When Will COVID-19 Become Endemic?

“It could mean we’ve hit this point where molecular evolution has played out its hand, or it could be this is the quiet before the storm,” the University of Minnesota’s Michael Osterholm tells CFR.

The world has made significant progress immunizing against COVID-19, but roughly one-third of people have yet to receive a vaccine dose, and the vaccination rate has slowed. At the same time, health experts have raised concerns about waning immunity in vaccinated people and vaccines’ reduced effectiveness against new variants.

Some countries are already treating COVID-19 as an endemic disease, while others, namely China, are keeping rigid pandemic measures in place. These policies can depend on infection trends as well as on the social mood, says CFR’s Jennifer Nuzzo. “In terms of when a pandemic is over, it’s really a social term,” she says. “We don’t have an epidemiologic criteria for the end of a pandemic.” Portugal, with among the highest vaccination rates, was an early model for dropping many of the tighter COVID-19 restrictions. Mexico and Spain have also moved toward treating the virus as endemic. And in a September interview, U.S. President Joe Biden stirred debate by stating that “the pandemic is over,” though a federal public health emergency declaration remains in place.

What are the risks of prematurely thinking the pandemic is over?
The predominant risk is that the world will again find itself largely unprepared in the face of a more dangerous variant of the virus, and the possibility remains that a variant could emerge against which existing vaccines are ineffective.

Complacency and government inaction contributed to the devastating surge of the delta variant across India in early 2021. And the United States found itself scrambling as the omicron variant spread like wildfire at the end of that year, without sufficient tests and other supplies to manage the record infection levels. U.S. health officials say the majority of Americans have been infected with COVID-19 at least once, but they caution people not to presume they have protection for the future.

What should governments do until the world reaches an equilibrium with COVID-19?
The best-case scenario is that broad immunity from vaccination and previous infections indeed prompts the transition to endemic COVID-19, but that is just one possibility. Governments should be prepared to handle the worst, such as a case in which the world’s current vaccines are unable to defend against a new variant.

The WHO continues to advocate for vaccination, particularly across Africa and parts of the Middle East where small portions of the population are immunized. Experts including Nuzzo and Osterholm also urge dedicating more resources toward developing vaccines and treatments and making them more widely available. Scaling up testing capabilities and improving monitoring and surveillance networks are also high on the list, since having accurate, regular measurements of infection levels in a community allows officials to implement the most effective response.

Claire Klobucista is Deputy Editor at CFR. This article is published courtesy of the Council on Foreign Relations (CFR).