virus which causes Covid-19.

As the curtain falls on 2020, what do we expect 2021 to look like?

Covid-19

Covid-19 could become the “new normal” in 2021 and beyond, scientists have said. The disease has devastated the globe in the past one year. Unfortunately, the virus is here for the long haul, scientists have predicted.

Epidemiologists around the world have been projecting future Covid-19 cases and deaths, with an intention of helping governments prepare and mitigate the spread and impact of the virus. According to researchers, the future of Covid-19 depends on many unknowns including whether people will develop a lasting immunity, seasonality and the choices governments and people will make.

The World Health Organization (WHO) says Sars-Cov-2 will continue to be spread by ‘silent spreaders’. WHO is investigating the extent to which the silent spreaders are contributing to transmission.

If Sars-Cov-2 behaves like other human coronaviruses in circulation, whose immunity lasts for less than year, there could be annual surges in Covid-19 infections through to 2025 and beyond, states an article in the journal Nature.

With the virus constantly changing, there could be many more mutations in 2021, which could cause jitters just like the recent mutants - B.1.1.7 detected in the UK, and 501.V2 variant in South Africa.

A large number of people previously infected with Covid-19 will develop a post-Covid syndrome, said Dr Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases.

“Anywhere from 25 to 35 percent — or more — have lingering symptoms well beyond what you would expect from any post viral syndrome like influenza and others. It is fatigue, shortness of breath, muscle aches, dysautonomia, sleep disturbances and what people refer to as brain fog,” he said during an interview last month.

Tracing Sars-Cov-2

The origin of Sars-Cov-2 remains a puzzle. However, there are efforts to trace the source and how the virus jumped from animals to humans. Currently, there are two such efforts led by the WHO and the Lancet and it is expected that by 2021 they will bear fruit.

WHO has established a multinational team of researchers to pursue how the virus leaped species and on November 10 the organisation released its plans to identify the origins of the virus. The search will start in Wuhan, China where the virus was first identified and later expand across the country and elsewhere.

An international team of epidemiologists, virologists and researchers with expertise in public health, animal health and food safety will lead WHO’s Covid-19 investigation.

Lancet, for its part, has put together a 12-member taskforce to trace the virus. The experts will retrace a chain of transmission, from one source or multiple leaps of the virus from the animal to human being.

Covid-19 vaccines

The world has its eyes on a Covid-19 vaccine to protect them from contracting the virus. Kenya, for instance, has said it will roll out vaccination in the first quarter of 2021 and 24 million people are expected to get the jab in the first round.

The government has already ordered 24 million units of AstraZeneca’s Covid-19 vaccine, the ChAdOx1 nCov-19 vaccine. It is estimated that the first batch will cover 20 per cent of the country’s population.

The government may also enter into an agreement with Chinese organisations so that it can procure developed Covid-19 vaccines.

Currently, there are three Covid-19 vaccines, authorised for emergency use by some governments. WHO is expected to give a nod for wide use of the vaccines by Pfizer-BioNtech, Moderna and AstraZeneca which have already been rolled out for emergency use.

As of last week, there were 61 vaccines under clinical development and 172 vaccines in pre-clinical development. Some of these are expected to be ready for use in 2021. According to Bill Gates, as many as six vaccines could be ready by the first quarter of 2021.

Other companies expected to release final results for their vaccine candidates trials early 2021 are Johnson & Johnson as well as Novavax. Russia is also expected to release results of Sputnik V vaccine, which is undergoing a stage three clinical trial. In November, Dr Fauci said no one was certain how long a vaccine protection would last.

Covid-19 drugs

Currently, limited drugs treat Covid-19. The most effective of the drugs being repurposed or being developed to treat Covid-19 is dexamethasone. The drug was found to have a positive impact on patients on ventilators.

It was shown to reduce mortality by about one-third, and for patients requiring only oxygen, mortality was cut by about one-fifth, according to WHO.

But, in 2021 more drugs used to treat the disease are expected to be advanced further. Drug makers are looking at new formulations and drug delivery methods so as to bring vaccines and therapies to more people around the world. 

For instance, manufactures are targeting to deliver inhaled drugs and nasal sprays to “strike Covid-19 where it deals most damage”.

The current treatment types are infused, making them hard to be rolled out for wider use. But, the Eureka Therapeutics is developing a nasal spray antibody. It hopes that “targeting the airway — where inhaled viral droplets enter the body — could defend against disease. In a research, the company recently showed that its drug- InvisiMask, could protect mice against Sars-Cov-2 pseudovirus for at least 10 hours.

Regeneron is also expected to start delivering its antibody cocktail, which is a nasal spray. Other drug makers like Australia’s Starpharma are developing advanced delivery methods of the Gilead's approved antiviral, Veklury, also known as Remdesivir so that it can be administered by injection, meaning that even outpatients can get it.

Schools reopening

In Kenya, all learning institutions are expected to be reopened officially in January.

Millions of school going children are expected back in school despite the pandemic. But, are schools prepared to handle a huge number of learners without endangering their lives? The government has developed Covid-19 protocols on how learning will be carried out.

But many schools lack adequate infrastructure – spacious classrooms, dormitories and other facilities to cater for the many learners and enable social distancing to prevent the spread of Covid-19.

The government has already procured additional desks for learners. Various schools have issued circulars to parents stating the new requirements which students will need such as sanitisers and masks. With some learners having testing positive for Covid-19, it is expected more students may contract the virus while in school.

“Schools may become reservoirs of the disease from where it will start spreading in the community,” says Dr Bernard Muia, a public health expert. Learners and teachers are also expected to be among those who will be prioritised for the Covid-19 vaccine.

