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Playing the Pools: Omicron and Common Security

National COVID 19 Vaccine Introduction Launching Program at Eka Kotebe Hospital Addis Ababa, March 13,2021 Administering, trained health professionals at Eka Kotebe Hospital vaccinating health workers in Ethiopia.

With the ultra-infectious Omicron variant looking set to sweep the world, Paul Rogers argues that the greatest global security challenge facing us is to heed WHO advice and ensure rapid world-wide vaccination against COVID to reduce the risk of new, more lethal variants of the virus emerging in future.

Introduction

The rapid spread of the Omicron variant of COVID-19 in the past four weeks has radically altered the global path of the pandemic. At the time of writing (17 December) it has spread across much of South Africa, it is growing exceptionally fast in the UK and this pattern is also emerging in Western Europe. The expectation is that this will be repeated across much of the rest of the world.

The full behavioural spectrum of Omicron is still being unravelled. Evidence from South Africa is that it outperforms previous variants in rate of spread, possibly at twice the speed, and is resistant to most vaccines unless three injections have been given over time. In Britain it is currently doubling in less than two days, an exceptionally fast rate of spread. At least in South Africa it does appear to produce less serious illness than other variants, though this may be because of the specific demographic characteristics of South Africa. These include the relative youth of the population and the presence of high levels of immunity resulting from infection by earlier variants.

At this time of uncertainty, the one clear element is its remarkable infectivity. That alone justifies an initial analysis of the implications of its development and, in doing so, it makes sense to put it in the context of the overall development of the virus, especially in recent months.

Context

Since March I have published regular briefings on the pandemic’s development, analysing its evolution from international and human security perspectives. The briefings so far are:

March: COVID-19 and the Structures of Human Insecurity  More than twelve months on, the pandemic was showing few signs of abating and was even accelerating in parts of Europe, South America and Asia. The briefing argued that massive increases in global inequality were as central to this unfolding human security crisis as the immediate health impacts.

May: Third Wave Nationalism: The Case against COVID Complacency  There was early success in vaccination in many high-income countries contrasting with increasing death tolls across much of the Global South even as many countries were facing a third wave. Slow rates of vaccination in low-income countries were compounded by vaccine nationalism in the Global North including hoarding and export controls.

July: Pandemic and Protest: The Evolution of COVID Politics  Close to eighteen months into the pandemic and many countries believed they were getting COVID under control. Meanwhile the WHO was still warning against the slow rate of global vaccination, only a minority of the world’s people was fully vaccinated and there were frequent local tensions over the impacts on livelihoods and liberties.

September:  Vaccine Inequality: We are not all safe  The chaotic Western withdrawal from Afghanistan overshadowed a fourth COVID wave sweeping across much of the world but global vaccine inequality showed up the limits of vaccines in controlling the Delta variant while creating a highly conducive environment for the evolution of new variants.

The pandemic in November

By the end of November and prior to the rapid spread of the Omicron variant there were five main features of the pandemic to note. One was the welcome success of the vaccinations developed during 2020 coupled with the speed of implementation of mass vaccination programmes in some countries. This was a major scientific achievement often involving considerable government funding even if private companies were to the fore in production.

A second feature, though, was far more negative and partly because of this success. It was the rapid onset of vaccine nationalism, with high-income states concentrating on their own populations and playing little more than lip service to the needs of the global community. A glaring example of this was the contrast between commitments made at the G7 Summit in Cornwall in June with states pledging one billion doses for low-income countries. By late November the UK had fulfilled 11% of its pledge, the EU 19%, Australia 18%, Switzerland 12% and Canada just 5%.

Thirdly, throughout this period the WHO was constantly warning of the urgent need to achieve full global vaccination, but this was ignored by wealthier states. To ensure sustained protection requires, as a minimum, two injections of most types of vaccine plus a booster at a later time. A global population of eight billion, allowing for some inevitable wastage, means that close to 25 billion doses are required. A former WHO director, Professor Anthony Costello has recently reported that, “the current share of people fully vaccinated in high, upper-middle income, lower-middle income and low-income countries is 69%, 68%, 30% and 3.5% respectively.” At present rates of progress, global vaccination will not be achieved until well into 2023, by which time annual boosters may also be required world-wide.

Fourth, the actual death rate has proved to be far higher than official figures, the latter dependent on statistics that are often very far from complete. The Economist is one of the main sources of more comprehensive assessment and, as of 14 December, was reporting 18.1 million deaths,  3.4-times the ‘official’ death toll. The great majority of the deaths and long-term post-COVID health problems are reported to be in poorer countries, and this is causing sustained economic damage, mainly affecting the poorest and most marginalised sectors of society.

