Omicron Questions We Will Keep Asking Through the Holidays

(Bloomberg Opinion) -- As the omicron variant of Covid-19 spreads across the world, scientists are scrambling to get a bead on the threat it poses. Political leaders, with a wary eye on the approaching Christmas holidays, are pondering the appropriate policy responses.

Bloomberg Opinion columnist Therese Raphael and Bloomberg Intelligence senior pharmaceuticals analyst Sam Fazeli joined Bobby Ghosh in a Twitter Spaces discussion about a rapidly evolving crisis. Here are the lightly edited highlights of their conversation.

Ghosh: Going into the weekend, the widespread perception was that omicron was likely to evade some of the protection that vaccines provide us, but on the other hand, it was not the protection for severe illness. So people would be infected, but it would not lead to extremely severe illness. Is that still the general perception among scientists?

Fazeli: That’s the general hope. What we’ve learnt in the past week is mostly anecdotal. Most of the information is still coming from South Africa, the first country to identify the virus. The epicenter was Gauteng, which is the most populous province. Of course, population density has a direct bearing on how rapidly cases rise or infections pass on. The trajectory of the infection rise has been much, much faster than had been seen in the same province for the previous three waves. But we need to still figure out why that is.

Ghosh: What has been the response of the South African government, and of governments in other parts of the world?  Is there a concerted effort from the developed countries to help South Africa?

Fazeli: South Africa is doing a pretty good job with distribution of the vaccine supplies it has. But we don’t know how that relates to protection afforded against the omicron variant. When you look at the data for infections among people who go to a hospital, the majority are under the age of 50. That’s the group with lower vaccination rates, and is also the most socially active. We’ll have to wait until we have a more balanced data set.

As for the West, I haven’t seen anyone really do anything apart from imposing a ban on travel from South Africa. Travel restrictions make life pretty difficult for the South Africans just when they need access to reagents and other instruments to conduct the kind of research that alerted us to the presence of omicron.

I hope that the developed nations sort this out because it is critical. I also hope they quickly send vaccines — not necessarily to South Africa, because they have a decent supply, but to the surrounding countries, which are now also on several red lists.

Ghosh: How have governments in Europe responded, and does the response reflect an evolution from what we saw in previous waves?

Raphael: There was a very rapid initial response — to take a baby step. Britain was first out of the gates: The government, which likes to proclaim that it is world-beating when it comes to the virus, immediately announced a travel ban on South Africa and Botswana, where the variant had appeared. Since then, we’ve seen a couple of what I would call low-cost measures, like requirements for mask wearing on public transport and in shops. There have been some additional travel restrictions. This past weekend, they added Nigeria to the red list, much to the consternation of, of Nigerians.

These measures don’t cause a great deal of inconvenience to most people.

We’ve also seen like countries like Switzerland, which initially required incoming travelers to quarantine for 10 days. That killed the ski season there. Last week, the Swiss reversed themselves and said people arriving just need to take tests.

At least in this part of the world, countries are trying to figure out how to be responsive without taking away some of the liberties they’ve just given back to people with recent re-openings. On the continent, countries like Austria, Germany are France are still dealing with a pretty serious Delta problem. There are lower levels of vaccination in some places or vaccine hesitancy, and governments have increased restrictions. You’ve got mandates and vaccine passes.

Ghosh: In your latest column, you point out that British Prime Minister Boris Johnson is encouraging people to proceed with their Christmas plans, and not let omicron cramp their style. But within his cabinet and among his scientific advisors, there is disagreement about whether this is the right way to go.

Raphael: We had a several days of a pretty bizarre public debate between ministers about kissing under the mistletoe!

At the start of the year, the British government said, Look, we’ve got three things that we think are going to help people return to normalcy: There are vaccines, there are Covid treatments coming online and we’ve got mass testing.

Omicron is the first real test of how we live with Covid in this post-vaccine world, where we can genome-sequence variants quickly, where we have several options of viral treatments and hospitals are better equipped. This is where the Johnson plan is put to the test.

