BNS0027 Written evidence submitted by AnotherDay Background and introduction 1. After months of quantitative and qualitative research, the organisation that I work for, AnotherDay, has just finalised a white paper titled, ‘The Vaccine: How the end of one crisis could become the beginning of the next’, which looks at the seismic geopolitical, security, and societal implications of this possible COVID-19 eradication programme. We wanted the paper to be a first look at this important next step in the trajectory of the pandemic - and to help policymakers, journalists, international security professionals and humanitarians talk more confidently about what might come next. 2. As such, we are submitting the findings of this white paper to the UK Parliament Committee as evidence to address; The main drivers of biosecurity risks to human health in the UK, including from pandemics and emerging infectious diseases and biosecurity risks within overall national security risks. 3. AnotherDay, is a security, risk and intelligence consultancy, based in London. Our intelligence team has worked very closely with clients both prior to, and throughout the pandemic to provide them with actionable intelligence and crisis management skills to navigate the ever-changing and complex landscape. 4. Our clients include world leading banks, large multinationals, NGOs, retail outlets, insurance companies, law firms and individuals, and are based/operate around the world. 5. This white paper is the product of months of data gathering, analysis and expert forecasting on behalf of our intelligence team. Foreword: On 27 July 2020, the Director-General of the World Health Organisation (WHO) stated that COVID-19 is easily the most severe global health emergency ever declared under the International Health Regulations (IHR). Believed to have first emerged in China in late 2019, the disease has already led to more than 30 million cases and over a million deaths, with every country on earth affected. As such, a truly global response is needed – and fast. However, to date, only one infectious disease affecting humans has ever been successfully eradicated globally: the world was declared free from smallpox in May 1980, over two decades after the first eradication programme was initiated. SARS-CoV-2, the strain of coronavirus responsible for the respiratory illness COVID-19, continues to be an evolving organism. The WHO declared the initial outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020, and a pandemic on 11 March. However, global incidence continues to grow rapidly, new symptoms and side-effects are still emerging, we are starting to see ‘second spikes’ in countries that seemed to have had a solid grip on their outbreaks, and healthcare systems are reaching their limits. Add to this that several months down the line there continue to be a multitude of ‘known unknowns’, ‘unknown unknowns’, and divided opinions on a number of factors including incubation and contagiousness, transmission, symptoms, recovery, immunity, and, critically, potential preventative and reactive treatment options at both country and local levels. As with other diseases that have driven a global response, the ongoing spread and potential mutation of the SARS-CoV-2 virus must be prevented to not only minimise mortality, morbidity, and disruption of healthcare systems, but also to preserve economies and social development. The answer would seem to be simple: a global eradication programme similar to those implemented for diseases such as smallpox, polio, and yellow fever. And the need for such a programme has never been clearer as we see the current pandemic push numerous countries worldwide into severe recession, compounded further by a range of potential wide- reaching and long-term health, social, and economic welfare consequences. However, this brings about a number of important questions:

• Is an eradication programme actually achievable on the scale required for COVID-19 and in this age of massive uncontrolled urbanisation and global mobility? • If so, what would it need to look like? • If so, what are the dynamics and infrastructure needed? • How would it be successfully implemented, and protected, in remote and conflict- ridden regions? • How quickly can an appropriate global programme be developed and initiated? • How long would the campaign take to eradicate COVID-19, if that is indeed possible? • And what impact might the programme have on future security risk and political stability? We begin by analysing the large-scale eradication programmes undertaken for smallpox, polio, and yellow fever, showing that while these have had much success in dramatically reducing or even eliminating disease occurrence, they have also revealed there is no ‘quick win’; eradication is a lengthy and resource-intensive process, requiring a broad range of measures tailored to the individual disease and geographies being targeted, and generating an array of ‘lessons learned’. We then seek to address the questions posed above on the viability of a global eradication campaign for COVID-19, highlighting key comparisons with the nature and context of the other diseases outlined and the implications of these differences. Next, we comment on the potential impact of such a programme on the global security risk and political stability environment going forward, and finally we provide a range of country case studies to demonstrate our observations. We’ve also been rigorous in avoiding the question of whether a vaccine is even possible to develop. Clearly the availability (or not) of a COVID-19 immunisation will create its own monumental social, economic, and political effects. For the purposes of this research, though, we’ve focussed on how the actions, infrastructure, and decisions associated with a global eradication programme specifically will redefine our world, create new conflicts, or inflame existing ones. As with any seismic shift in human history, it may also create specific spaces in which there’s the potential for a new peace rather than a new war. Sophocles once opined that nothing vast enters the life of mortals without a curse: there’s no doubt that a global eradication campaign is critically important to move beyond the COVID- 19 pandemic, but policymakers and thinkers need to begin identifying the potential risks associated with such a gargantuan effort – which eventually may have to reach all seven billion humans on the planet – so that these risks can be effectively mitigated and controlled. So far, most public discourse has focussed on if and when a vaccine will arrive – we have therefore put together this white paper to help begin a conversation between international security professionals, the wider private sector, humanitarians, policymakers, and journalists on how we should start preparing for a world that could be fundamentally altered by the decisions, infrastructure, and conflicts over immunisation. From empty streets in London, to vibrant and teeming streets in Dhaka, to isolated fishing communities in the Canadian Arctic, we’ve tried to assess and explore the implications of what might come next – the implications, of The Vaccine. Key findings: (a) What we can learn from previous eradication campaigns  Large-scale eradication programmes have shown that at least 67-80% of the population at risk need to be inoculated to prevent transmission where there is an outbreak. As such, the method of vaccination is critically important.  Risks associated with the method of vaccination must be taken into account; side- effects, efficacy and health impacts to certain population sub-groups will all need to be considered as part of the eradication programme.  Any coronavirus vaccine will require a stockpile larger than any previous eradication effort in human history. When discussing the potential for vaccinating almost everyone on the planet, or at least enough of a proportion to make a difference to transmission (at least 67-80%), this would be tens of billions of doses – an order of magnitude larger than smallpox, polio, or yellow fever.  Without an effective test and trace programme at the national level in every affected country, a mass immunisation programme would lack the intelligence needed to understand whether vaccinators are already losing the battle. This would be particularly true if The Vaccine only leads to an effective immune response for a few months.  A community approach to the eradication programme will need to be adopted. Only a small proportion of the population visit conventional healthcare settings, which are designed primarily for those who seek help. In order to successfully deliver preventive as well as remedial services to the wider population, particularly in hard to reach areas, special outreach methods will be required.  Despite emerging indications that a viable vaccine might be available for distribution in the first half of 2021, the world will need to continue existing public health measures such as hand hygiene, mask wearing, and physical distancing, as well as rigorous testing, tracing, and isolating for the foreseeable future.  Access to other life-saving vaccinations worldwide has declined or been halted amid the COVID-19 pandemic, and the WHO has warned that this drop in routine immunisation could cause more harm than COVID-19 itself, consideration should be given to combining the delivery of COVID-19 inoculations with other vital disease vaccinations missed since movement restrictions were put in place.

