Omicron and Global Management of the Pandemic
The failure to achieve universal vaccine coverage and effective global pandemic management is a very serious barrier to tackling the Covid-19 pandemic.
Didie SW
Three days ago, the World Health Organization (WHO) announced the emergence of a new Covid-19 variant named Omicron (B.1.1.529). This variant was first detected in Botswana, in southern Africa. The variant has spread quickly throughout the country and others, including several countries in Europe and Asia. This variant spreads sporadically.
Concerns arose. The Omicron variant is believed to be a major obstacle in dealing with the Covid-19 pandemic.
Since the beginning of the pandemic, mutations and variants of the Covid-19 virus have indeed been a game changer. Variants can quickly exacerbate the pandemic. Several countries, such as India, South Korea and Israel, have succeeded in controlling the spread of Covid-19.
However, when the Delta variant emerged in these countries, Covid-19 cases again increased significantly (surged). In the end, these countries experienced a catastrophe in their health services.
Indeed, some variants have high transmissibility. If the original Covid-19 strain has a transmission rate (reproduction number) ranging from 2-3, the Delta variant has a reproduction number of around 5. These figures indicate that people infected with the original Covid-19 strain can go on to transmit the disease to two to three people, while people infected with the Delta variant can infect up to five people. This means that Delta spreads twice as much.
‘Variant of concern’
The Covid-19 virus undergoes genetic changes from time to time, which is known as mutations. Changes in a virus’ genes over time is a natural process. Most mutations produce only minimal effects and do not affect the transmissibility of the virus. New variants emerge when a significant mutation changes the virus’ transmissibility.
Variants are categorized by their attributes, distribution and impacts on public health. Categorizing them in this way helps facilitate communication and management, especially in monitoring, anticipating, preventing and limiting the spread of the virus.
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The WHO uses the categories variant under monitoring (VUM), variant of interest (VOI), and variant of concern (VOC). It also has another category, variant of high consequence (VOHC).
Each category has a different magnitude, in particular the variant’s potential for spreading and effects. A variant is classified as a VOI if it has genetic mutations that could affect transmission and the severity of disease. A variant is classified into VOC if it starts to cause increased transmission, increased virulence and decreased effectiveness of the diagnosis or vaccine.
So in general, the magnitude of the VOC classification is greater than that of VOI or VUM. However, a variant’s classification can change according to its epidemiological dynamics. A variant that was originally categorized as a VOI can be “upgraded” as VOC and vice versa.
The WHO has categorized the new Omicron variant as a VOC. The reason is because this variant fulfills a number of the criteria for VOC, including the significant increase in cases of this variant in a number of African countries in the last few weeks.
Some experts also believe that this variant can cause a more severe form of disease, reduce vaccine effectiveness, and be difficult to detect with the existing diagnostic tools.
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The preliminary data indicate that this variant is truly different from all previous variants. Its rate of development is faster than other VOCs, including the Delta variant.
Therefore, the fear that this variant could be more contagious and spread faster is understandable. This variant also has more mutations. It has more than 50 total mutations, of which 30 occur in the spike protein that the various Covid-19 vaccines target.
This means that the Omicron variant has the potential to interfere with vaccine efficacy. With so many mutations, experts are hypothesizing that this varian could have more complex impacts, mainly related to the speed of transmission, severity of disease, recurrent infections and vaccine resistance.
However, these complex impacts are all still hypothetical and as yet unconfirmed. It will take several weeks to confirm the effects of the Omicron variant regarding these aspects.
Product of suboptimal program
This is not the first time that a southern African country has become the site of emergence of a new Covid-19 variant. The Beta variants and a number of other VUMs also emerged in South Africa. In this context, South Africa can be examined from two sides, the plus side and the minus side.
South Africa needs to be appreciated for successfully identifying a new variant in its country and its honesty in reporting it to the WHO and the global community. Taking this course of action is not easy because it involves geopolitical, economic and social considerations. The South African government was certainly aware of the negative effects of its finding, but still reported it for further management.
