Why a Coronavirus Vaccine May Be Within Reach At least 90 vaccines are under development, with some already in human trials. by Zania Stamataki

The first coronaviruses known to infect humans were discovered more than half a century ago – so why are there no vaccines against these viruses? Should we be optimistic that an effective vaccine will be developed now?

SARS-CoV-2, the recently discovered coronavirus that causes COVID-19, is similar enough to other coronaviruses, so scientists make predictions about how our immune system might deal with it. But its novelty warrants its own careful study. Similar to Sars and Mers that cause severe acute respiratory syndrome, the novel coronavirus has emerged from animals and can cause damage to the lungs and sometimes other organs.

Why don’t we have a vaccine against other human coronaviruses? The emergence of Sars and Mers, in 2002 and 2012 respectively, were either quashed relatively quickly or affected small numbers of people. Despite the interest from keen virologists, there was no economic incentive to develop a vaccine for these diseases as they posed a small threat at the time. Virologists with an interest in coronaviruses were struggling to secure funding for their research.

In contrast, COVID-19 has caused huge disruption around the world. As a result, at least 90 vaccines are under development, with some already in human trials.

How a vaccine works

A vaccine gives our body a harmless flavour of the virus, alerting the immune response to generate antibodies and/or cellular immunity (T cells) ready to fight the infection. The idea is that we can then deploy a ready-made defence system next time we encounter the virus, and this spares us from severe symptoms. We know that most people who have recovered from COVID-19 have detectable antibodies in their blood.

We don’t know if these antibodies are fully protective, but a vaccine still has the potential to elicit powerful neutralising antibodies and scientists will evaluate these following vaccination. Researchers will also look for potent T cell responses in the blood of vaccinated people. These measurements will help scientists predict the efficacy of the vaccine, and will be available before a vaccine is approved.

The best way to evaluate a vaccine, of course, is to judge how well it protects people from infection. But exposing vulnerable groups to the virus is far too risky, so most vaccines will be tested in younger people with no underlying health problems. There are ethical considerations for deliberately infecting a healthy person with a potentially dangerous virus for a vaccine trial, and these need to be considered carefully.

In the course of a pandemic, a vaccinated volunteer may become infected with the novel coronavirus, especially if they are a healthcare worker. It will take time to gather data on protection following infection and compare them to people that received a placebo vaccine.

Vaccine challenges

The ideal vaccine should protect everyone and cause lifelong defences with a single dose. It would be quick to produce, affordable, easy to administer (nasal or oral administration) and wouldn’t need refrigeration, so non-specialists can distribute it to hard-to-reach parts of the world. In reality, we don’t fully understand how to produce a vaccine that induces long-lived protective immunity for different viruses. For some infections, we need to administer booster vaccinations.

Ageing comes with a tired immune system that struggles to respond to vaccination, and this is also the case for people with weakened immune systems, so it is difficult to protect the most vulnerable. Therefore, vaccination programmes that protect over 80% of the population can reduce the incidence of virus spreading and protect the vulnerable by proxy, through herd immunity. Currently, the percentage of people who may have had COVID-19 in different parts of the world varies, but this is hard to estimate because of test availability.

Scientists test and confirm a vaccine’s safety before it is approved. We appreciate that in some viral infections, existing antibodies from an earlier infection with the same type of virus can cause more severe disease. However, there is no strong evidence for any adverse effects of antibodies for SARS-CoV-2 infection.

Within reach

Here are some reasons to be optimistic. One, this virus can be cured. Unlike some viruses such as HIV that embed their genome in our own and make fresh copies of themselves after immune elimination, we know that SARS-CoV-2 is unable to persist in this way.

Two, most infected patients develop antibodies and there is evidence of virus-specific T cell responses. Although we don’t know if these responses are protective yet, these are precisely the responses that can lead to immunological memory, the cornerstone of vaccination. Vaccine products will be refined and enriched to induce more potent immune responses than natural infection.

Three, coronaviruses mutate slower than viruses such as influenza, and we know from Sars and Mers that antibodies can persist for at least one to two years following recovery. This is good news for an effective vaccine that may not require updating for quite some time.