(b) Societal resistance to vaccination  Societal resistance to vaccination, and the relationship with the spread of dis/misinformation over social media, is currently the most critical risk to any eradication programme. Up to 30% of people have asserted in surveys that they will not receive a SARS-CoV-2 vaccine, and this is even higher in some countries: this may create a scenario where many nations are able to reach the herd immunity threshold, while others cannot due to vaccine refusals and subsequently become reservoirs of disease.  A study released by US firm Health Testing Centers in November 2019 found over half of US states saw a decline over the decade prior in the rate of children being administered vaccines against diseases such as measles, mumps, hepatitis B and polio. It was suggested that between 2009 and 2018, 27 of the 50 US states experienced a drop in the percentage of vaccinated kindergarten-age children.  Anti-vaccination groups tarnish the reputation of large pharmaceutical companies, causing a cyclical effect whereby the occasionally tarnished reputation of the pharmaceutical industry could contribute to societal resistance to COVID-19 vaccines.  A 2015 study by the London School of Hygiene and Tropical Medicine looking at vaccine hesitancy across 69 countries found that Europe had the highest levels of immunisation refusals in the world. Moreover, this was shown to be driven by the same anti-establishment sentiment that led to a rise in support for populist political movements.  In the context of the COVID-19 virus, there is evidence that there has been a surge in state-sponsored misinformation and social media campaigns questioning the efficacy and safety of vaccines: the trajectory and content of these campaigns could have a significant effect on the effectiveness of The Vaccine.  Parental refusal to let their child be vaccinated is a growing trend. In a 2011 medical study carried out across the US, it was found that 77% of all parents polled reported having concerns about one or more childhood vaccinations.  One of the most common reasons parents provide for not allowing their children to be vaccinated stems from their religious beliefs. Religious grounds are generally linked to the core beliefs of the parents, and so on this basis are distinct from other cited reasons as they are most often are linked to a complete refusal of all vaccines: these types of views are extremely difficult, if not impossible, to dissuade.

(c) The terrorist-disease nexus  Terrorist groups have a binary relationship with deadly diseases, which can generally be termed the ‘terrorist-disease nexus’. On the one hand they express an interest in exploiting pathogens to create bioweapons, and on the other they can be more subtle and passively manipulate societal responses to epidemics by blocking health care workers and vaccination programmes.  Local health workers, where ‘community surveillance’ will be of importance, such as pharmacists, traditional healers, and clerics, could be met with increased suspicion on the back of misinformation, anti-vaccine sentiment, and the deliberate actions of militant groups.  Countries that are largely conflict-ridden or mostly sit outside of central government control could become new reservoirs of disease. This is largely because previous large-scale eradication programmes have shown that at least 80% of the population at risk need to be inoculated to prevent transmission where there is an outbreak.  Conflict and instability can generate obstacles to healthcare access for those who remain in situ rather than travelling overseas as affected regions may have weakened health infrastructure including damage to facilities and shortages of medicines or personnel. Additionally, access by humanitarian organisations, including those delivering medical care, is frequently prevented in such areas.

(d) Potential flashpoints of The Vaccine  Since it is widely accepted that the COVID-19 coronavirus emerged out of Wuhan, China, tensions between China and other nations around the world have escalated. Arguably none more so than with the United States, as President Donald Trump has repeatedly blamed China for the outbreak and spread of the pandemic. This has led to unprecedented levels of military brinkmanship in the South China Sea. The pandemic has accelerated a process of moving from a unipolar world to a multipolar one.  If vaccinations from both the United States and China appear on world markets at the same time, the potential for significant economic competition could influence the timelines and effectiveness of the eradication effort. This ‘vaccine diplomacy’ would most likely be felt in countries already walking a tightrope between the two powers, particularly in Africa and Latin America.  Although multinational initiatives such as COVAX are seeking to negate geopolitical tensions by standardising funding for vaccine distribution in the developing world, the prospect of China and the United States missing an opportunity to provide incentives to each draw nations away from the other is likely to be slim.  