Omicron: The global perspective

A discussion on equity and practical steps

“Forget travel bans. Vaccinate the African people.” - Dr. Peter Hotez

“Vaccine inequity = more COVID19 transmission and death = more opportunity for new variants to emerge = more social and economic disruption.” - WHO

Viruses mutate. We’ve said for months that the MORE virus circulating due to public health measures not being followed properly (like masking, distancing, etc), the more opportunity the virus can mutate. Mutations are a bit random - which is good and bad. Bad because we don’t really know when the virus will mutate to a version that is more lethal and one that evades vaccines. That’s what we need to look at.

Enter Omicron. (BTW, if you want to know why the WHO decided to use Omicron instead of Nu go here. In short, the WHO skipped Nu (easily confused with “new”) and Xi (because it’s a common surname) to Omicron. I applaud the WHO for the sensitivity in naming due to country-blame-shifting and racist remarks that has occurred already in the pandemic (like people saying “China-virus”, etc).

Here’s what we know:

1. Omicron does have numerous mutations on the spike protein, more than the other variants. Come on, Omicron. We didn’t need you to be an overachiever. =) HOWEVER, we do not know yet if that means it is not covered by our current vaccines. The number of mutations does not necessarily mean an increased chance that vaccines won’t work. It could given the high number of mutations but we don’t know yet. Pfizer and Moderna are both testing if the current vaccines protect against Omicron and we should know within 2 weeks. Hold tight, friends.

2. It’s unclear if Omicron causes more severe disease. Preliminary evidence shows it could be more transmissible than Delta - which means more cases and is not a good thing for communities/countries with low vaccination rates. But are those cases more severe? We do not know yet. VERY limited data from South Africa shows that some Omicron cases tend to be mild - but that is VERY limited data. We have to wait for more data to see. In terms of transmissibility, it does look like it’s higher (much?) than Delta or Beta. (Graph source.) Again that’s not good for communities with low vaccination rates or those that remain vulnerable even after vaccination (like immunocompromised persons).

   

3. There have been other variants of concern (like Omicron) that the WHO has named. For example, Beta and Lambda were partially resistant to vaccines but never took off as Delta did. A variant-of-concern is one to watch and thank goodness we have super smart scientists watching for these. But, not all will turn out to be really bad. And not all will evade vaccines.

4. Speaking of Delta, will Omicron outcompete it? Or will Delta remain dominant? We’ll know in the coming weeks. This is important depending on which variant is more severe and/or transmissible and whether or not Omicron is covered by the vaccine. If Omicron does outcompete Delta, that means it will likely become the dominant strain. IF it is more transmissible, that means an explosion of cases particularly among unvaccinated groups. IF it is more transmissible and severe, that means our hospitals will be overwhelmed again. This does not look good for the winter months if that’s the case. I heard Dr. Collins (Director of the NIH) say that he thinks our current vaccines and boosters will cover some/most of Omicron. This highlights why it is so important to get your vaccines and boosters. If you’re hesitant, now is the time to finally do it. Also get your flu shots and here’s a post explaining why!

5. IF Omicron is vaccine resistant, Pfizer said it can create a booster specifically against Omicron in around 100 days. I anticipate Moderna could do the same.

6. Even if Omicron turns out to not evade vaccines, it looks like it can spread really quickly. That makes me frustrated for thousands of people and children who are not protected because of immune compromised conditions. We have to continue to remember them as we wear our masks and get vaccines and boosters for them.

Now that we have the details, I want to focus more on the real problem here. Vaccine inequity.

My opening quote was from Dr. Peter Hotez and I fully agree. “Forget travel bans. Vaccinate the African people.”

Vaccines continue to be incredibly unequal. Rich countries are benefiting and hoarding while poorer countries are severely left behind. Still. After months and months of advocacy work. As an example, 35% of South Africa has been vaccinated. Yes, the US and Canada and the UK have donated millions of doses. But not enough. I’ve also heard some say the problem is not the doses - it’s people in low income countries being hesitant. That might be the cases for a small group within these countries. BUT that is missing the mark on the real problem. The real problem is inequity in distribution. Look at the graph below.