There are more reasons to be upbeat. Scientists are testing several approaches so there is a higher probability of success, and pharmaceutical companies have been engaged early, scaling up production and working out logistics for distribution even before there is evidence the vaccine will work. This is worth the investment because resources can be quickly repurposed for the most promising vaccines following the first clinical trials.

A coronavirus vaccine is within our reach, and it is our best hope to stem transmission and generate herd immunity to protect the most vulnerable. Taking away its hosts for replication, we can eradicate this virus from the human population just as vaccination previously eradicated smallpox.

Coronavirus Pandemic Underscores Class Divides in Britain There is a sharp divide between the fraction of deaths in managerial and professional occupations versus routine and manual occupations. by Mark Williams

We often hear that Britain is a “class-based society”. Ask people what class is and you’ll get a wide range of answers – from accent to cultural tastes – leaving you perplexed as to how it might ever be a useful construct to understand much about the realities of British life. But really it’s all about what job you do.

I study the relationship between a person’s class and their life chances and it has become glaringly apparent during the coronavirus crisis that class – what job you do – has never been more important.

There is a clear class divide in the COVID-19 death rate, with working class jobs such as carers, taxi drivers, security guards and retail assistants clearly worse affected than middle and upper class jobs who can much more easily self-isolate and work from home.

Analysing data released by the Office for National Statistics (ONS) on registered deaths in England and Wales among people aged 20 to 64, up to and including April 20, I find a sharp divide between the fraction of deaths in managerial and professional occupations and routine and manual occupations. While routine and manual occupations account for around 34% of jobs, those working in such jobs account for more than 43% of COVID-19 deaths among those of working age. Conversely, managerial and professional occupations account for 43% of all jobs but 28% of these deaths so far.

Digging further into the detail makes very tragic reading. The deaths are highly concentrated in occupations that have been working on the frontline: caring and health, delivery workers, drivers and those working in retail. Of the 369 occupations listed by the ONS, just five account for 17% of COVID-19 deaths among those of working age in England and Wales. Just ten occupations account for 27% of these deaths, with 20 accounting for 40% (only 20% of people work in these 20 occupations).

These jobs are also overwhelmingly manual and routine occupations – those carried out by the economically least advantaged. While the class divide in COVID-19 deaths is not wholly out of sync with the divide in non-COVID deaths, these figures are a powerful reminder that what you do quite literally determines your life chances.

Impact of easing lockdown

Workers who cannot work from home can now return to their workplaces. This will clearly affect classes differently. Around 75% of managerial and professional workers will almost certainly carry on working from home because they can. By contrast, a similar proportion of routine and manual workers will most likely be back at their workplaces. According to my analysis of ONS data, these are occupations where less than 10% have ever worked from home.

One way to get a handle on the class dimension of the risks of going back to work is by using recent statistics published by the ONS on occupational exposure to infectious diseases and proximity to others at work. Those in routine and manual occupations are most likely to be exposed to infectious disease in their job. These workers are also most likely to work in close proximity to others, making social distancing measures more difficult.

Combining these two indicators to form an overall risk index reinforces the pattern that those workers being told to go back to work are also most vulnerable to infection at work. By contrast, managerial and professional occupations are less at risk – with some notable exceptions, such as those related to health like medical practitioners, nurses and dentists.

What is more, routine and manual jobs are the lowest paid, have the poorest sick pay and other workplace benefits and are the most insecure. But this predates the coronavirus crisis – class inequalities in conditions of employment have been becoming more entrenched over the past four decades.

What COVID-19 does is accelerate the impact of these class differences and throw the issue into stark relief. Reorganising workplaces to enable social distancing will likely be the most challenging and least effective in those jobs being told they can go back to work. They are also most at risk to infection, as well as being the ones needing to go back to work the most to make ends meet. What kind of job you have has never been more important for your life chances.

Substance Abusers are at Greater Risk During the COVID-19 Pandemic The COVID-19 pandemic comes on the coattails of the U.S. opioid epidemic. by Melissa Cyders, Kevin L. Ladd and Melissa S. Fry

The closures of businesses and states throughout the U.S. due to the COVID-19 pandemic have been stressful, costly and challenging for many.