Efforts to break away from the WHO by the US – the biggest financial contributor to the former’s budget – would create a significant obstacle for the COVID-19 programme, particularly around coordination and sharing best practices. This move away from multinational approaches to significant problems would not manifest itself in military terms, though it is notably a by-product of the US’s ongoing tussles with China.  The way the COVID-19 vaccination programme is rolled out on a logistical level, and to whom it is given priority will likely cause geopolitical tensions, and at worst potential vaccine conflicts. On an intrastate level the programme itself and the way it is conducted has the prospect to erode government-community relations and lead to societal resistance.  Pharmaceutical companies holding monopolies over vaccines could create new power dynamics. Companies exclusively controlling vaccine supply to protect research and development investments could exacerbate tensions between those countries without vaccine access and those that are home to the world’s pharmaceutical firms.  There has been an emergence of corporate ‘vaccine nationalism’: in essence, wealthier countries asserting corporate secrecy, ownership and control over publicly funded COVID-19 vaccine research. This has led to multiple high-profile accusations of the hacking of western pharmaceutical companies by Russian and China. These developments were framed as major serious national security issues, and threaten a new kind of tension between those states involved.  Countries will have the ability to dictate the procedural elements and legal framework of how the vaccination programme will be implemented within their geographical remit. However, difficult, highly technical policymaking could serve to undermine the confidence in the vaccination process and significantly increase the number of refusals – leading to a situation where mandatory vaccination may be the only route, in extremis, to achieve herd immunity. Fig 1.1: Fig 1.2:

Fig 1.3: Conclusion: a) In our rush to exit the current crisis, we can’t ignore the risk of creating an entirely new one Exhibiting bias toward a current situation is an intrinsic part of the human condition: Joseph Banks, the botanist on Captain James Cook’s expedition to Australia in 1770, recorded in his diary that he was baffled that local indigenous fishermen completely ignored their - at the time, entirely alien - sail ship. Cook’s arrival would lead to a tectonic shift in the fortunes and futures of up to two million of Australia’s inhabitants, but at the time local people were more concerned with survival than the appearance of something so alien that it could barely be perceived. This isn’t entirely dissimilar to the situation in which we find ourselves in late 2020. The pandemic has created a kind of cognitive hangover: we’re trying, and failing, to envisage an end to the crisis while still trying to process its extensive, and still accumulating, impacts. Conflating ‘The Vaccine’ with ‘The End’ is a very straightforward way for us to cope with an uncertainty which might last into the middle of the decade, because through this conflation we create our own mental off-ramp. The Vaccine exists - at some unknown time in the future, requiring some unknown level of effort, exerted by people who aren’t us - and that’s enough to be comforting. Like the fishermen on the coast of what would eventually be known as Queensland, this obsession with dealing with the problems of the present keeps the difficulties, risks, and opportunities of The Vaccine blurry in our minds’ eye. It’s definitely now the time to bring it into sharp focus, and accept that any COVID-19 eradication programme would be one of the largest and most complex undertakings in human history. It will dwarf previous public health interventions, and would attempt to achieve widespread global immunity in a few short years - a fraction of the two to three decades of consistent surveillance and inoculation required to (almost) banish smallpox and wild poliovirus. Difficult doesn’t mean impossible. But, it will require a clear multinational strategy which brings together over 200 disparate and conflicting national initiatives, many of which will lack infrastructure, funding, and know-how. It will need to be achieved in regions which are impassable, in societies which are already fractured, and in states which aren’t safe, stable, or secure. This might also need to be achieved in very short order; unless The Vaccine can provide lifelong immunity, coronavirus anywhere is coronavirus everywhere. So are governments and organisations already mobilising, strategising and preparing for this gargantuan public health effort? Well, not exactly. The GAVI COVAX initiative, raising funding and commitments from states to ensure that the world’s poorest won’t be waiting at the back of the line for their dose, is an excellent start. It’s also likely not enough. We need to accept that the pandemic, so far at least, has not led to the same push for and reinforcement of pragmatic multilateralism that was seen after the last bout of wanton economic vandalism during the Second World War. Broadly speaking, most national governments have turned inwards and have reduced their capacity to engage on overseas issues in a meaningful, non- tokenistic, way. A clear, well-designed and multilateral eradication strategy