Omicron shows why vaccine data and sharing are crucial in fight against Covid
We underestimated SARS-CoV2. History has taught us that for transmissible respiratory viruses, which can spread as asymptomatic infections, have a genome made up of RNA, and enter a totally unexposed population, the threat is real and foreseeable. It was also expected that as the virus spread across geographic regions, infections would increase and decrease and, over time, new versions of the virus would emerge.
Yet countries with better health infrastructure than India were overwhelmed in 2020 and 2021. While the scale of the pandemic in India and elsewhere is unlikely to have a precise estimate for years to come, it is clear that our collective preparation was insufficient. Preparedness is an insurance policy and requires assets in terms of infrastructure, processes and systems, people and plans in the areas of public health, health care, regulation, science and technology, with close links to industry, facilitated and supported by governments. Preparedness facilitates the response, but in its absence, countries use data, policy and resource tools to try to predict and manage the spread of infection and its consequences.
Approaches used at the start of the pandemic borrowed heavily from China in the use of lockdowns and strong restrictions. These have been complemented by testing, tracing and isolation approaches that have been shown to be effective in epidemics (not pandemics), especially in the early stages. There has been an unprecedented and necessary investment in vaccine development, and a somewhat less, but still valuable, focus on the development of diagnostics and the evaluation of new and unproven treatments. At the end of 2020, we had absolutely amazing efficacy results from mRNA vaccines and good, if confusing, results from the AstraZeneca vaccine. 2021 was the year of vaccines and immunization, with pre-purchase agreements making it easier for high-income countries to access most vaccine platforms in the first half of the year. India and China have had the unique privilege in Asia to see their vaccine manufacturers supplying vaccines on a large scale.
After the first supply problems, the electronic registration system and the luckily short-lived policy dividing purchasing and supply between the state and the plant, India increased its production in the second half of 2021 and has vaccinated much of its population, doing better than global expectations.
Vaccines were the triumph of 2021, and even as variants emerged and spread, it became clear that they protected against serious illness and death. However, the level of protection against infection decreased significantly, which was expected, although it seemed to come as a surprise to many. Nonetheless, rich countries have started using booster doses and opening up immunization to younger, lower-risk groups, as immunization inequalities widened with some low-income countries barely able to start. to vaccinate their vulnerable populations. It is not known whether the lack of good vaccine coverage in Africa led to the emergence of the Omicron variant, but it is clear that leaving large swathes of the world unvaccinated is a threat not only to disease transmission but also for the evolution of the virus.
The vaccine equity gap will be resolved in 2022 and 2023. Vaccine makers are finally producing doses at incredible rates. In November and December 2021, the world received roughly as many vaccines as in the previous 10 months.
What does 2022 have in store for us apart from vaccination? There is, and will continue to be, a global call for greater sharing, not only of vaccines, but of data, skills, resources and policies for coordinated action. South Africa has given the world an early warning of the emergence of Omicron. Without his surveillance systems and willingness to share, there might have been a delay of a few very crucial weeks before the world noticed a spread signal.
Surveillance and data are essential for pandemics. We can either repeat the mistakes of the past or rely on warning signals from elsewhere, or we can be transparent in creating systems for testing and capturing data and sharing that data. The Indian SARS-CoV-2 Genomics Consortium (INSACOG) and CoWIN are examples that show that this can be done, but this data and others cannot yet be linked, which is an important need to build a system. public health prepared and responsive.
There will be research on new and improved vaccines. We do not yet know if they will be necessary, but this is a test case, to show that we can respond to emerging variants. The vaccines we have today are unlikely to be the last vaccines we will use in the future.
Will we need vaccines and boosters forever? At the moment, it seems like a never-ending cycle, but we have to remember that we haven’t actually done the studies to show whether a first round of three vaccines might be better than two, or what should be the ideal schedule or whether mixing different vaccines gives better responses. As we settle in and develop our longer-term SARS-CoV2 management strategies, we will need these optimization studies to continue for vaccines, as well as for existing and new drugs and diagnostic approaches.
Science gave us the solutions that got us through this storm, but national interests held back global access. In 2022, the Covid-19 situation will improve, but we must remember the hard lessons of protecting and preserving community trust, empowering people with information, advice and resources they need to get through difficult times, to invest in science and technology and the need for global solidarity.
The opinions expressed above are those of the author.
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