But the restrictions do not affect everyone equally. Particularly vulnerable are those with substance use disorders. With schedules disrupted, medical and psychological care curtailed and support networks shut down, the COVID-19 pandemic may jeopardize their recovery.

The COVID-19 pandemic comes on the coattails of the U.S. opioid epidemic. Between 1998 and 2018, about 450,000 people died from opioid overdose.

Progress was being made until COVID-19 appeared. Those of us who work in the field of substance use disorders became concerned for those in recovery as the pandemic spread and social distancing was put in place. Social connection and support are key parts of recovery. Without them, relapse is more likely. When people with opioid use disorder relapse, there’s more involved than a loss of sobriety, ruinous as that is. Often there is a loss of life.

Right now, our team, including the three of us – an associate professor of psychology at IUPUI, an associate professor of sociology at Indiana University Southeast and a psychology professor at Indiana University South Bend – are trying to understand how people with substance use disorders are managing their recovery during the COVID-19 pandemic. Between March and April 2020, we spoke with 45 adults ages 28 to 73, half of whom have opioid use disorder. The other half have a combination of other substance and/or alcohol use disorders. Their stories reflect many challenges, but also some silver linings; they also suggest ways we can do better.

Stress, cravings, hopelessness

The interviewees rated their chances of infection from COVID-19 at 63%. That’s more than double the rating from members of the general community (about 30%). The higher numbers may reflect reality; nearly two-thirds (63%) of our participants report preexisting conditions (such as chronic respiratory illnesses) in themselves or someone in their household. This places them at higher risk for COVID-related complications.

Evidence also suggests that people with substance use disorders are disproportionately more likely to experience homelessness or incarceration, two more risk factors for higher COVID-related complications and death.

Adding to the problem: Diagnosing COVID-19 in people who use substances is not always straightforward. Withdrawal may worsen or mimic COVID-19 symptoms. In turn, a COVID-19 infection may aggravate the breathing impacts of opioids, benzodiazepines and alcohol.

We were not surprised that 78% of our sample reported higher stress than before the pandemic, due primarily to increases in job or family responsibilities (42%) and job losses or reductions (30%). These changes in routine, coupled with unstructured free time, make recovery more difficult for them. The added stress contributes to feelings of loneliness, frustration and hopelessness.

Stress can exacerbate substance cravings and contributes to relapse. About 20% of the sample reported increases in cravings, and 17% reported using substances since the pandemic’s start. This may foreshadow an increase in relapse rates as the pandemic continues and in its aftermath.

Less access to support

Study participants report closures of recovery houses, suspensions of in-person support meetings and premature dismissals from treatment centers. Restricting these critical supports creates significant challenges for maintaining sobriety. The majority of respondents indicated they are now attending support meetings online or by phone; a small percentage no longer attend meetings due to cancellations, perceived reductions of support or because meeting forums feel “chaotic” and “not the same.” Those who have lost the communal support of meetings are at substantial risk of relapse.

Overdose reversal medications save lives from opioid overdose. However, some localities are reporting decreased use of overdose reversal medications by first responders to limit COVID-19 transmission.

Many with opioid use disorder rely on lifesaving opioid replacement medications. These treatments often require regular urine monitoring; this is to make sure the medications are not being diverted. But those once-routine visits are now restricted due to COVID-19. Fortunately, the government has developed new guidelines to ease restrictions and enable continued treatment using these replacement medications despite limited monitoring.

On the positive side

Those struggling with drug and alcohol use are showing great resilience in the face of the pandemic; 83% of our sample have maintained sobriety. Many of our respondents say isolation is an opportunity to better connect with friends, family and support group members. Some say they now have more time for journaling, praying, cooking and spending time outside. One individual highlighted the new ability to attend more meetings via online formats. Thus, although these are challenging times, as one participant noted, “[My treatment facility] and Alcoholics Anonymous have prepared me very well for this time.”

What can we do to help those in recovery? Yale University’s Program in Addiction Medicine offers guidelines for treatment during the pandemic. Flexibility is key. Options include reducing monitoring requirements, which would allow extended take-home doses of opioid replacement medications. Still, individuals should be prepared for limited access to syringe exchange programs, and providers should heighten awareness of blood-borne diseases caused by sharing or reusing needles.

