The Omicron response is not making sense
The onus is on countries in the global south to show leadership and let rationality and science determine the course
We noticed that towards the end of November 2021, when a new SARS-CoV-2 variant, B.1.1.529, was designated as a variant of concern (VOC) and named Omicron, by the World Health Organization, the response of many countries had an uncanny similarity to the initial pandemic response around February-March 2020. The flights to the countries which had reported the new variant were unilaterally halted. A few countries jumped into action to either expand or start COVID-19 booster dose vaccination for their population. The virus was often referred to as the South African and Botswana variant.
An irrational retreat
It appeared as if the world had barely learnt anything, while the reality is that the world of December 2021 is very different from that of March 2020. Back then, SARS-CoV-2 was a new virus and everything was unknown. In contrast, Omicron is just another variant of a virus we have known for nearly two years. Back then, nearly everyone was susceptible and now, with natural infection and/or vaccination, the pool of susceptible population has come down.
What the Omicron variant means for India
Currently, a little more than half of the world’s population has received at least one shot. Also, there is reasonable testing and genome sequencing capacity, including the availability of some new drugs with greater evidence of effectiveness, which are widely used.
All of this should have brought some nuance and granularity in the response. The scientific developments should have assured all that the response ought to be calmer, composed and evidence-informed. However, that seems to be missing, mostly if not always and all throughout. It is not making enough sense.
The South Africans, instead of being applauded for the work of their medical doctors, researchers and scientists in the identification and the reporting of the new variant in real time, have ended up as a nation that has been punished with a travel ban, which had even threatened essential COVID-19 lab supplies. Contrast this with the Netherlands, which had detected Omicron earlier than South Africa and did not report it.
Excessive reaction and why
It is true that Omicron has many mutations and some of those in the spike protein may have an impact on transmissibility, immune escape and sub-optimal response to the treatments. Clearly, this is enough to designate it as VOC, as it was. However, the response which followed should have been measured, evidence-based, derived from the experience earned in previous months and commensurate with the knowledge and understanding. However, it definitely has been excessive, in most cases if not all.
The problem is not solely with governments. A few researchers and scientists, bereft of the ground reality in South Africa and often not in touch with anyone at ground zero, must also take some of the blame for the superlatives and hyperbole, which have been used to describe the variant.
It will not be an exaggeration to say that some of the so-called ‘experts’ on social media and prime time television behave on what can be called the ‘borderline of public health malpractice’; with most of their information from sources on the Internet, yet always speaking as if they have the definitive and final words; and as if that is the only true science — which might be an unfortunate reality of the social media era.
Then, there are the television debates where invited guests — often the influential voices though not necessarily experts on the subject — conveniently take a position which echoes popular sentiment, and where the sense of rationality is drowned out. The impact of such misinformation is widely known to the people of India, where unsubstantiated claims that ‘children would be affected in the third wave of COVID-19’ could not be dispelled for long, and continue to affect learning of children where parents are still wary of sending children for in-person schooling.
From the ground
Both countries from where we writers belong, have responded to the emergence of Omicron largely with balanced, evidence-informed and measured responses, with occasional exceptions such as a demand from a few Chief Ministers in Indian States to ban all international flights. The last part raises serious doubts about their advisers on the COVID-19 pandemic as well as how there is a continuous need for science, and not merely political wisdom, to guide the pandemic response.
With the emergence of new variants, the next natural step has to be that countries should become more alert about the need for tackling vaccine inequities; in reality, a few high income countries have rather started looking inwards and focusing on administering boosters. Another reality is that many ‘experts’ seem to have taken a rigid stand on how the new variant is more transmissible, has immune escape, and has a high probability of re-infections.
Thereafter, as an example, even when the ground report from South Africa indicates that most cases are mild, some experts seem to be unwilling to budge from their position.
Similarly, the point that a majority of cases were detected in the travelling vaccinated individual is being argued as evidence of immune escape or re-infections, while missing the point of confounding or the ascertain bias, as international travellers are required to be mandatorily vaccinated and tested. Therefore, it is not enough to argue that these cases are being reported more commonly amongst the vaccinated individuals, thus having higher vaccine breakthrough infections than the previous variants.
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Most importantly, the role of current COVID-19 vaccines in preventing infections is limited. Therefore, as the global pool of vaccinated individuals is increasing, the absolute number of infections in this subgroup is likely to rise proportionately, especially when the practice of mask wearing is anything but universal and is going down.
The world seems to be divided into two groups of ‘experts’. One which is in a feverish rush and in competition to arrive at a certain conclusion before anyone else. Here there is a sub-tribe which argues that even though it may take many weeks or months before anything can be conclusively known, ‘let us assume that everything is worse with the variant’. This is not the right approach. However, this gets the first group more public attention than the second group which is talking about rationality and evidence-guided response. The approach of this group (the second group) is to look at the entire set of cumulative evidence and not the isolated one which best suits the argument one wishes to make.
One needs to remember that the impact of the Omicron variant, no matter what new characteristics it has, will be dependent upon the context and the settings. A highly transmissible variant in a well-vaccinated population is unlikely to change scenarios, while it might pose a real threat to populations with low vaccination uptake. An immune escape alone may have limited relevance if not accompanied by high transmission and severity. Re-infection or breakthrough infections are common with all vaccines and all variants. Therefore, the solution is not a booster dose (which in the case of most vaccines is not helpful in reducing the transmission); the approach must be to increase coverage with the first two shots of vaccines and focus on improving adherence to COVID-19 appropriate behaviours.
However, political leaders may resort to doing the easiest thing which echoes the sentiments of the people. The flight restrictions and the booster shots are reflections of that challenge. It is here where the voice of technical advisers, independent experts providing data on COVID-19 and the epidemiologists who are trained to make inferences based on limited information should be heard more frequently.
The rich countries have mostly disappointed the rest of the world in terms of global solidarity in the pandemic response, which includes vaccine inequity. There seems to be no end in sight to this tragic tale. Now, the onus is on countries such as India, South Africa and many others in the global south to show leadership, and let rationality and science determine the course of the pandemic response. Along with this, it is time for a dynamic pandemic response and not that of a worst case scenario. All of this is very much doable.
Dr. Chandrakant Lahariya is a physician with advanced training in epidemiology and public health, based in New Delhi, India. Dr. Angelique Coetzee is a physician in general practice and the Chair of the South African Medical Association, based in Pretoria, South Africa