For now, the message from the government is: Just party on for Christmas, don’t cancel your plans, and we’ll keep our fingers crossed that by January or February, it won’t be as bad as everyone thinks it might be.

Ghosh: Looking past the vaccines, what are most important treatments that are coming down the pipeline? What should people expect in terms of availability and how the treatments work?

Fazeli: The closest ones to us are obviously the monoclonal antibodies which have already been approved: from GlaxoSmithKline and Vir Biotech, Eli Lilly and AbCellera, and Roche-Regeneron, soon to be followed by another from AstraZeneca.

Then you’ve got the antivirals, from Pfizer and Merck, which are expected to remain active against omicron. 

And then you have all the therapies, like dexamethasone, that are for unlucky people who end up in hospital. And Roche’s Actemra, which functions in a completely different way, irrespective of the virus.

And lastly, you have some companies like Synairgen in the U.K. that are developing very different therapies still, which have yet to be proven. 

Ghosh: Are we seeing an effort to make these treatments available in a more equitable way than the vaccines were distributed?

Fazeli: Certainly. The antiviral pills from Merck and Pfizer are going to be in very large volume. Also, both companies have agreed licensing deals with producers of generic products in other countries to produce these drugs for low- and middle-income countries. Access should be higher because they’re easy to ship and to store. But there has to be a system in place to identify the patient and give them the drug.

The antibodies are tougher to make, the volume is potentially lower and the cost is higher. And you can’t just transfer technology because manufacturing is more complicated.

Ghosh: But the best course is still to get the vaccines. The pills are not obviously meant to be substitutes.

Fazeli: Absolutely. The vaccines are preventative and a lot cheaper. Next year, between all the different vaccine manufacturers, we’ll have between 12 billion and 16 billion doses. That’s more than enough to vaccinate the global population. The next move is getting these doses into people’s arms, a major determinant of which is people actually offering their arms. And that’s the bit that will be tested in 2022, in some of these lower vaccinated areas.

Ghosh: Governments are excited about the prospect of these treatments becoming more generally available. Arte they also conscious of the risk of complacency—of people thinking, There’s a treatment coming, so we don’t need to take the vaccine?

Raphael: We’ve gotten very good at protecting the most vulnerable people against the virus. Older people you have, by and large, received the vaccine. There is always a risk of younger people growing complacent. But with omicron, there’s now a greater sense of urgency from the government about vaccination and boosters. They haven’t done much advertising on these antivirals and monoclonal antibodies. And I think people are vaguely aware they're out there, but the real push has been vaccinations and measures to make people mindful of transmission during the Christmas period.

Ghosh: There’s also been some complacency from officials of the World Health Organization.  

Fazeli: Yes, there’s a report quoting a WHO official saying there have been no deaths from omicron. There are also reports insisting that it is not causing severe disease.

We all hope this virus turns out to be a pussycat, if you like, and that it will just move on without severely affecting anybody. Everybody wants that. But officials should think about what they say, because it actually impacts people’s behavior. I might turn around and say, Okay, fine, if the WHO says there are no deaths and the disease isn’t severe, I’m just going to go out and run around with my mask on under my nose.

It takes 3-4 weeks for death numbers to be impacted by cases. It takes a couple of weeks for hospitalizations to be impacted by rising cases. Let’s just sit tight, look at how it goes and celebrate in a few weeks’ time if omicron really turns out to be that pussycat we all wish it to be.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Sam Fazeli is senior pharmaceuticals analyst for Bloomberg Intelligence and director of research for EMEA.

Therese Raphael is a columnist for Bloomberg Opinion. She was editorial page editor of the Wall Street Journal Europe.

Bobby Ghosh is a Bloomberg Opinion columnist. He writes on foreign affairs, with a special focus on the Middle East and Africa.

©2021 Bloomberg L.P.