Based on our conversations, interpersonal connections remain at the core of recovery. Online meetings are far from universally helpful. Though it may seem old-school, phone calls, physical letters or other personalized contacts may have significant roles to play in maintaining support networks.

Individuals and groups looking for ways to contribute might contact local agencies to coordinate donations of letters, masks or other tokens of encouragement for distribution among clients. To ensure their sustained sobriety, we must support people in recovery who need access to health care, stable housing and community. And then it is our responsibility to remain mindful of those needs after the pandemic becomes a memory.

Could Blood Thinners Be a Lifesaving Treatment for COVID-19? A growing body of research evidence suggests COVID-19 causes abnormalities in blood clotting, which means blood thinning drugs may have a role to play in treatment. by Karlheinz Peter, Hannah Stevens and James McFadyen

A spate of recent media headlines have described blood thinning medications – which include aspirin and warfarin – as a “breakthrough treatment” for COVID-19 that could “save lives”.

It’s early days yet but a growing body of research evidence suggests COVID-19 causes abnormalities in blood clotting, which means blood thinning drugs may have a role to play in treatment.

Here’s what the research says on this question – and how it applies to you.

Mounting evidence

When COVID-19 first emerged, it was thought the illness was a typical respiratory disease causing symptoms such as fever, sore throat, dry cough, and potentially lung infection (pneumonia) and a build-up of fluid in the lungs making it difficult to breathe.

However, as we outlined in a previous article in The Conversation, 30-70% of COVID-19 patients admitted to intensive care units, developed blood clots.

These rates of blood clotting appear to be much higher than what is expected when compared with people who are hospitalised for reasons other than COVID-19.

Blood clots in the veins often present in the legs (deep vein thrombosis) and are dislodged into the lungs (called pulmonary embolism); approximately one in four COVID-19 patients admitted to intensive care will develop a pulmonary embolism (where an artery in the lungs gets blocked).

Arterial blood clots associated with COVID-19 can lead to strokes, including in younger patients, with potentially devastating outcomes.

In addition, COVID-19 appears to cause tiny blood clots that can block small vessels in the lungs. These “micro” blood clots may be a key reason why patients with COVID-19 often have very low oxygen levels.

Blood clots appear to be associated with a higher risk of dying from COVID-19. Likewise, elevated markers of blood clotting are associated with an increased risk of admission to the intensive care unit and a worse prognosis overall.

Should blood thinners be standard treatment for COVID-19 patients in hospital?

Because the rate of blood clotting is so high, all people admitted to hospital with COVID-19 should receive a low dose of blood thinner medication to prevent blood clots. This prophylactic dose of blood thinner is standard across most hospitals in Australia.

However, many blood clots in COVID-19 are occurring despite the use of low-dose blood thinners. As such, it is a question of intense discussion whether people admitted to hospital with severe COVID-19 should receive a higher-than-usual dose of blood thinners to prevent blood clots and improve clinical outcomes.

A recent study from the US suggests patients admitted to hospital and prescribed full dose blood thinners had a better chance of survival and lower chance of needing a ventilator.

However, this finding has to be confirmed before the higher dose can be generally recommended. Fortunately, several research studies are underway in Europe, the UK and elsewhere to test and answer this question definitively.

Several other blood thinner treatments are also being evaluated in people with COVID-19. Aspirin is commonly prescribed to people who are at high risk of strokes or heart attacks. There are now studies underway examining if aspirin can reduce risk of blood clotting in people with COVID-19. In the US, some stronger clot-busting medications are also being trialled in people with severe COVID-19.

It is important to note blood thinners are not without risk, as this treatment can increase the risk of bleeding. So without definite evidence to support the benefit of high dose blood thinners in all hospitalised patients with COVID-19, the decision to use higher doses of blood thinning medication outside of a clinical trial must be made on an individual basis.

Should I take an aspirin to prevent blood clots?

