Vaccine equity is key to battling Omicron

The only remedy for the latter is the passage of time, as health authorities gather more data on the latest COVID influencer that is Omicron. She has become quite the attention seeker, stealing away the limelight from Delta.

Omicron is the ultimate Christmas Grinch. Yet her appearance on the world stage shouldn't be a surprise. With large portions of humanity having dismally low rates of vaccination, allowing countless opportunities for the virus to replicate, especially in immunocompromised people, it was only a matter of time before SARS-CoV-2 evolved into something more troublesome.

While its ancestry remains a mystery, Omicron's genetic pedigree has been laid bare for all the world to see, and it's not pretty. People in over 80 countries are unwilling participants in a clinical trial initiated by nature itself. It is through these trials and tribulations that we will understand the real-life implications of this new variant on developed nations with high levels of vaccination.

So far, what we have learnt has been a mixture of good and bad news. The bad news is that a primary immunisation course of the vaccines that we have used here is far less effective at preventing symptomatic infection against Omicron than it was against Delta. This is not surprising, given the large number of mutations Omicron possesses - especially on the spike protein, allowing it to evade our immune system like a rumba dancer gracefully weaving and sidestepping on the dance floor.

At the end of the day though, if there is no increase in hospitalisations, then does it matter if Omicron wreaks its replicatory havoc? Probably not, apart from the uncertain impact of "long COVID". Herein lies the tentative good news. Clinical data from South Africa have estimated that two doses of Pfizer provides 70 per cent protection against severe disease - not as good as Delta, but good nevertheless. Furthermore, a booster dose seems to provide substantially more protection, at least in the short term. But there are caveats, in that we need larger studies, and even in "boosted" individuals, breakthrough infections and hospitalisations have been documented.

There is a belief that Omicron will be the panacea to tame COVID, through causing many mild infections despite increased transmissibility; however, this mantra may be misplaced. It is uncommon for viruses to become less virulent, though we all hope they do. Perhaps a coronavirus that causes the common cold today (OC43) may have been the cause of a pandemic over 100 years ago, but we can't be sure. Also, the ferocity of Ebola, in the many outbreaks that it has caused, hasn't shown any signs of abating. And even if Omicron is less virulent, remember that a less deadly but more transmissible virus can kill more people than a more deadly, less transmissible one, through sheer weight of numbers.

So, what to do? Instead of relying on the mantra "Omicron, Omicron, Omicron", we should instead embrace "boost, boost, boost". Only about 5 per cent of our dual-vaccinated population has had a booster shot. As more supportive evidence appears, ATAGI may decide to shorten the interval for the booster.

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As usual, nothing is simple with COVID. The discovery that a booster dose will improve vaccine effectiveness against Omicron is a double-edged sword. On the one hand, it gives us a strategy to combat this wily variant; on the other, it is likely to further widen the gulf between the vaccination statuses of rich and poor countries.

Don't forget the other measures, too. Even before Omicron, the spectre of Delta cases flourishing in the festive Christmas period loomed large. Even before Omicron, maintaining COVID-safe practices while still having a good time was going to be important. This is more so now that Omicron is here.

As to allowing individuals to take personal responsibility for COVID-safe measures such as mask wearing, let me reflect on an anecdote involving a media personality. After I had spewed forth various analogies and facts on the risks of complications from a vaccine, this intelligent and articulate man told us that he was scared during the pandemic, that he accepted that we were experts, and that he just wanted - he needed - to be told what to do. The time is here again for those with expertise and authority to provide direction.

Despite Omicron, as we approach the end of another tumultuous year of COVID, imagine where we would have been if we had no vaccines at all. By now, we may well have depleted the letters of the Greek alphabet and moved onto Egyptian hieroglyphs for naming variants.

So as we exercise caution with Omicron, we should express gratitude for these vaccines. But even with this embarrassment of immunisation riches, if we don't correct global vaccine inequity, another variant will emerge, making Omicron look like nothing at all.

Merry Christmas, everyone. Be safe.