Travel bans are not the answer. It’s easy to close borders, but they have not worked in the past. COVID is airborne and our surveillance systems globally are awful to catch variants early enough. Look at the graph below at who suffers when we have travel bans. (This is from Dr. Madhu Pai, a leading global health epidemiologist and equity advocate you should follow.) It’s a bit nonsensical that countries like the US will ban travel from certain countries but not share vaccines enough OR make mask/vaccine mandates more widespread in our own countries. Do you see the inequality of that?

Yes, the US has donated billions of vaccines. We need more though. It’s a pandemic (meaning the world, not singular places) and a fast moving one. What really needs to be done is a massive push to share surplus vaccine doses, an all-hands-on-deck approach to expand access to vaccines, AND quit hoarding intellectual property for vaccines. (If you want to read more on why sharing IP is important, click on the link in the previous sentence.) This IP issue makes it extremely hard (impossible) for other countries to make their own vaccines, even though countries like India and South Africa have the infrastructure and capacity to do so. It is not a lack of capacity in these countries. It’s a lack of sharing IP from big companies like Moderna or Pfizer.

This leads to vaccine apartheid and was summarized by Dr. Madhu Pai here:

Another major global leader is Dr. Agnes Binagwaho (a personal hero of mine). If you work in global health, you know who she is. In short, she’s a boss and a deeply trusted voice for global health advocacy. Read what she says about rich countries being responsible and the inability of poor countries to even buy vaccines.

“This threat knows no borders and the lack of solidarity kills.”

For now, Omicron is something to be watched very closely and thousands of scientists are doing just that. I want to commend our Botswana and South African colleagues who detected the variant due to their surveillance system. I would urge people to not use racist language saying this is the African-variant or blame-shifting to the African continent. If anything, high-income countries, like the US, have let the pandemic go unmitigated for too long especially in 2020 (resulting in some the highest case rates in the world) and poorer countries are now paying the price without vaccine access.

What do we do?

1. Now is the time to get vaccinated and a booster if you haven’t. I can’t stress that enough to you. Remember it takes time for your body to develop antibodies from the vaccines. So do it early before Omicron takes off here. Continue wearing your mask too. Here’s a longer post on the booster data.

2. Natural immunity is not enough. You need a booster. Let me show you here.

3. If your children are not vaccinated, now is the time to finally do that too. You can look back on my previous posts here for littles and here for adolescents about these vaccines for children/adolescents if you want the efficacy and safety data. They work and are safe. COVID is not a benign condition in our children and vaccines are one way (the best way) to protect them.

4. Shut down blame-shifting comments and racist remarks about Omicron if you hear them. If you are a Christian, these types of comments are unholy and unjust. I am a Christian myself and bring this up specifically within evangelical circles because those are the circles I have heard the most racist comments against minorities, immigrants, or Africans coming from since the beginning of the pandemic. It is unholy. Jesus would get a vaccine too.

5. Advocate for vaccine equity here through signing the WHO vaccine equity petition or donate.

6. Read this wonderful piece of collective solidarity and why the time is now to act.

7. And, breathe. The news can be scary and social media is 24/7. So, protect yourself and don’t doom scroll. We have been in this pandemic for 20 months and it looks like we still have a bit to go. It is tiring, friends. So, take care of yourself and one another. None of us have the stamina like we did pre-2020. That means we need to be extra careful to take care of our minds and hearts.

We will keep you updated on Omicron when more data is available. For now, love your neighbors and get your vaccines. Advocate for those with limited access.

On a personal note, we all know that the pandemic has affected those on the margins the most. One of those ways is by increasing food insecurity and poverty and reducing health access for those most in need - primarily children already in poverty around the world. Tomorrow is Giving Tuesday and I have an exciting, personal announcement to make on how you can be a part of health equity to help! Stay tuned and I’d love for you to be involved if you’re looking for a place to give on Giving Tuesday. This new initiative hits at the heart of reducing global poverty and improving children’s lives in some of the hardest-hit areas of the world.

In solidarity,

FNE

***I only respond and read comments here on Substack for paid subscribers. I do not read or respond to comments via social media or email. Thank you all for the community here and your support as we continue to walk through this together. Solidarity, friends.