isn’t a nice to have - this is a long process at the best of times, let alone in the middle of a global pandemic where the WHO is struggling with international suspicion, and relationships between permanent UN Security Council members are at a very low ebb. Planning needs to start now for us to have any chance of pursuing an end to COVID-19 without destablising entire regions in the process. b) As with any significant event in human history, The Vaccine will have far-reaching effects This doesn’t mean it shouldn’t happen - it must happen. From barmen in New York City to stallholders in Nairobi, the end of the pandemic would herald a return to an economic normality which dictates the health, success, and education of billions of people. The UN has already warned that lockdowns in 2020 have pushed up to 500 million people back into poverty, erasing the equivalent of 10 years’ of poverty eradication work. A ‘new normal’ of avoiding human contact only works for those who are already economically and socially stable. This inevitability doesn’t, however, relinquish responsibility for making sure that any eradication campaign is deployed in a way which mitigates risks as far as possible: a rush to vaccinate hundreds of millions of people without this planning is not just likely to exacerbate its worst impacts, it’s probably also doomed to failure. Understanding and visualising the effects of reaching and inoculating almost every human on the planet in a short period of time helps us to begin assessing what can be done proactively to reduce the risks associated with such an effort. Very few countries have emerged from the opening act of the pandemic with greater stability; in many ways, the political and economic atmosphere hasn’t been this febrile in most people’s living memory. This is also the atmosphere in which we’ll endeavour to do something which has never previously been attempted. Most previous disease eradication programmes have been conducted by technocrats, in slow time, and with little fanfare: in some ways, this is really what made them so successful. Public health responses to COVID- 19 have already been marred by politicisation, disinformation, geopolitical tension, and incompetence. The next challenge will be to make sure that The Vaccine is not condemned to a similar fate. c) The Vaccine could either slow or accelerate the move away from a unipolar world - that choice now belongs to the United States In many ways, the trajectory of the current crisis correlates closely with the relationship between the United States and China. The pandemic has brought into sharp focus an entirely new set of geopolitical considerations which may not have appeared until well into the 2020s: many firms are now reassessing their supply chain exposures to both superpowers in an environment where regulation and legislation have taken the place of gunboats and summits. The institution of the National Security Law in Hong Kong while world powers were distracted by COVID-19, or new US legislation governing the use of American machinery overseas to manufacture Huawei semiconductors, exemplifies an entirely new battle over intellectual property, technology, and economic interdependence. Although the pandemic isn’t the cause of this tension, it’s certainly the accelerant. Since the collapse of the Soviet Union, the United States has been the sole guarantor of international security. This unipolar world, with a single set of ‘rules’ for prosperity managed and promulgated by organisations such as the International Monetary Fund and World Bank, appears to be giving way to one in which competing sets of norms now need to coexist. Even before COVID-19, the arena of overseas financial aid was becoming increasingly competitive - why promise reform and anti-corruption drives for IMF assistance when Belt & Road initiatives would be just as lucrative without the same strictures? The actions of the United States in the coming years, particularly with regard to their support to the developing world to achieve comprehensive immunisation, will play a huge role in shaping the perceptions of national capitals towards or away from an American order which seems to be slowly evaporating. They will also have competition. It’s not far-fetched to imagine a scenario in which Chinese and American-made vaccines are both available, and the efficacy of both is untested or comparable: if the US decides to embargo export of this vaccine under an ‘America First’ policy and China does not, how does this shift relationships with important economies of the future such as Nigeria, Brazil and Indonesia? This ‘vaccine diplomacy’ will become as important, if not more so, than the ‘infrastructure diplomacy’ which both the United States and China have pursued aggressively for many years. Had the pandemic struck 20 years ago, it’s likely that the US would have played the leading role in planning for, funding and executing eradication on almost every continent. If that role becomes vacant, the question of who steps in to fill the gap becomes a serious one which could define geopolitical influence for many years. The actions of pharmaceutical companies will also play a role. Intellectual property protection is at the heart of medical research