Pearls and Irritations

The new Omicron coronavirus variant is a wakeup call on the need to fully vaccinate the world’s poorest nations, and our own children.

Alarm bells are ringing as South Africa warns the world that a new variant of the SARS-CoV-2 virus has emerged in southern Africa featuring mutations that could make it highly infectious. It is infecting individuals in 12 African states and has been transported by travellers to Belgium, Hong Kong, Israel and no doubt many other countries. The World Health Organization has labeled this the “Omicron” variant.

As has been obvious for at least 18 months the inequity responsible for the failure to immunise citizens of the world’s poorer nations has provided the virus with a global laboratory in which it can manufacture an array of new modifications to its anatomy. This is a crucial endeavour for the virus as it searches for changes that provide an improved capacity to infect human cells. To be very simplistic, you can’t expect to save a house on fire by only pouring water into the kitchen.

This is the first time that scientists have been able to watch in real time, the machinations an infectious agent pursues to improve its chances of survival. The drama is all about a virus creating a key that can slip smoothly to lock onto a human cell that fools the cell into allowing entry of the virus. The lock on the human cell in question will not change its characteristics but the “spike” proteins that project from the surface of the virus (the key) are being modified constantly by the coronavirus.

We can appreciate the logic used by the virus. We have vaccines that cause us to make antibodies that can bind to parts of the “key” interfering with its ability to slip into the targeted lock. If the virus could change the shape of parts of the key so that it would not be recognised by vaccine induced antibodies yet still be able to bind to human cells that would be a game changer for the virus, That is exactly what these variants are hoping to do.

Within days of the new variant being detected scientists could see 30 or so changes to the spike proteins of Omicron. As yet we do not know if these changes make the virus more infectious. Omicron is certainly infectious but there is a good chance that is not more so and that it will be neutralised by the antibodies our vaccines produce. Time (and a short time at that) will give us the answer. Meanwhile, probably doomed efforts are being made to restrict the travel of people from countries where Omicron has been detected.

However the real significance of this development is the wakeup call it sounds on the imperative of generating a far more active and universal effort to vaccinate all of us. Note that Omicron developed in an environment where only 7 per cent of the population were vaccinated. As of this week 78 billion doses of vaccine have been administered but only 5.6 per cent of people in low income countries have received one dose.

Don’t get me started on the irony of having millions of the desperate poor crying out for vaccines as they run out of ground to bury all their dead while thousands of Australians march through Sydney and Melbourne angrily protesting that their governments want to mandate vaccination in certain circumstances.

Again this week US President Joe Biden has urged vaccine manufacturers to remove patent protections from their vaccines. Closer to home we learnt that, on current trends, only 3 per cent of people in Papua New Guinea will be immunised by 2026! It is abundantly clear that not only must the wealthy purchase vaccines for the poor they must fund/provide the logistics for delivering and injecting the vaccines. Some countries have lamented that they received generous doses of vaccines but have no syringes with which to inject them.

Here at home we have much to think and worry about as we challenge the virus to let us live a near normal life. It turns out that fewer than 1 per cent of Australians are fully vaccinated. We have done well in getting 86 per cent of the nation, 16 years or older, to have two shots of the vaccine, and that achievement has slowed the spread of Covid. But if “fully vaccinated” means “having achieved as much immunological protection as vaccination can provide”, we have a long way to go.

Protection after two shots of a vaccine is excellent in the short term but, as is true for many vaccines, protection wanes after six months or so and this explains why we are seeing more vaccinated people becoming infected and even ill with a Covid infection. Fortunately serious illness and death occurs far less frequently as immunity wanes but, over time the ability of the vaccinated to be reinfected and infectious increases. This is why there is universal scientific agreement that a third booster dose is required for longer protection of oneself and others. With time we will obviously know more, but very good protection for at least 18 months follows a booster dose.

You may have noted the publicity given during the week to the announcement from the EU that the vaccination certificates they use, as do we, as proof of vaccination, will now have an expiry date added.

While pursuing third injections for those aged 16 and older, we need to up our game to get the 12–15 year olds protected.

We are preparing to vaccinate children aged over five in the new year but this initiative needs a rethink. A report published this week from the University of New South Wales highlighted data showing that childcare and schools were fast becoming the new frontier of COVID-19 in Australia. We must ensure safe indoor air, masks and vaccination for younger children by the time students return from summer holidays in 2022.

The crucial issue of ventilation in schools is a subject for another day but epidemiologists are becoming convinced that we will need  to vaccinate children as young as two to achieve infection control. Pfizer and Moderna will publish results of their trials in 2–4 year olds by the end of the year but no problems have been encountered.

As you read this you may well be disturbed, as am I, that this is a luxurious discussion given the third world scenarios described above.

Of immediate concern is the observation that Australia is not sufficiently concerned about the universal lessons the fifth wave of Covid infections in Europe provides. Nowhere is vaccination alone containing community spread of COVID-19. If we had 90 per cent of all Australians (all age groups) vaccinated with three doses, that might contain the spread of the disease. We are a long way from that probably impossible target.

The pace with which we are abandoning the crucial public health initiatives that compliment vaccination is of great concern. Country after country that has done so have paid a high price. I am particularly concerned that the contact tracing units may be demobilised. Denmark, which ceased all restrictions, including masks in September, is now experiencing a huge surge in cases despite relatively high vaccination rates.

The December 15 plans for NSW could so easily backfire. Indeed I am not alone in anticipating a big increase in infections in January and February with our hospitals again under strain. The Covid virus is far from tamed. The 90 per cent double vaccinated milestone will be a great achievement but looking at that statistic with a game over sigh of relief could be the mindset that determines that this is not so.

While we struggle with the moment we do not have the luxury of not worrying about the future. The likelihood of further pandemics with viruses that have colonised animals and, when given the opportunity, jumped into humans (the zoonoses) is so likely that the establishment in Australia of a Centre for Disease Control, an initiative that we have sought for 30 years, is an absolute imperative. Being better prepared for the next pandemic is absolutely essential.

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