Next year could see the end of COVID-19 as an emergency worldwide, but global healthcare systems are still at risk of being overwhelmed, the World Health Organisation has told Sky News.
Now as we close out the third year of the pandemic, and look towards the fourth, Sky News looks at how different regions have dealt with everything from vaccines to disinformation – and what to expect in 2023.
One of the biggest storylines this year was the growth of the Omicron strain, which has come to dominate the global COVID-19 caseload.
“We reached a peak of more than 23 million cases reported in a week,” the WHO’s Dr Maria Van Kerkhove told Sky News.
“We had to re-draw our scale. On the one hand while we saw that huge increase in transmission, on average Omicron was not as severe as Delta but still in some countries caused more deaths because of just the sheer number of cases.”
Omicron may have become the dominant variant, Dr Van Kerkhove says, but it is still evolving and changing, with around 500 sub-lineages in circulation.
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She added: “And this is why surveillance needs to continue.
“We need to track the known variants. We need to be able to detect new ones.”
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Image: Deserted streets in China were a common sight as the country pursued aggressive lockdown policies
But despite the changes with Omicron, the original vaccines are continuing to hold up against severe disease, Dr Van Kerkhove says.
There is more to do in terms of vaccine coverage worldwide however, she added.
While more than 13 billion doses of vaccines have been administered globally, the WHO target of 70% of populations in each country has not been reached.
This is one of the areas where inequalities in access can be seen.
Worldwide some 79% of people aged 60 or over have received their primary vaccine, but that number is only 60% in Africa.
“We’re not reaching those targets. And we have to in every single country, but predominantly in lower income countries, we’re missing those individuals.”
Image: A mental health worker with Doctors Without Borders (MSF) attends to a patient in Caracas, Venezuela
Dr Van Kerkhove urged those who have yet to get the vaccine to do so, saying that it is not too late.
“And what we see right now is the people that are requiring hospitalisation, the people who are dying, are the people who have either not received any vaccine at all or they haven’t received the full number of doses that they need.”
Looking back at 2022, she says the year was marked by countries adjusting their strategies as they opened up and sought to live with COVID-19.
Some countries in the Asia and Pacific regions, for instance, had been much more closed off during the pandemic as they sought to seal themselves off while rolling out vaccination programmes.
Thailand, which is highly dependent on tourism, was one of the first Asian countries to open up, while Japan and Hong Kong were some of the last.
There remains a prevalence of mask wearing in those regions, which has been largely abandoned in other parts of the world.
Image: People hold white sheets of paper in protest over COVID-19 restrictions in Beijing, China
“It’s clear that we are in a very different phase [of the pandemic], but in my mind, that pending wave in China is a wild card,” Dutch virologist Marion Koopmans, who sits on a WHO committee tasked with advising on the status of the COVID emergency, said this December.
Image: President Joe Biden receives an updated vaccine
India, however, has seen very little impact from coronavirus this year compared to the devastation it caused in 2021.
Markets, schools, colleges, factories, manufacturing units, government and private offices are all open, while work from home has been largely withdrawn after becoming the norm.
This has been helped by the country’s large-scale vaccination programme that has seen 2.2 billion vaccines administered, covering almost 70% of the population with two jabs.
In the US, President Joe Biden declared that the “pandemic is over” in September.
This was despite hundreds of Americans dying with the virus every day at the time – down from more than 3,000 deaths a day earlier in his presidential term.
Image: A man is escorted by police amid protests over vaccine mandates in Ottawa, Canada
However despite more countries opening up in 2022, Dr Van Kerkhove said there remains a risk that healthcare systems could be overwhelmed.
“In countries around the world the virus is spreading unchecked and healthcare systems right now are extremely fragile everywhere.
“Health workers are absolutely exhausted. Many have retired. Many have left. And we don’t see that strength in the system that we need to see.”
But she added that despite COVID-19 being here to stay, next year could see an important change in the way the virus is viewed.
Image: A visitor walks past an illuminated COVID-19 model in Paris, France
“We’re hopeful next year we can end this as an emergency everywhere because countries are better at dealing with it.
“The big wildcard is the virus. The wildcard is the mutations and the evolution of this virus.”
Long COVID is a “significant concern” and will be a big emphasis going forward as more research is done into what it is and how to treat it, she said.
Another huge issue that remains is around disinformation and partisan politics about the virus.
“So trust is really at an all time low because of what everyone has gone through with the politicisation, attacks on science, misinformation.
“And we have to work really hard to build that. It’s so hard won, but easily lost.”
America appears to have hit the three key locations in Iran’s nuclear programme.
They include Isfahan, the location of a significant research base, as well as uranium enrichment facilities at Natanz and Fordow.
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Natanz was believed to have been previously damaged in Israeli strikes after bombs disrupted power to the centrifuge hall, possibly destroying the machines indirectly.
However the facility at Fordow, which is buried around 80 metres below a mountain, had previously escaped major damage.