and development, and provides the reassurance needed to private firms that spending billions of dollars on treatments which are likely to fail is a worthwhile endeavour which will eventually generate future profits. Does that reasoning still hold for a coronavirus vaccine? A patent-free drug could enable production to be ramped up at the national level far more quickly than could ever be achieved by a single well- meaning organisation, and the nationality of the pharmaceutical companies which eventually reach the milestone of having an approved vaccine could play a key role in whether releasing it on an ‘open source’ basis could even be possible. The final geopolitical consideration will be the timeline, and prioritisation, of vaccine distribution. In 1972, a pilgrim returning from Iraq to Kosovo (then part of the Socialist Federal Republic of Yugoslavia) came down with smallpox: the country subsequently vaccinated 18 million people in 10 days using military roadblocks. The action of inoculation is not what takes the time, it’s the supply chain of providing enough doses and maintaining their efficacy. Should the developing world see countries like France, the United Kingdom, and China blocking vaccine exports to guarantee the safety of their own populations, the potential long-term strategic impacts could be very significant. If The Vaccine provides limited protection and requires almost constant top ups (say every four months, particularly for frontline health workers), this becomes a very realistic scenario. d) Eradication done badly could add fuel to the fire of existing conflicts, or create entirely new ones Taking a specific example makes it easier to understand how The Vaccine presents significant risks in areas of armed conflict. In the Taliban-held Korengal Valley, Afghanistan, who has the right to carry out vaccinations? The same logic applies to vast swathes of the Earth’s land surface which are de facto under the control of non-state armed groups. National governments have a difficult choice: do they attempt to exert their sovereignty through military operations, creating space for vaccination, or hand over the tools of immunisation to groups with which they’ve been fighting for years, or even decades? The third option is equally unthinkable - withholding potentially lifesaving drugs from the civilian populace to avoid the casualties of a military campaign, or the political embarassment of acquiescing to the territorial claims of secessionist or terrorist actors. In 2012, it was estimated that up to 200 million people fell into the category of ‘conflict-affected residents’ who are subject to the whims of rebel organisations. We’ve also outlined in this paper how terrorist groups, particularly those that hold territory, have weaponised previous vaccination campaigns: preventing inoculation teams from carrying out their jobs can prove to the populace, or other political actors, that they are a force to be reckoned with and can create public health crises which weak governments find it hard to respond to effectively. Groups such as the Pakistani Taliban, Boko Haram and Al Shabaab have all pursued this strategy repeatedly and are likely to do so again. The Pakistan example is instructive: at least 101 vaccinators have been assassinated, alongside many of their military and police escorts, since 2012. International organisations and their national donors need to begin considering how vaccinators will be protected in these situations and many others. This also begins a self-fulfilling prophecy. As vaccinators find it difficult to access conflict- affected areas, weak national governments attempt to facilitate eradication campaigns by force - in so doing, local populations associate vaccination with military operations, increasing the percentage of residents who refuse to be treated. Even worse, some governments may also see an opportunity to use vaccination as a cover for intelligence gathering in areas which are usually inaccessible: although most agree that the politicisation of these types of campaigns must be avoided, for some the temptation is likely to just be too great. These trade-offs, and how they’re navigated, will determine how long the coronavirus is able to continue to circulate in the absence of any kind of herd immunity. Oppressed or discriminated-against minorities are also unlikely to hold enough trust in national governments to accept an intensive vaccination campaign without violence: the Rohingya in Myanmar, for example, have suffered at the hands of the regime’s military for almost a decade. The prospect of the same national government taking steps to bring immunisation to villages that they have previously attempted to eradicate is problematic at best. This problem isn’t just confined to intra-state conflicts: does Armenia have the right to lead the eradication campaign in Nagorno-Karabakh, or does Azerbaijan? The same question could apply to dozens of frozen conflicts across the former Soviet Union, Africa and Asia. Equally, the prospect for The Vaccine could create the space for subject-specific dialogue between conflict actors that have never previously engaged: with the right international support, these individual discussions could lead to more