November 26 saw a blood bath in the markets — indices across the world nose-diving, crude prices falling, and gold surging. There was panic selling across the board and no sector was spared. It was a day in which Indian investors lost several lakhs of crores in value, while the interest in low-risk instruments such as bonds soared. The reason — a new heavily-mutated variant of COVID-19 reported from South Africa.
Governments across the world scrambled to ban flights from several southern African countries. Airline and hotel stocks tanked, with the holding company of British Airways losing as much as 20 percent of its value. The reaction from countries was met with justifiable anger from South African government.
The new variant (B 1.1.529, now called as Omicron by the World Health Organization) certainly seems to be more infectious than the Delta variant. In less than 25 days, the variant has a share of more than 80 percent in all the genomic sequencing done in South Africa. But more transmissibility does not always mean more morbidity or mortality. We also don’t know how the virus will behave in a population with high vaccine coverage. Remember that only less than 25 percent of South Africa’s population is fully vaccinated. Therefore, we still don’t know the real-world impact of the variant.
Though we cannot blame country governments for taking a ‘safety-first’ approach, it puts extensive pressure on the countries in that travel ban list. These are countries which are already reeling under the impact of COVID-19. For example, the Gross Domestic Product of Botswana was down by 7.9 percent in 2020, despite the country not having too many cases till June.
Besides, these are places where the Human Immunodeficiency Virus (HIV) has had a gargantuan impact. In countries such as Lesotho or Eswatini, which are included in the travel ban list published by the United Kingdom, more than 25 percent of the adult population is affected by HIV. So, isolating them, and penalising them for no fault of theirs does not make sense. Blanket bans on travel often results in disproportionate damage, and does not incentivise countries to be transparent about their disease statistics.
What we need now is international co-operation to ensure that the southern African countries have access to tools, and resources to study, and contain the variant. Based on preliminary understanding about the mutations, and easy transmissibility, the WHO has classified the new strain as a ‘variant of concern’, which is the organisation’s highest category for COVID-19. But we need to understand a lot more about this variant, before starting to panic. How lethal is the infection? What proportion of patients are likely to land up in a hospital? Will it overcome the effect of vaccines? Which vaccines can offer a reasonable degree of protection? The global healthcare community needs full co-operation from the countries to answer these questions.
Besides, the continent needs unprecedented level of support to increase the vaccination rates. As per the Africa Centers of Disease Control & Prevention, only 6.6 percent of the continent's population is fully vaccinated against COVID-19. This presents a nightmarish situation as the virus may have a free run, especially in the background of weak health systems, and immunodeficiency due to HIV infections. Also, there are studies showing that COVID-19 mortality is higher in black population as compared to other ethnic groups.
If the strain is more transmissible than the Delta variant, there is no doubt that it will spread throughout the world, and become the most dominant strain. No amount of border closures or flight cancellations are going to prevent that. The fact that the strain has already been picked up from Belgium, Hong Kong and Israel, shows that it is spreading around the world.
But the real benefit from these travel restrictions is that it buys us time. It will help us to understand the transmission dynamics, and natural history of the disease better. But isolating the countries in which this strain has been detected, and then hoping that the problem will go away on its own, is nothing but hara-kiri.
The travel restrictions should be reasonable; and should be based on rigorous testing and isolation. Any person returning from aboard, and their primary contacts who test positive for COVID-19, the sample should be taken for genomic sequencing. India has a robust network of 28 labs called Indian SARS-CoV-2 Genomics Consortium (INSACOG), which are doing the sequencing work now. This network has to be strengthened, with more labs and resources.
Panic reaction, and locking your airspace does not prevent COVID-19 from spreading, it just delays the inevitable. The world should be understanding it by now. Besides, m-RNA platform for vaccines is incredibly versatile and can be adapted quickly if the new variant can escape the vaccines.
The gross vaccine inequity, and the injustice meted out to the African countries is a sign of a bigger malaise. Our policy community does not understand that the health of human beings is closely linked to the health of other human beings, animals, environment, and the planet itself. When viral transmission happens freely in one part of the world, it is bound to give rise of variants. Most of the variants will be harmless, but there can be some, like Omicron, which can place us all at risk.
Than looking only at piecemeal solutions such as border closures, the global governance structures should advocate for more vaccine equity and greater access to treatment options in countries of Africa, Asia and Latin America.
Philip Mathew is a physician, public health consultant and a doctoral student at Karolinska Institutet, Stockholm. Twitter: @pilimat.
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