Details about the damage in the US strikes is not yet known, although Mr Trump said the three sites had been “obliterated”.
The US has carried out a “very successful attack” on three nuclear sites on Iran, President Donald Trump has said.
The strikes, which the US leader announced on social media, reportedly include a hit on the heavily-protected Fordow enrichment plant which is buried deep under a mountain.
The other sites hit were at Natanz and Isfahan. It brings the US into direct involvement in the war between Israel and Iran.
Israeli Prime Minister Benjamin Netanyahu hailed the “bold decision” by Mr Trump, saying it would “change history”.
Iran has repeatedly denied that it is seeking a nuclear weapon and the head of the UN’s nuclear watchdog said in June that it has no proof of a “systematic effort to move into a nuclear weapon”.
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Trump: Iran strikes ‘spectacular success’
Addressing the nation in the hours after the strikes, Mr Trump said that Iran must now make peace or “we will go after” other targets in Iran.
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Commenting on the operation, he said that the three Iranian sites had been “obliterated”.
“There will be either peace or there will be tragedy for Iran far greater than we have witnessed over the last eight days,” he said.
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Benjamin Netanyahu said Donald Trump and the US have acted with strength following strikes on Iran’s nuclear facilities.
In a posting on Truth Social earlier, Mr Trump said, “All planes are safely on their way home” and he congratulated “our great American Warriors”. He added: “Fordow is gone.”
He also threatened further strikes on Iran unless it doesn’t “stop immediately”, adding: “Now is the time for peace.”
It is not yet clear if the UK was directly involved in the attack.
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Among the sites hit was Fordow, a secretive nuclear facility buried around 80 metres below a mountain and one of two key uranium enrichment plants in Iran.
“A full payload of BOMBS was dropped on the primary site, Fordow,” Mr Trump said. “Fordow is gone.”
There had been a lot of discussion in recent days about possible American involvement in the Iran-Israel conflict, and much centred around the US possibly being best placed to destroy Fordow.
Meanwhile, Natanz and Isfahan were the other two sites hit in the US attack.
Natanz is the other major uranium enrichment plant in Iran and was believed to have possibly already suffered extensive damage in Israel’s strikes earlier this week.
Isfahan features a large nuclear technology centre and enriched uranium is also stored there, diplomats say.
Israelis are good at tactics, poor at strategic vision, it has been observed.
Their campaign against Iran may be a case in point.
Short termism is understandable in a region that is so unpredictable. Why make elaborate plans if they are generally undone by unexpected events? It is a mindset that is familiar to anyone who has lived or worked there.
And it informs policy-making. The Israeli offensive in Gaza is no exception. The Israeli government has never been clear how it will end or what happens the day after that in what remains of the coastal strip. Pressed privately, even senior advisers will admit they simply do not know.
It may seem unfair to call a military operation against Iran that literally took decades of planning short-termist or purely tactical. There was clearly a strategy of astonishing sophistication behind a devastating campaign that has dismantled so much of the enemy’s capability.
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3:49
How close is Iran to producing a nuclear weapon?
But is there a strategic vision beyond that? That is what worries Israel’s allies.
It’s not as if we’ve not been here before, time and time again. From Libya to Afghanistan and all points in between we have seen the chaos and carnage that follows governments being changed.
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Hundreds of thousands have died. Vast swathes of territory remain mired in turmoil or instability.
Which is where a famous warning sign to American shoppers in the 80s and 90s comes in.
Ahead of the disastrous invasion that would tear Iraq apart, America’s defence secretary, Colin Powell, is said to have warned US president George W Bush of the “Pottery Barn rule”.
The Pottery Barn was an American furnishings store. Signs among its wares told clumsy customers: “You break it, you own it.”
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Iran and Israel exchange attacks
Bush did not listen to Powell hard enough. His administration would end up breaking Iraq and owning the aftermath in a bloody debacle lasting years.
Israel is not invading Iran, but it is bombing it back to the 80s, or even the 70s, because it is calling for the fall of the government that came to power at the end of that decade.
Iran’s leadership is proving resilient so far but we are just a week in. It is a country of 90 million, already riven with social and political discontent. Its system of government is based on factional competition, in which paranoia, suspicion and intense rivalries are the order of the day.
After half a century of authoritarian theocratic rule there are no opposition groups ready to replace the ayatollahs. There may be a powerful sense of social cohesion and a patriotic resentment of outside interference, for plenty of good historic reasons.
But if that is not enough to keep the country together then chaos could ensue. One of the biggest and most consequential nations in the region could descend into violent instability.
That will have been on Israel’s watch. If it breaks Iran it will own it even more than America owned the disaster in Iraq.
Iran and Israel are, after all, in the same neighbourhood.
Has Israel thought through the consequences? What is the strategic vision beyond victory?
And if America joins in, as Donald Trump is threatening, is it prepared to share that legacy?
At the very least, is his administration asking its allies whether they have a plan for what could come next?