There is no evidence aspirin or other blood thinners should be taken to prevent blood clots in the general population. Also, there is no evidence blood thinners are required to prevent blood clots for people with mild COVID-19 who are isolating at home. Because blood thinners can cause bleeding, they should not be taken unless prescribed by a doctor.

It is important for people who are taking blood thinners for another reason to continue taking these medications as normal, particularly if they are diagnosed with COVID-19.

In summary, our understanding of COVID-19 and how the coronavirus attacks the body continues to rapidly evolve. Researchers from around the world are publishing data almost daily. However, not all of this research has been peer reviewed.

If you develop symptoms, the most important thing you can do is to get tested for COVID-19 and talk to your doctor about potential treatments, including hospital admission and then about blood thinning medication.

In summary, our understanding of COVID-19 and how the coronavirus attacks the body continues to rapidly evolve. Researchers from around the world are publishing data almost daily. However, not all of this research has been peer reviewed.

If you develop symptoms, the most important thing you can do is to get tested for COVID-19 and talk to your doctor about potential treatments, including hospital admission and then about blood thinning medication.

Similar to our colleagues in the UK and the US, we as doctors specialised in the field of blood clotting are indeed optimistic and hope clinical studies currently underway will show rigorous strategies for prevention and treatment of blood clotting will help to reduce severity and improve survival of patients with COVID-19.

Coronavirus: Why We Need Manual Contact Tracing Arguing for the superiority of automated tracing for reasons of cost and speed risks ignoring the significant benefits of tracing carried out by people. by Roderick Bailey

The UK has launched its smartphone app to assist with contact tracing. The government is full of enthusiasm and the Isle of Wight is the guinea pig. But for all the fanfare and faith in its potential, is the right kind of tracing being done? And are we missing the human touch?

The idea behind the app is for those who download it to self-report symptoms of COVID-19 and receive alerts when the phones of users who may be infected come within transmission range.

If enough people use it, claim supporters at the University of Oxford, it can get the epidemic under control. They also assert that it offers a way of gathering and transferring data that is cheaper and faster than traditional, manual methods of contact tracing.

Those older methods typically involve health officials carrying out in-depth questioning in person or over the phone, with subsequent follow-ups, to establish, monitor and control paths of human-to-human transmission. The process is certainly resource-heavy. It can also be very slow.

But arguing for the superiority of automated tracing for reasons of cost and speed risks ignoring the significant benefits of tracing carried out by people.

The problem with apps

Apps may improve the quality of data sharing and analysis but have little record of decisive application to contact tracing.

Common obstacles met by phone-based technologies rolled out to tackle Ebola in West Africa, for instance, included network gaps, software problems and unfamiliarity with smartphones. Self-reporting of symptoms, meanwhile, was considered no substitute for professional, independent, in-person verification.

By contrast, manual methods of contact tracing have a rich history of accomplishment.

They contributed significantly to the eradication of smallpox and the containment of SARS. They enhance responses to sexually transmitted diseases such as HIV and remain a critical tool for tackling Ebola.

Why manual tracing works

To understand this success, it is important to see that the benefits of manual tracing are not confined to finding people and recording their temperatures.

Of particular value is trained tracers’ ability to assess symptoms, detect asymptomatic carriers, and flag other possibilities for compromised health and onward spread, which untrained eyes – and apps – may struggle to spot.

In 2014, after three cases of Ebola were diagnosed in Texas, manual tracing identified 179 contacts. Defined as anyone who had been in physical contact with an infected case, within three feet of one for 15 minutes, or in a potentially contaminated shared space, they were found to include eight children of school age, three non-English speakers, two people with existing and serious health conditions and one person assessed to be homeless.

Manual tracing also offers a way to build trust among at-risk populations, especially when local norms, values and concerns are catered for with respect and empathy.

This can be particularly helpful in times like these, when individuals and communities in so many corners of the world are suspicious of state intentions and interventions, exposed to misinformation, or concerned about questions of confidentiality and the purposes to which data may be put.

During Allied military efforts to control a major outbreak of typhus in Naples during the second world war, teams of Italian-speaking US Army doctors joined up with local civilian nurses and priests to successfully trace dozens of cases.

