Editorial 8: Omicron Offers an Opportunity to Get Global Health Collaboration Right

By Laird Treiber

As Americans celebrated Thanksgiving this year, the news broke that South Africa reported the detection of a new COVID variant of concern, Omicron, which is more transmissible than even the Delta variant, and has already been found in forty countries around the world.  Many countries did not wait for scientific evaluations of the new variant but re-introduced immediate bans on arrivals from southern Africa as a preventative measure.   African leaders denounced the travel bans, noting that this looks like South Africa is being punished for warning the world, and that African countries have been singled out relative to other countries that also report the Omicron variant.  This is on top of their frustration with the inequity in vaccine availability in Africa that created the conditions Omicron needed to emerge.   In the back and forth, it is easy to lose some important perspectives.  However unwelcome, Omicron provides a good test of the world’s shared pandemic response system as we approach the end of 2021.  We still have a number of areas to work on, particularly when we remind ourselves that scientists warned us in 2020 that COVID-19 would not be the last pandemic the world faced.  A core lesson that seems to bear repeating is that we truly are all in this together, and that no one country can ‘solve’ the COVID pandemic on its own.  Another lesion is that there needs to be consistency and equity in the response to COVID – whether its vaccine access or measures taken to prevent further outbreaks.

A good place to start is in how countries respond to COVID outbreaks.  We should expect countries to close their borders and reimpose restrictions, however economically disruptive, in response to the emergence of variants of concern, or when their hospitals get overwhelmed.  However “unscientific” it may be, imposing these restrictions can help ‘flatten the curve’ of infections, giving health authorities more time to marshal supplies and personnel.  Countries cannot, however, just impose a travel ban and believe that will take care of the problem.  Clearly, the only long-term solution is to increase vaccination rates across the world to reduce the risk of significant outbreaks and the emergence of new variants.  The world also needs to incentivize timely reporting of outbreaks and variants, rather than effectively imposing economic penalties.  Countries need to be willing to also step up with immediate delivery of enhanced diagnostics, treatments and vaccinations, complete with the means to deliver them in the event that commercial aviation links are suspended.  Countries imposing these bans should also be much clearer about their criteria (i.e., the specific nature of the public health threat that led them to impose the ban) as well as  duration – for example, until testing facilities for passengers can be set up.  Greater clarity at the time of imposing bans would help mitigate economic disruptions. 

Clearly, the world needs to continue to push harder to vaccinate more people.  In April 2021, the World Health Organization forecast that humanity could reach some level of protection if 70% of all people globally were vaccinated.  At the end of November, more than 55% of people worldwide have received at least one dose, which translates to 7.9 billion doses.  55 countries have administered at least one dose to 70% of their population, covering a wide range of rich and poor countries in every region of the globe.  Companies are on track to produce roughly 12 billion doses by the end of 2021, slightly more than what the world would need to meet the 70% total.  The challenge has been the uneven rate of vaccinations, particularly for Africa.  Only 10% of Africans have received at least one dose, versus more than 60% of people in Europe, Asia and the Americas.  Only one country in Africa, Mauritius, has administered at least one dose to more than 70% of its population (with Morocco close behind at 67%).  The only other country above 50% is Cabo Verde (with Rwanda at 45%).  By contrast, seven countries in Africa have lower vaccination rates than war-torn Yemen, at 1.8%, and 16 of the 19 countries in the world that have lower rates than Syria (at 5.2%) are in Africa. 

Despite this uneven vaccine distribution, the world is in a much better place than just one year ago.  Companies are on track to deliver 12 billion vaccine doses by the end of 2021, and another 12 billion by the middle of 2022.  Supply chain woes bedeviled production and distribution of vaccines in the first half of 2021.  While those remain an issue in some cases, companies have increasingly been able to develop solutions that have allowed them to expand production, including adding facilities and licensing arrangements to expand the number of places in the world manufacturing vaccines and their inputs.  Several companies have expanded production in Asia and Africa, with welcome support from international financial institutions like the Development Finance Corporation.  The first of several treatments have been developed, with two companies (Merck and Pfizer) having developed simple pills that can treat those infected with COVID and reduce the need for hospitalization – while not requiring refrigeration.    Merck and Pfizer have already announced that they will work with the Medicines Patent Pool to make their COVID treatment pills available for generic manufacturers worldwide.

Scientists have cautioned from the first onset of COVID that we should expect this virus to mutate often, generating new strains that could only be mitigated by effective testing and tracking.  The speed with which South Africa’s initial detection has been widely reported within the scientific community, enabling rapid global research, is much faster than the initial round of variants.  Incredibly, at least three vaccine manufacturers have announced that they are already testing modifications to their vaccines to see if they will be effective against Omicron; two of these are from companies that have vaccines in late-stage trials that had not yet been approved for distribution, offering the prospect of a response even faster than the initial mRNA vaccine developed to fight the initial COVID outbreak. 

While access to vaccines is critical, so is overcoming vaccine hesitancy.  Hospitals in the United States and Europe continue to report that the majority of their COVID patients are unvaccinated, with disease outbreaks threatening once again to overwhelm local treatment capacity in several cities.  This issue has received a lot of attention in the United States and Europe, where people have protested against vaccine mandates, but it is also a problem in some African countries.   South Africa and four other southern African countries recently asked their international suppliers to slow down vaccine delivery because they have had problems generating demand for shots.  Particularly as supply continues to ramp up, finding ways to overcome this hesitancy across the world will become an increasingly important issue. 

The emergence of Omicron gives us all an opportunity to employ some of the lessons we should have learned from two years of COVID, and start responding in a more coordinated way.  A critical component of that is increasing the collaboration and communication between governments and the private sector.  As encouraging as the quick response of several companies to the emergence of Omicron in terms of developing new boosters/vaccines has been, it would be even more encouraging to see developed countries figure out a better distribution system that increases access to Africa.  This is also a great opportunity for public health authorities to come to a clearer set of guidance and consensus on when it makes sense to consider imposing travel bans,  as well as deliver more consistent, coordinated public messaging, and improve vaccine distribution within countries.

CCA’s Health Security and Resilience Initiative is focused on addressing exactly these kinds of problems, bringing both U.S. and African private companies together to see how they can help governments address challenges and improve health outcomes in Africa.  CCA stands ready to engage with African, American and other international partners to put in place the conditions for much greater health security in Africa as a key factor in sustainable prosperity and greater partnership between the U.S. and Africa.