There’s very little we know for sure about omicron, the COVID variant first detected in South Africa that has caused tremors of panic as winter approaches. That’s actually good news. Fast, honest work by South Africa has allowed the world to get on top of this variant even while clinical and epidemiological data is scarce.
So let’s get our act together now. Omicron, which early indicators suggest could be more transmissible even than delta and more likely to cause breakthrough infections, may arrive in the United States soon if it’s not here already.
A dynamic response requires tough containment measures to be modified quickly as evidence comes in, as well as rapid data collection to understand the scope of the threat.
Vaccine manufacturers should also immediately begin developing vaccines specifically for omicron.
The United States, the European Union and many nations have already announced a travel ban on several African countries. Such restrictions can buy time, even if the variant has started to spread, but only if they are implemented in a smart way along with other measures, not as pandemic theatrics.
The travel ban from several southern African countries announced by President Joe Biden on Friday exempts American citizens and permanent residents, other than requiring them to be tested. But containment needs to target the pathogen, not the passports. As a precaution, travel should be restricted for both foreign nationals and US citizens from countries where the variant is known to be spreading more widely until we have more clarity.
We need stricter testing regimes involving multiple tests over time and even quarantine requirements for all travellers according to the incubation period determined by epidemiological data. We also need more intensive and widespread testing and tracing to cut off the spread of the variant. This means finally getting the sort of mass testing program that the United States has avoided and which has been part of successful responses to COVID in other countries.
If we aren’t willing to do all that, there is little point in a blanket ban on a few nationalities.
South African example
The reason we can even discuss such early, vigorous, responsible attacks on omicron is because South African scientists and medical workers realised it was a danger within three weeks of its detection, and their government acted like a good global citizen by notifying the world. They should not be punished for their honest and impressive actions. The United States and other richer countries should provide them with resources to combat their own outbreak — it’s the least we can do.
Tragically, one reason South Africa put in place the advanced medical surveillance that found the omicron variant was to track cases of AIDS, which continues to be a crisis there.
The antiviral cocktail that turned AIDS from a death sentence to a chronic condition was developed by the mid-1990s, but pharmaceutical companies, protected by rich nations, refused to let cheap generic versions be manufactured and sold in many poorer countries - they even sued to stop South Africa from importing any. Millions died before an agreement was finally reached years later after extensive global activism.
The callous mistreatment of South Africa by big pharmaceutical companies continued into this pandemic. Moderna, for example, has run some of its vaccine trials in South Africa but did not donate any to the country or even to COVAX, the global vaccine alliance, until much later.
Decades of such policies have contributed to high levels of medical mistrust in South Africa, including vaccine hesitancy. Only 35% of the adult population is fully vaccinated despite sufficient supplies. (Vaccine supply problems persist elsewhere in Africa: Only about a quarter of even health care workers in the continent are fully vaccinated - a horrible situation).
Good level of protection
Even if current vaccines lose some effectiveness against preventing omicron breakthrough cases, it’s reasonable to expect them to maintain a good level of protection against hospitalisation and deaths — something we’ve seen with other variants. This is because preventing breakthrough infections and blocking progression to severe disease involve different parts of the immune system — the latter is more able to keep recognising a virus and continue working well despite some mutations. Still, we can do much better.
All vaccines are still designed to protect against the original virus that emerged in Wuhan, even though that version is rarely found at this point. The Food and Drug Administration has previously said it was ready to approve variant-specific vaccines without the same scope of trials required for the initial vaccines. The FDA should start getting ready for that possibility.
In other good news, new antiviral drugs that may cut down death rates and hospitalisation in high-risk patients by as much as 90% are not affected by mutations in variants because they target enzymes that the virus needs to replicate. At the moment, this recent antiviral drug is expensive, though Pfizer has talked of cheaper access for lower- and middle-income countries.
Such drugs need to go wherever there are outbreaks, not be hoarded by wealthy countries with early contracts, and their production or price cannot be held hostage to the vagaries of even more profits by companies that have received substantial taxpayer support and use publicly funded research to develop their drugs.
Wealthier nations must provide financial support, as well, for nonpharmaceutical interventions, such as improved ventilation and air filtering, higher-quality masks, paid sick leave and quarantine.
All this requires leadership and a global outlook. Unlike in the terrible days of early last year, we have an early warning, vaccines, effective drugs, greater understanding of the disease and many painful lessons. It’s time to demonstrate that we learnt them.
Zeynep Tufekci is an associate professor at the School of Information and Library Science at the University of North Carolina
The New York Times