That various variants were first detected in South Africa also indicates that epidemiological research and testing in whole genome sequencing (sequencing the complete genome) of variants is going well. The new variant may have infiltrated other countries, but it was neither identified nor reported due to certain limitations.
On the other hand, the detection of a new Covid-19 variant in South Africa could be an indication that the country’s pandemic management is still not optimal. Suboptimal management is an entry point for the emergence of new variants.
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South Africa has just passed its third wave of Covid-19 infections. The last few weeks has seen another significant increase in Covid-19 cases, especially in Gauteng and surrounding areas. Last week, the number of daily cases reached around 1,600.
This figure is much higher than in previous weeks, which reached around 500 or 200 cases per day. In the past week, the positivity rate skyrocketed from 2 percent to 9 percent.
At the same time, Covid-19 vaccination coverage is still very low. To date, only 29 percent of the South African population has received their first vaccine dose while 24 percent have received two vaccine doses. This is in stark contrast to the global vaccination rate, wherein 43 percent of the global population has received two doses.
This means that the country's pandemic management is still not optimal. The South African government has recognized this and predicted an impending fourth wave of infections. Amidst these unfavorable conditions, the Omicron variant emerged.
Blocking transmission and accelerating vaccination
Covid-19 mutations and variants are more likely to occur in areas with a high transmission rate and low vaccination coverage. This condition also prevails in Brazil and India, where two earlier VOCs emerged, namely the Gamma variant and the Delta variant. This sends a message about the need to optimize pandemic management efforts, especially in controlling transmission and accelerating vaccination.
Otherwise, this condition can provide fertile ground for the development of new variants. All countries, without exception, must optimize their management of the pandemic. A universal vaccine must be developed.
To prevent the spread of the Omicron variant, a number of countries immediately imposed travel bans and restrictions on migrants from South Africa and surrounding countries.
The Indonesian government has imposed a temporary entry ban against foreign nationals (WNA) from South Africa as well as a 14-day quarantine for Indonesian nationals (WNI) arriving from South Africa and surrounding areas. This step is strategic and appropriate while monitoring the latest developments regarding the Omicron variant.
The failure to achieve universal vaccine coverage and effective global pandemic management is a very serious barrier to tackling the Covid-19 pandemic.
With this step, it is hoped that imported cases will be prevented as much as possible. This is important, because this variant has high transmissibility. If Omicron succeeds in infiltrating an area, it is likely that it will spread widely. The strategy of restricting entry may be tightened or eased depending on the epidemiological developments in the Omicron variant.
The step to restrict and tighten entry must be accompanied by other strategies. One of these is to ramp up the vaccination program. This is the most important shield against the emergence and spread of new variants.
At the same time, it is necessary to continue to control and mitigate Covid-19 transmission by intensifying the 3M (handwashing, social distancing and mask-wearing) and 3T (test, tracing and treatment) policies. Empirical experience has taught that there is no more effective way of controlling variants than the 3M, 3T and vaccination programs. Whatever the variant, their management remains the same.
The emergence of the Omicron variant sends a message to the world on the importance of controlling transmission and accelerating vaccination as part of the Covid-19 response. It is not impossible that other variants will emerge after Omicron that may be higher in transmissibility and disease severity.
Moreover, no effective and optimal global pandemic management policy has been created to date. A number of countries have successfully implemented optimal health programs, including those with high vaccination coverage. However, many other countries remain hobbled with suboptimal health programs. In Africa, only 6 percent of the 1.2 billion population has been vaccinated.
This is in stark contrast to the United States, which has vaccinated nearly 60 percent of its population. To date, more than 50 countries did not meet the WHO’s target to vaccinate 10 percent of their population by the end of September 2021, and most of these countries are on the African continent.
Iqbal Mochtar
The failure to achieve universal vaccine coverage and effective global pandemic management is a very serious barrier to tackling the Covid-19 pandemic. Moreover, the emergence of new variants has the potential to affect the existing countermeasures. So it is natural that some people remain pessimistic that the Covid-19 pandemic will end soon.
Iqbal Mochtar, Medical doctor and chairman of Association of Indonesian Doctors in the Middle East
This article was translated by Kurniawan Siswoko.