We see further examples from Ebola to tuberculosis to HIV of vulnerable populations being more easily persuaded to comply with important control measures such as changing behaviour, sharing data and agreeing to isolation and treatment.

This can help to address, too, problems of stigma and segregation of people who are infected. Compassionate and connected contact tracers have also historically played important roles in soothing fears of positive diagnoses and supporting other aspects of mental health.

When Ebola was detected in Senegal, tracers’ demonstrable interest in contacts’ mental health and the provision of a hotline for psychological support helped foster public acceptance of containment measures.

No easy answers

Successful contact tracing is not easy. As the WHO observed at the height of West Africa’s Ebola outbreak:

"Persons who conduct contact tracing should have investigative skills to find and track all potential contacts, and the ability to analyse the evidence. They also need to be flexible and empathic with the cases, contacts and their families in order to build trust and good community relations."

Responses to past outbreaks tell us that tracing can indeed be time-consuming and expensive. To be effective, it must also be deployed among a battery of coordinated actions including isolation, testing and the development of vaccines.

Easy answers to epidemics are rare. “You cannot sit at a desk and do it,” as Brigadier General Leon A. Fox, a US Army medical officer tasked with halting typhus’s spread across Europe, observed at the end of second world war. “It takes a lot of drive, push, fight and work.”

Contact tracing remains a proven method of breaking chains of disease transmission, and, when capacity exists, ought to occupy a central role in bringing today’s pandemic to a close. And it will be at its best if those who embrace tracing’s potential appreciate its strengths as a process driven by humans.

Coronavirus Threatens Australia With Unprecedented Recession Having gained perhaps more than any other developed nation from open borders and trade, Australia now has more to lose. by Ross Garnaut

Pestilence is so common,” writes Albert Camus in The Plague:

"There have been as many plagues in the world as there have been wars, yet plagues and wars always find people equally unprepared. When war breaks out, people say: ‘It won’t last. It’s too stupid.’ And war is certainly too stupid, but that doesn’t prevent it from lasting."

So, too, with recessions. Too stupid, and so common. Yet they always take people by surprise; and they last.

The damage from the global financial crisis of 2008 lingers in the form of lower economic growth and stagnating wages.

That’s true even in Australia, one of just two developed countries (Korea being the other) that avoided a GFC-driven recession (two successive quarters of declining output).

As I argued in my book title Dog Days: Australia after the boom, Australia has long been primed for a recession. Now it is going to get one. Having gained perhaps more than any other developed nation from open borders and trade, it now has more to lose.

Why recessions happen

Big recessions happen when a shock reveals a weakness in the structure of the economy. There have been manifold points of weakness in the global economy in recent years:

• in the US, the Trump administration’s expansion of fiscal deficits by cutting taxes at a time of full employment with debt and deficits already at record peacetime highsthe retreats from China’s new model of economic growth from 2017

• • the breakdown in global governance on trade, climate change and security, sharpened by the US-China trade conflict

  • the unusually high levels of debt in most economies

  • the sustained low investment, productivity and wages growth throughout the developed world.                                                                                Australia has shared many of the developed countries’ points of vulnerability.

    Recession triggers

  • The immediate cause of recession can be any of many things.

    It could be the piercing of unwarranted confidence in the sustainability of an exchange rate fixed in Thailand. This is what led to the Asian Financial Crisis of 1997.

  • Or it could be an excess of financial deregulation promoting lending for houses far in excess of their value. This what led to the US subprime loans crisis a decade later, with the Global Financial Crisis the result.

    For any single country, the trigger can be other countries’ recession and the associated reduced demand for imports, or the associated financial stress.

  • This time it’s a new virus, emerging from the Chinese city of Wuhan in December 2019.

    Had the virus outbreak been contained in China, or its immediate neighbours, the effect would still have been enough impose great damage on the Australian economy. The Australian government was determined to do all it could to avoid a recession.

  • Avoiding recession is an important objective, because the costs are large and hard to unwind. But developments mean there’s no chance of that now.

    We can work, however, to ensure the recession is as shallow and short as possible, and that Australians have confidence there is a path to better days ahead.

