There are still more questions about the Omicron variant than answers. While the mutations identified suggest it has the potential to be more resistant to vaccines, invade cells more efficiently and be more transmissible than other variants, it may also turn out to cause less severe disease or it could just simply fizzle out. However, what it does tell us is that so long as there are large populations of unvaccinated people enabling the virus to spread and mutate unabated, worrying new variants of concern like this will continue to emerge. Once again, as borders close and stock markets tumble, it tells us that this crisis is far from over, and without dramatic course correction, will go on for some time.
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Given the rising levels of infection, the global shortage in ICU beds, the resumption of lockdowns and the riots, that much should already be obvious. And yet there is a growing perception – particularly in countries with high vaccine coverage where life appears to be returning to something close to normal – that COVID-19 has somehow become or is close to becoming endemic. That in itself is a concern, but a bigger worry now is that Omicron will trigger a knee-jerk response and a repeat of past mistakes. If the priority becomes to provide variant-specific boosters for people who are already protected, diverting efforts and resources from getting first doses to the 3.6 billion people who are still unvaccinated, then we could face a seemingly endless cycle of resurgences and new variants.
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If, as now seems likely, we won’t be able to eliminate this virus entirely, then the COVID-19 endgame will indeed mean that it eventually does become endemic – ever present, but with stabler and much lower levels of transmission and infection, much like flu. When that does happen, regular boosters will no doubt become the norm. But we are not anywhere near that stage yet. So, while it is encouraging and important that manufacturers are already working on Omicron-specific boosters, this cannot come at the expense of protecting those still most at risk, particularly those at highest risk, namely people who are still not vaccinated.
At this stage in the pandemic, COVID-19 has effectively become a disease of the unvaccinated. Because up until now vaccines have been incredibly effective at preventing severe disease and death, even against variants that have shown some resistance to vaccines like Delta. With Omicron it’s possible that that effectiveness could be reduced with existing vaccines, while boosters may offer some enhanced protection. But even if that is the case, what is likely to have the most impact on the pandemic: providing additional protection through third or fourth shots to people who are already at an extremely low risk or pouring efforts into reaching the billions of people who have still not had their first shot?
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This really is a no-brainer. The only qualifier is if Omicron really does significantly reduce the ability of existing vaccines to keep people out of ICUs, and that seems unlikely. While its mutations suggest it may be better at evading antibodies, even if this proves to be the case, vaccine immunity offers other lines of defense, which are often more resilient to such mutations.
So, while Omicron is a big concern, we need to be smart about how we respond. It’s nearly a year since the COVID-19 vaccines were first made available, during which time the vast majority of doses have been hoarded by the wealthiest countries. Had that not happened, had access been made more equitably available across the globe, with people most at risk prioritized, such as health care workers and vulnerable groups, then transmission could have been significantly reduced and it’s quite possible that variants like Omicron would not have been given the opportunity to emerge.
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Instead, as things stand nearly half the world’s population have not yet been vaccinated, and in the poorest counties only about 5.7% of people have had their first shot. This not only puts people needlessly at risk, but it allows the virus to continue to spread and mutate. With 1.5 billion doses now being produced a month, global vaccine supply challenges are finally easing and the race is on to protect the world, with COVAX aiming to deliver 800 million to 1 billion doses by the end of the year. Even if this variant outcompetes Delta, as we fear it may, unless there is firm evidence that existing vaccines are no longer protecting people and saving lives, the focus of governments and manufacturers must be to support this global effort, because that is the only way to break the cycle and alter the course of this pandemic.
Given that it looks like it’s already too late to contain Omicron, what we now need most is answers. The fact that we already know so much about it so quickly is largely thanks to the excellent science carried out in South Africa and the speed with which they shared that work with the world. If the fruit of that labor and spirit of partnership only benefits people in wealthy countries, in the form third or fourth boosters for protected people, while countries like South Africa are left on their own, then what motivation will they – or other countries – have to be so transparent the next time a variant emerges?