A joint WHO/World Bank study published on 12 December shows that the pandemic is likely to halt two decades of progress towards Universal Health Coverage, reporting that:

“In 2020, the pandemic disrupted health services and stretched countries’ health systems beyond their limits as they struggled to deal with the impact of COVID-19. As a result, for example, immunization coverage dropped for the first time in ten years, and deaths from TB and malaria increased. 

The pandemic also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for care. Even before the pandemic, half a billion people were being pushed (or pushed still further) into extreme poverty because of payments they made for health care. The organizations expect that that number is now considerably higher.”

Fifth, on the other hand the pandemic is turning out to be a remarkable money-spinner for “Big Pharma” in what Professor Costello describes as “Vaccine Apartheid”, with patent-protected vaccines sold mainly to higher income countries. He reported that “Between January 2020 and December 2021 the market capitalisations of Moderna rose from $6.9bn to $134bn; Pfizer from $206bn to $314bn; and BioNTech from $6.6bn to $84bn.”

Finally, even before the onset of Omicron, there were problems emerging in high and upper-middle income countries, with the Delta variant increasing its impact in European countries including Germany, Austria, Switzerland and Romania. Reasons differed with countries but included growing public resistance to vaccination and also social distancing measures. Even before the onset of Omicron, Austria, Germany and Switzerland were having to enact tougher measures, including accelerated vaccination and partial lockdowns to minimise spread.

The Omicron factor

The sudden recognition of a major health problem and the speed of reaction in some higher-income countries has been unprecedented. The nearest comparison would be that of states and administrations close to China reacting to the Wuhan outbreak right at the start of the pandemic. This was a reaction which, significantly, went almost unnoticed elsewhere in the world despite the WHO seeking to highlight the implications and dangers of the new disease.

Concerning Omicron, the UK prime minister, Boris Johnson, was making little of the problem until 09 December but three days later was addressing the nation and bringing in numerous measures of control as well as warning that more might be necessary. COVID-19 incidence is increasing rapidly and is now close to 100,000 new cases a day, higher than at any point in the pandemic so far.

In the United States, President Bidenhas warned that the variant is going to spread and that a winter of severe illness and death awaits the unvaccinated.

According to Reuters, Norway “is setting record highs both in terms of new COVID-19 infections and hospitalisations, partly due to the spread of Omicron, which is expected to become the dominant variant in the coming days”. The Norwegian public health institute is arguing that “Unless effective measures were established, the nation of 5.4 million people risks having between 90,000 and 300,000 new COVID-19 cases on a daily basis from early January”.

Meanwhile, Denmark may be an indicator of what is to come across Europe. It has the highest known Omicron rate in the EU, although this may be partly because it has one of the most advanced testing regimes. The concern is that if the country is showing a doubling of Omicron incidence every two days then this should be a warning to other EU states that are earlier in the cycle.

In the EU as a whole, the European Centre for Disease Prevention and Control has reported confirmed cases in the majority of EU/EEA countries, 23 countries in all, which may give many of them time to accelerate booster vaccinations, given their well-developed health systems. However, the main concern must be with the many low income states across the Global South where vaccination is still in its early stages yet Omicron incidence is already expanding.

Missing the point

Looking at the global development of the pandemic and the impact of Omicron, some tentative conclusions can be drawn. In general, there is more and more evidence that there are huge differences in impact on human security dependent largely on the wealth of countries, with the human costs to low-income countries being very much worse than higher-income countries.

This variant really is notably different from the original virus and from the other four main variants of the past two years. The negative change is a substantial difference in the Omicron variant’s infectivity, from a doubling every seven days to less than two days. It may produce less severe illness in largely vaccinated populations though that is not yet certain, but even that is hardly reassuring for low-income countries with very low vaccination rates.

The danger is that if Omicron can be controlled in higher-income countries, the complacency that was present a few months ago will return. This entirely misses the point. If the COVID-19 virus can throw up a variant as different as Omicron then it can do it again, only next time the changes could be far more lethal.

Conclusion

Omicron fits in ominously with the repeated WHO warnings about the need to expand global vaccinations, not just for current sufferers but to avoid the long-term existence of pools of new variants alongside partially vaccinated populations. The fear has long been that new variants would emerge with dangerously enhanced characteristics in any of three areas – rate of spread, vaccine resistance or lethality. Omicron has a very fast rate of spread and some resistance to vaccines but does not appear to be more lethal. If it was, then we would already be facing an unprecedented global health crisis.

Radically reducing that risk by rapid world-wide vaccination is crucial and transcends even the more immediate, if substantial, problems of handling Omicron. In terms of human and common security it is the greatest global security challenge facing us.


The views and opinions expressed in posts on the Rethinking Security blog are those of the authors and do not necessarily reflect the position of the network and its broader membership.


Image Credit: UNICEF Ethiopia. National COVID 19 Vaccine Introduction Launching Program at Eka Kotebe Hospital Addis Ababa, March 13, 2021. Via Flickr.

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