    The importance of knowledge

    We don’t know yet how deep the Great Crash of 2020 will dive. That depends a great deal on how governments in many countries respond. Those responses, in turn, depend on the knowledge of leaders, and of citizens, about how the economy works.

  • Knowledge turns out to be an important part of this story.

    First, medical scientific knowledge.

    Some governments, including Australia’s, have had access to good medical science and have taken it seriously. This has helped to contain the damage.

    Some governments have paid little and inconsistent attention to scientific knowledge. The people of the Brazil, Britain and the United States endured pain and expense for their government’s ignorance or stupidity.

    The virus keeps on doing what a coronavirus does, whatever humans think about it. Just as carbon dioxide keeps on doing what it does, whether or not governments accept scientific knowledge about its effect on climate.

    Second, economic policy knowledge.

    Since the Great Depression of the 1930s, we’ve learnt a great deal about how to reduce the depth and length of recessions. We’ve also learned much about the sources of broadly based modern economic growth.

    More to gain, more to lose

    Australia will have to perform better than most other countries to avoid economic outcomes being worse.

    Our economy’s relatively small size and dependence on exporting primary resources means we have more to gain than most other countries from open borders and international trade. We also have more to lose from disruptions.

    No other developed economy of comparable size has benefited as much as Australia from the easy international movement of people – for business, pleasure, education, and to build new lives as migrants.

    Unlike most other developed countries, Australia is also located in a region of developing countries. This means it will be damaged more by the pain the pandemic is likely to disproportionately inflict on the developing world.

    The challenge facing Australia is unprecedented. It will require solutions to match.

China outplayed the world on the day it was meant to face a reckoning over its coronavirus response by Alexandra Ma

• The World Health Assembly began on Monday, with dozens of countries looking to hold China accountable over the coronavirus outbreak.
• It would likely have embarrassed China on the world stage, casting its response in an unflattering light.
• But China ended up sidestepping that. President Xi Jinping deftly embraced a watered-down investigation likely to spare China any humiliation.
• He also made a high-profile pledge of $2 billion to the World Health Organization and more aid to countries in need.
• Meanwhile, US President Donald Trump refused to speak at the assembly and threatened to withdraw the US from WHO. US funding for WHO is already on hold.
• China moved nimbly on the world stage and made a show of generosity while the US appeared small-minded and reluctant to lead.

• China was meant to face a reckoning this week over its early response to the coronavirus outbreak, outnumbered in public by dozens of angry nations at the World Health Assembly. Instead, it ended up outplaying the world.

  At Monday's virtual World Health Assembly, countries were meant to vote on a draft motion, proposed by Australia, that would have begun an investigation into the source of the novel coronavirus and China's role in the outbreak.

  It likely would have cast an unflattering light on China's early inaction and its suppression of information, which cost valuable days of preparation.

  But that motion didn't even make it to the table.

• Instead, the assembly was presented with a watered-down draft motion from the European Union that called for a review on "lessons learned," with few specifics.

  In other words, the new version does not call for an investigation into the origins of the virus in China. At no point does it mention China or Wuhan, the city where the first cases were found.

  Also read: The White House has military-grade weaponry and a specialized air-ventilation system, but experts say that's not enough to protect a cavalier president from the coronavirus

  

  Wuhan's Huanan wet market, where China says the novel coronavirus outbreak originated, on January 21. 

  Dake Kang/AP

  More than 110 WHO member states had backed the motion on Monday.

• As it became clear that the motion was going to pass, China reversed its earlier opposition and embraced it instead. It passed on Tuesday with no objections.

  President Xi Jinping on Monday also gave a surprisingly conciliatory speech to the assembly in which he:

  • Backed an investigation — but only when the pandemic is over.

  "China supports the idea of a comprehensive review of the global response to COVID-19," Xi said, "after it is brought under control to sum up experience and address deficiencies" (emphasis added).

• Dozens of nations still have outbreaks, meaning this criterion is unlikely to be met anytime soon, especially with no vaccine. Many countries that eased restrictions, including Germany and China, had to partially reimpose them when new cases surfaced.

  • Worded his pledge in such a way that countries will struggle to hold China to account.

  The WHO investigation "should be based on science and professionalism, led by WHO, and conducted in an objective and impartial manner," Xi said.

