The emergence of Omicron, as the latest COVID virus variant of concern (VOC), has brought into sharp focus the consequences of global vaccine inequity as well as the discriminatory practices that have been directed at southern African countries.
High income countries procured and consumed high volumes of COVID vaccines, administering booster shots to their adult populations and initiating child vaccination, even as a minuscule proportion of adults have been vaccinated in Africa.
Now, they have imposed travel restrictions on several African countries, at the very first reported sighting of a new variant in that region.
It is not surprising that VOCs emerge in grossly under-vaccinated populations, which also have a high prevalence of immunocompromised persons such as those with HIV infection.
It is in the nature of viruses to increase their transmissibility through new mutations.
Long stay within the bodies of infected persons, whose low levels of immunity do not permit them to overcome the virus soon, gives the virus time to experiment with several mutations.
Of the variants that emerge, those whose features confer an advantage for species propagation will survive longer and spread farther. That is the logic of evolutionary biology, which guides the behaviour of viruses.
Africa vs Western Nations: An Abysmal Contrast
Western governments know this well. The Alpha variant, first of the VOCs, had emerged in a British immunocompromised person who was chronically infected with the ancestral COVID virus. This gave the virus a long time to replicate often and evolve in the process.
Booster shots were also originally scheduled for the elderly and immunocompromised persons in the population, both to protect them against lethal disease and also reduce the probability of worrisome variants emerging.
However, Israel set the trend for administering booster shots to all persons above 12 years of age. USA followed suit and European nations will emulate.
Hoarding and high consumption of vaccines by western nations has contrasted sharply with abysmally low levels of vaccination in Africa, where less than 10 percent of adults are fully vaccinated. Indeed, global vaccination rates testify to vaccine inequity.
While 66 percent of persons in high-income countries are fully vaccinated, only 2.5 percent of people in low-income countries are similarly covered.
Till recently, 147 vaccine doses were administered per 100 people in high income countries, contrasting with seven doses in low income countries.
Vaccine supply to Africa, via the COVAX facility was constrained, delayed, and uncertain in delivery schedules. Vaccines reached some countries so close to expiry date that stocks had to be destroyed.
Africa contributed to COVID vaccine trials but did not benefit from assured supply of successful vaccines at affordable prices.
The proposal for patent waivers to enable domestic production, tabled at the World Trade Organisation by South Africa and India, has been opposed by European countries protective of Big Pharma.
Amid Calls for Global Solidarity, the Triumph of Vaccine Nationalism
Despite proclaimed allegiance to global solidarity and lofty statements that no country is safe till every country is safe, vaccine nationalism prevailed and Africa was unsupported.
This was bound to have serious consequences. In a commentary on booster doses, published in The Lancet in October 2021, I wrote:
“Vaccine inequity across countries is a matter of global concern. If the practice of administering a third dose to all individuals older than 12 years becomes established in vaccine-rich countries, it can aggravate supply shortages for other countries. In this scenario, under-vaccinated populations could generate the conditions for the emergence of new variants, which might not only be more infectious but also exhibit greater immune escape, and those variants might enter vaccine-rich countries to trigger fresh waves of infection. That is not the kind of natural experiment the world would like to see. As countries discharge their responsibility to protect vulnerable individuals in their populations, they must ensure adequate supply to other countries. Global policy must weigh the risks of adopting booster doses ad libitum across the world at this stage of the pandemic.”
The danger I warned against has come to pass. Omicron has exposed the short-sightedness of vaccine nationalism.
Indeed, if high and upper middle income countries neglect the need to vaccinate universally across all countries, while prioritising elderly and immunocompromised persons everywhere, new variants will continue to emerge and haunt the vaccine rich nations.
They will then continually devote their resources to tweak the vaccines and provide more and more boosters, like a dog chasing its tail. Surely, governments must act intelligently, combining ennobling altruism with enlightened self-interest.
The Reception of Omicron
Even the emergence of Omicron has been received without grace and consideration to Africa. South Africa identified the new variant quickly and immediately informed the global community within a matter of days.
Contrast this with the Alpha variant, which was detected in November 2020 in a sample taken in September 2020 from a patient in Kent and only informed to the world in December 2020 when infections began to surge in the UK.
Should Africa be punished, for efficiency in genomic analysis and integrity in prompt reporting, with extensive travel restrictions? While the visceral fear of a new and more infectious variant leads to such reflexive measures, there is no evidence that the global spread of the Alpha and Delta variants was stopped by travel bans that were enforced after the virus moved beyond one country. We are already seeing the spread of Omicron within Europe. Ostracising African countries now harms them without helping anybody else.
We are yet to know enough about the behaviour of this variant. The 32 new mutations probably make it more infectious and perhaps reduce the efficacy of vaccines, which are directed only against the spike protein. These aspects are still being studied.
Early reports from South Africa indicate that the illness caused by this variant is mild, with sore muscles and tiredness. If this is corroborated in larger studies, it might indicate that the virus is evolving towards a more infectious but less virulent form. That is the course that evolutionary biology predicts and such a change in the virus may actually come as a relief to the embattled humanity.
We still need to study this variant in greater detail, to assess this. In the meanwhile, the rest of the world must do everything needed to support Africa and not subject it to COVID colonialism.
(Prof. K. Srinath Reddy, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). This is an Opinion article and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)