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