The views of experts and health professionals on the Omicron variant, its spread, and the consequences of the government’s response.
First published in November 2021.
WHAT THE EXPERTS SAY...
... on the Omicron variant.
Dr Meru Sheel, Global Health Researcher and Infectious Diseases Epidemiologist with expertise in Public Health Emergencies, Emerging Infectious and Vaccine-Preventable diseases, Australian National University:
“Viral mutations are a part of natural selection and are common. When the virus enters a cell, it can make copies of itself that go off and infect other cells and then pass to another person.
“Sometimes during this process of copying in non-immune persons, it may introduce an “error” or mutation, and at times these mutations can offer competitive advantage to the viruses to spread from one non-immune person to another.
“But if a person is already immune (say from vaccination), then the virus cannot spread between people, preventing the emergence of new variants.
“Although it is too early to say if any of this holds true for Omicron, or if there are any “real” differences in characteristics in terms of its transmission, its ability to cause severe disease and if it will replace the Delta variant of Sars-CoV-2, it is a timely reminder that we need larger populations of the world to be vaccinated against Covid-19.
“Vaccination is one of the best ways to avoid emergence of new variants.
“As countries embark on booster, adolescent and paediatric vaccination programs we need faster policy-level solutions that increase vaccine supplies in low- and middle-income countries.
“The current approaches are not optimal.”
Professor Sharon Peacock, Professor of Public Health and Microbiology, Department of Medicine, University of Cambridge, Executive Director of the Covid-19 Genomics UK Consortium:
“Once a new variant emerges and it is fitter than previous variants it can be difficult to stop it going into a country unless you have very stringent lockdown rules.”
Professor Christina Pagel, Director of University College London’s clinical operational research unit, member of Independent Sage:
“About [the new variant] and bad timing, the benefit of delaying spread and what we should do...
“First, timing: A new dangerous variant arrives just before millions of people across the world start travelling internationally for the Christmas holiday period – not good.
“[There were] millions of people travelling within and to the United States this week for Thanksgiving, just as the new variant is announced – not good.
“Second, delaying spread: The UK won’t keep it out forever. But delaying has large benefits. We’re currently boosting almost 2.5 million people every week. Even a few weeks’ delay is millions of more vulnerable adults with extra protection. That matters.
“Then too it gives us time to learn more about [the new variant] – how infectious is it? how vaccine evasive? how virulent? It gives precious time to tweak existing vaccines if necessary. It gives time to ramp up response capabilities like intensive testing and contact tracing.
“Third: what we should do? Reduce transmission, now! Delta arrived in the UK during lockdown – it still spread but it was harder for it to infect others. Right now it is very easy for a new variant to spread – let’s make it harder with for example masks and home working, and HEPA filters indoors.
“If we can keep it out until after the Christmas break then we’ve bypassed a massive mixing opportunity.
“Now, if [the Omicron variant] spreads through a few people then there’s nothing to stop it carrying on… So that’s why if we start putting in things like mask-wearing and working from home – now you’re in a situation where it’s not going to stop it, but it’ll slow it down. We’re boosting about 2.5 million people a week, so delaying even a few weeks really does help.”
Ewan Birney, Deputy Director-General of the European Molecular Biology Laboratory, member of SAGE’s Spi-M:
“What we’ve learned from the other situations like this – some have turned out OK and some haven’t – is that whilst we’re [investigating], you have to be reasonably paranoid.
“There is not yet data to suggest that the Omicron variant increases the severity of disease or resistance to our current vaccines. This will require future laboratory investigation and continued surveillance in many countries over the coming weeks.
“Our experience and understanding of the Alpha and Delta variants make it clear that early action is far better than late response. It may turn out that this variant is not a major threat, but the consequences of not acting early could be devastating.”
Professor Richard Lessells, Infectious Diseases doctor and TB/HIV researcher, University of KwaZulu-Natal in Durban:
“At the beginning of a resurgence, we sometimes get fooled into thinking everything is a milder disease and that can be because it’s initially spreading in younger age groups, so we have to see as the spread becomes more generalised whether we are seeing cases of more severe disease.
“What gives us some concerns [is] that this variant might not just have enhanced transmissibility – so spreads more efficiently – but might also be able to get around parts of the immune system and the protection we have in our immune system.”
Dr Deepti Gurdasani, Senior Lecturer in Epidemiology, Statistical Genetics, Machine Learning, Queen Mary University of London:
“Although there is much uncertainty, given the potential threat, it makes sense to assume a worst-case scenario and plan for this, rather than respond too late. If the response turns out to be an overreaction, it can always be scaled back.
“But missing early opportunities to contain a real threat will be fatal. As with Delta. This means strict border restrictions – not just prospective red list bans, but more comprehensive mandatory quarantines across the board (given this is likely widespread).
“PCR testing with TaqPath assays that are able to detect these variants in travellers and those quarantining, as well as retrospective identification across people who have travelled in from affected areas recently.
“The holes in the UK response concern me.
“Given this variant is already in the UK, given the rapidity of spread, we also need to consider domestic measures to contain this, as Israel is doing. This variant is likely to outpace surveillance efforts given the sort of spread seen so far.