  The omission of the word "independent" is telling, CNN's James Griffiths noted.

  

  A medical worker takes a swab sample to be tested for COVID-19 in Wuhan on Saturday. 

  HECTOR RETAMAL/AFP via Getty Images

  Carrying out independent investigations in China is notoriously difficult, especially if it could embarrass the ruling Communist Party.

• When international bodies demanded access to Xinjiang, home to the beleaguered Uighur Muslims, China gave heavily choreographed and chaperoned tours and forbade researchers and journalists from investigating independently.

  If this is a glimpse of what a coronavirus investigation would look like, the world will struggle to hold China to account.

  • Announced an additional $2 billion in funding to WHO, with a focus on developing countries.

  The extra $2 billion almost matches WHO's entire annual program budget for 2019, Reuters reported. It means China is WHO's largest financial contributor.

• The top contributor used to be the US. But President Donald Trump earlier this year withdrew $400 million in funding to protest what he said was WHO leadership's "China-centric" nature.

  

  Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, meets Xi at the Great Hall of the People in Beijing on January 28. 

  NAOHIKO HATTA/AFP via Getty Images

  On Monday, a White House National Security Council spokesman, John Ullyot, called the $2 billion injection "a token to distract from calls from a growing number of nations demanding accountability for the Chinese government's failure to ... warn the world of what was coming."

  Throughout the pandemic, WHO has praised China's response to its outbreak — despite widespread reports of a cover-up — and repeatedly rejected accusations that it is too close to China.

  • Pledged to help African nations better their healthcare systems and promised that any Chinese vaccine development "will be made a global public good."

  • The US is reportedly planning to disassociate from a WHO resolution to let poor countries bypass patents to access coronavirus vaccines or therapies.

    Even early reports of such a move invited accusations that the US cared more for its pharmaceuticals industry than for impoverished countries suffering from COVID-19 outbreaks.

    The reports followed a public spat when the French drugmaker Sanofi reversed a pledge to give the US priority access to a coronavirus vaccine candidate after pressure from the French government.

    China, meanwhile, has in recent weeks been crafting an image for itself as a global benefactor in the fight against the virus, rather than the country where the virus originated.

  • It has sent medical supplies around the world, and Xi pledged on Monday to start an exchange with 30 hospitals in Africa and to help accelerate the construction of the Africa Centers for Disease Control and Prevention headquarters.

    Experts have overwhelmingly dismissed these acts as a propaganda stunt, but it is undeniable that China is making a play for global leadership when few other nations seem willing.

    

    US President Donald Trump. 

    Associated Press

    Trump made it easier for China to claim victory

    As China made grand pledges at the World Health Assembly, Trump went on the offensive.

    He rejected an invitation to speak at the assembly, instead sending Health and Human Services Secretary Alex Azar, who went on to blame WHO for failing to warn the world about COVID-19 in the pandemic's early days.

  • "In an apparent attempt to conceal this outbreak, at least one member state made a mockery of their transparency obligations, with tremendous costs for the entire world," he said, clearly referring to China.

    As  John Haltiwanger noted, the fact that Trump declined to speak at the assembly — while Xi did — showed that the US was pulling away from its responsibilities on the world stage.

    

    Trump and Alex Azar, the secretary of health and human services, at a coronavirus task force briefing at the White House on March 20. 

    Associated Press/Evan Vucci

    Late Monday, Trump tweeted a furious four-page letter he had sent WHO Director-General Tedros Adhanom Ghebreyesus in which he threatened to make the "temporary freeze of United States funding to the World Health Organization permanent and reconsider our membership in the organization."

    Trump also accused WHO of favoring China and censured it for not praising his response to the US's outbreak.

  • China described the letter as an attempt to smear it and shift focus away from Trump's mishandling of the US crisis.

    The contrast was clear. China was given an opportunity to, however cynically, present itself as a calm, peaceful leader. Meanwhile, the US appeared petty and reluctant to engage.

    It is not hard to see China angling to fill the power vacuum Trump is leaving at WHO — which could help the country walk away relatively unscathed from the pandemic that began inside its borders.