wide-ranging peace talks. This is a good example of how public health initiatives can pose both risks and opportunities. e) We also can’t ignore the potential for social fracturing at home should The Vaccine become a political ‘wedge issue’ With surveys suggesting that vaccine refusal in developed countries is already hovering around 30% even before one has been developed, there is absolutely no room for complacency on the part of national public health agencies - and private organisations. Although some officials have already suggested that a vaccine would likely be reserved for high-risk demographics, if immunisation is to be the ‘off-ramp’ from the current crisis then the planning assumption is that an eradication campaign needs to target 67%-80% of the population. If this threshold isn’t reached, the coronavirus will continue to circulate and economies and societies will continue to suffer. Potential refusals increasing from their current indicated level could end The Vaccine before it’s even started, underlining the importance of public trust building long before a viable drug becomes readily available. As it stands, there’s significant room for this refusal rate to fluctuate wildly: social media and conspiracy theories seem to hold an outsized influence on suspicion of immunisation, and a popular viral post or video questioning the safety, motivation, or efficacy of The Vaccine could push refusal rates beyond the herd immunity threshold placing entire societies more at risk than in other countries. This is going to be a particular problem for the United States, United Kingdom, France, Russia, and eastern Europe. If politicisation of the eradication campaign undermines public trust, and the prospect of being immunised becomes a ‘wedge issue’, all bets are off. For the first time, a political issue would be directly connected to the health of every person in society: this is likely to exacerbate societal fracturing, particularly when coupled with social media recommendation engines. These engines, which recommend posts, videos, or groups to look at next, amplify content which has higher engagement rates - these engagement rates themselves are usually associated with content which elicits emotions like fear, paranoia, distrust, or hate. If these engines create a feedback loop of popularity for fringe conspiracy theories concerning The Vaccine, it may start a runaway chain reaction of misinformation eroding public trust which could take years to effectively combat. Social media companies need to take the lead in managing the public discourse. If a significant proportion of the population refuse vaccination, obstructing an ultimate goal of protecting everyone in a country through herd immunity (and therefore eventually eradicating the virus), what steps would governments begin to take? Organisations also have a lot to think about here. Those who refuse vaccination may, at best, be prevented from taking part in normal social or economic activities: at the most extreme end of the spectrum, they may eventually fall foul of mandatory immunisation laws. All of these extraordinary measures could lead to even further societal fracturing at a time of inherent instability. This may also have the effect of physically separating groups of society based on their willingness to be vaccinated: should a private organisation refuse access to their offices to a person that hasn’t provided a vaccination certificate? Would this open the company up to liability? If this decision-making process is extrapolated at scale across society, in the worst case these groups with differing views could be physically separated - a drastic escalation from being digitally distanced in separate dialogue chambers on social media. This can also play out on the international stage. Some countries, particularly in Asia, report potential vaccination refusal rates of less than 10%: they would naturally reach herd immunity levels far more quickly than nations with refusal rates closer to 30% or 40%. The gradual lifting of travel and economic restrictions, then, would probably favour states with lower vaccination refusal rates. This would have myriad real-world effects, from companies losing business to overseas competitors who have greater freedom of movement, to political backlashes by individuals who see citizens with different passports being able to travel more freely than they can. This entire question will depend heavily on the global immunisation strategy. f) The final risk sits outside the scope of this paper - whether eradication is even possible We’ve seen the world change profoundly in the last 12 months: to imagine that it’s not capable of changing again is naive. There’s no guarantee that The Vaccine will ever arrive, or that eradication will ever be possible, but organisations should be preparing for the seismic shifts that it would bring all the same. Insurers should consider how it will affect losses, companies must assess how they’d respond to the social fracturing created by individual decisions, and humanitarians and governments need to begin preparing for the upheaval associated with the vaccination process. The Vaccine isn’t just the end of the current crisis - it could become one of its own. 19 October 2020