“This means we cannot rely solely on test, trace, isolate, and support (TTIS) to contain it. We need to take measures like mask mandates (high-grade masks), and strict mitigations in classrooms, where the spread of Alpha and Delta initially happened, and Omicron will also likely happen if it does enter the community.
“It also means speeding up vaccination efforts – boosting and vaccinating children – while the variant may show a degree of escape. Every single layer is needed and will help. Israel is putting HEPA filters in classrooms – we should speed this up in the UK as well.
“Border restrictions are vitally important, even if the variant is present here already because this can slow spread, which may give us vital time to prepare a response to protect the public and the NHS maximally – particularly at a point where the NHS is already in crisis.
“But it is best to plan for the worst, rather than get by on hope. It is much better to overreact than underreact given the potential of this threat. And signs so far suggest that the potential threat is high.”
Sir Jeremy Farrar, Director of the Wellcome Trust, former SAGE Member:
“New variants are inevitable. The virus remains highly plastic, still evolving and will continue to do so. New variants are not a reason to stop doing what we know works.
“New variants are a reminder, if we needed it, that the pandemic is far from over. Inequity is what will extend the pandemic. We do need to do inclusive public health better, including urgent equitable access to vaccines and all the tools needed to stop pandemic.
“The only way stop new variants is to stop the pandemic, reduce transmission, prevent illness, save lives, education, economies, trade, with equitable access vaccines, tests, treatments, PPE, and oxgen. Enlightened self-interest. Until we do that we are all at grave risk of a more protracted pandemic.
“On the rush to “new vaccines”... current vaccines were designed against the original strain. As an image, they may sit in middle of an “immune map”, i.e. they cover the variants. Make new vaccine against a variant at the extreme of the map and you may reduce the protection against other existing variants.
“We need to ensure the vaccines give good protection with the whole “immune map” – so far, that has been with the vaccines against the original strain at the centre of the map.”
WHAT THE EXPERTS SAY...
... on Omicron and the current vaccines.
Clive Dix, former Head of the UK Government’s Vaccine Taskforce, CEO of C4X Discovery:
“I don’t think [Omicron] will evade immune systems so that we get a huge number of increases in death and serious illness…
“If we boost and also make sure that as many people as possible are vaccinated, we will be OK with this particular variant.”
Stéphane Bancel, Chief Executive of Moderna:
“There is no world, I think, where [the effectiveness of the vaccine] is the same level... we had with [the] Delta [variant].
“I think it’s going to be a material drop. I just don’t know how much because we need to wait for the data. But all the scientists I’ve talked to... are like, ‘This is not going to be good’.
“It took around four months for Delta to take over Beta, and it seems it’s taking just a couple weeks for this new variant to take over Delta.
“Given the large number of mutations, it is highly possible that the efficacy of the vaccine, all of them, is going down. But we need to wait for the data to know if this is true, and how much is it going down.
“We’ve lowered the dose of a booster of a current vaccine, and so we have a lot of safety data showing that we could go back to a higher microgram dose at double the dose of a current vaccine, which should provide better protection than the third dose booster at 50 micrograms. [Basically a two-dose booster]
“So that’s the first line of defence, actionable right away.”
Professor Eleanor Riley, Professor of Immunology and Infectious Disease, University of Edinburgh:
“We won’t really know for a few weeks until there are enough cases of omicron infection to see what the hospitalisation rate is and who is being hospitalised (age, vaccination status etc.). This data will likely come first from Southern Africa where the virus seems to be most prevalent currently.
“We can assess in the lab how susceptible omicron is to neutralisation by vaccine-induced antibodies; this correlates very well with how good the antibodies are at preventing infection. These assays are going on now at the labs at Porton Down and elsewhere. I would expect some initial results in the next few days and that will give us our first real hard data.
“However, there is no lab assay to measure immunity to severe disease; we need to wait for the clinical data.”
Dr Peter English, Retired Consultant in Communicable Disease Control, former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee:
“The number of mutations in the omicron virus, compared to the virus used to develop vaccines, suggests that vaccines are unlikely to work as well. We do not yet know how significant a real-world effect this will have.
“We will need to monitor cases (infections without symptoms as far as possible, although this relies on routine testing; symptomatic cases; hospitalisations with Covid-19; ditto critical care admissions, and deaths) in real world populations, and to relate the individual cases to their vaccination status. This will tell us how effective one, two, three, or four (people getting a three-dose “primary” course plus a “booster”) doses are, for different vaccines and vaccine combinations.
“We know that the vaccines have held up pretty well against variants, with only a slight drop in efficacy – particularly of a single dose – against the delta strain. That is somewhat reassuring, but we cannot rely on it.
“It is certainly worthwhile developing and rolling out variant modified vaccines, as a precaution, and because it might improve efficacy against existing, as well as new strains, as they arise.”
— AUTHORS —
▫ PMP News reporting.
GET THEM INVOLVED:
- Text: This piece was first published in PMP Magazine on 30 November 2021.
- Cover: Pixabay/geralt. (Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)