HIV vaccine

It has been over 30 years since the first case of HIV was identified. Unlike the Sars-Cov-2 whose vaccine has been developed in a record one year, it has taken decades to develop a vaccine for a virus which wrecks the immune system, leaving patients susceptible to Aids.

But after decades of waiting for a vaccine which offers protection from the virus, the end of the wait is nigh, as researchers expect to release results for two vaccine candidates in 2021.

There are three experimental HIV vaccines in the final stages whose results are expected to be released between 2021 and 2023.

Scientists say they are optimistic the trial of HVTN 702, Imbokodo and Mosaico will yield good results.

HVTN 702 is the oldest vaccine trial. Its development is based on another vaccine candidate, the RV144 whose clinical trial findings showed the vaccine lowered the rate of infection by about 30 per cent. It was launched in 2016 in South Africa and became the first trial vaccine to be approved. Clinical results for HVTN 702 are expected in 2021. The results for Imbokodo, another vaccine candidate being tried in five southern Africa countries, are expected in 2021.

“Imbokodo uses vaccine components designed to induce immune responses against a wide variety of global HIV strains,” says the National Institutes of Health.

Mosaico trial results are expected to be released in 2023.

Climate change conference

Covid-19 disrupted initial plans to hold the 26th session of the Conference of the Parties (COP26) to the UN Framework Convention on Climate Change (UNFCCC). It had been scheduled for November 9 to 19 in Glasgow, UK but was postponed to November 1-12.

COP is the decision-making body responsible for monitoring and reviewing the implementation of the UNFCCC. Its objective is to stabilise greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous human activities from interfering with the climate system.

COPs help governments to set their own climate change targets for different sectors, localities and organisations. During the COP21 in 2015, governments agreed to limit greenhouse gas emissions to 2°C above pre-industrial levels; and to pursue efforts to limit the increase to 1.5°C, in what is referred to as the Paris Agreement.

The agreement was negotiated by representatives of 196 state parties but the US left the accord in 2020. However, through Joe Biden’s administration, the US is expected to rejoin the Paris Accord as early as 2021. The US historically has spewed the most greenhouse gases into the atmosphere compared to other countries.

President-elect Joe Biden vowed to rejoin the Paris agreement “on day one” and to restore the US as a world leader in climate action. “I’ll immediately start working with my counterparts around the world to do all that we possibly can, including by convening the leaders of major economies for a climate summit within my first 100 days in office,” he said.

Universal Healthcare Coverage

The Kenyan government committed itself to achieving the Universal Health Coverage by 2022. The pilot study for UHC in Machakos, Nyeri, Isiolo and Kisumu counties ended this year after launch in late 2018.

Through the initiative, county governments discontinued all user fees at secondary public hospitals and, in return, received commodities and additional funds from the national government.

It is expected that UHC will be rolled out nationally before 2022.

The pilot project helped ease access to health services for millions of people and currently covers more than 200 community health units and 7,700 community health volunteers and over 700 health workers have been recruited. Through the project, the Health ministry, identified gaps including inadequate staffing and “the need for accelerated staff recruitment, better links between local and higher-level health facilities, timely funding and supply of medical commodities as well as coordination and management”.

Consequently, the government is now expected to scale up universal health coverage based on the experiences from the pilot phase. In 2021, it will focus on further reforming the National Hospital Insurance Fund (NHIF), establishing a mandatory UHC scheme, adopting an essential package of health services and providing health coverage for an initial one million low-income households to be biometrically registered, states WHO.

Weather

The weatherman has already predicted drought in 2021. According to the Kenya Meteorological Department, Climate Outlook for the October-November-December (OND) 2020 or the short rains season, several parts of the country are likely to experience depressed rainfall while western Kenya is likely to receive near-average to below-average rainfall.

This is because there is a negative Indian Ocean Dipole (IOD) in the region. This is not favourable for good rainfall over most of East Africa. Therefore, a drought is expected in 2021.

“In December sunny and dry conditions are expected to prevail over several places in the country as the cessation begins,” stated KMD in its forecast.

According to the Famine Early Warning Systems Network, mixed short rains performance is expected to impact crop production negatively.

Currently, most of the counties are food stressed and the situation is expected to deteriorate with the new year as rainfall is expected to cede in most of the areas.

Technology

Technology has been deployed in 2020 to monitor and manage Covid-19 and its spread as well as dispense healthcare services to people who cannot go to the hospitals.

When Facebook used artificial intelligence to boost blood donation in Kenya mid this year, it set the stage for what could become the driver for faster, effective medical attention in 2021.

With more technology companies setting office in Nairobi, Kenya could benefit from the most advanced deployments of Machine Learning, a sub-set of AI, especially in controlling cardiovascular diseases.

Now that Kenya has an AI taskforce and a Data Protection law, using the power of Big Data analytics, which forms the basis of AI, the country will highly benefit from the technology from a feasibility point of view. It is envisioned that in 2021, these will be used to replace clinicians for diagnosis

“Drones will be used to deliver vital medicine,” says Bernard Marr in Forbes.

On gene editing, Kenya has in the past years been doing light research. But with the efforts seen in boosting food security by adopting genetically modified organisms technologies, the innovation could see wider application in 2021.

While global researchers are confident the ability to edit the human genome will cure many genetic diseases, Kenya is experimenting with crops first before thinking of how to alter the human cell.

Pwani University has been pioneering research along this line, having conducted studies on the enhanced shelf life for cassava using genome editing.

Another research team at Kenyatta University is already developing sorghum varieties resistant to striga weed using the famous CRISPR-Cas9 technique, an advanced gene editing tool.

Additional reporting by Faustine Ngila