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--:-- Sean Rameswaram: It's Today Explained. I'm Sean Rameswaram for them, and we've got a new variant. It's called the Omicron. Omicron. The Omicron variant. Let's face the Omicron variant. Sorry, Mr. President, it's actually called the Omicron variant, or maybe the Omicron variant, but definitely not the Omnicron variant. Let's go with Omicron. Omicron. Andrew Joseph was reporting on it over the weekend for Stat News. This new variant is called Omicron. It was designated as such on Friday, and it is the fifth variant to be elevated to variant of concern by the World Health Organization. Omicron B.1.1.5.2.9 is named as a variant of concern because it has some concerning properties.
--:-- Andrew Joseph: Well, it has a constellation of mutations, which would be strongly indicative that this will be highly transmissible. This variant is a cause for concern, not a cause for panic. Like, remind me how they're naming these things. They're going by the Greek alphabet. New Psi, Omicron, Pyro, Sigma, Tau, Epsilon, Phi, Chi, Psi, and Omega, Tau. The World Health Organization started using the Greek alphabet in part because the scientific nomenclature of B.1.1.7 versus B.1.3.5.1 versus P.1. Omicron is like officially known as B.1.1.529. It's just kind of a mess. And they also didn't want variants being named based on where they were first identified because that's kind of like stigmatizing.
--:-- Andrew Joseph: If I'm in Boston right now and if there was a new variant that emerged here, they wouldn't want it to be known as the Boston variant. They would want to give it sort of more of a neutral but also easy to use name. So that's why they're using Greek letters. Got it. And there have been many variants. Of course, everyone got to know Delta pretty well. Why is this one particularly worrisome?
--:-- Andrew Joseph: I feel like I'm going to be annoying to your listeners because I'm going to say like we don't know in so many different ways throughout this conversation. But basically there is reason for concern with this variant, but no one really knows what might actually happen or how big of an impact, if any, it might have in terms of the course of the pandemic. The virus is constantly evolving and sometimes even variants that seem really worrisome for a time kind of dissipate. So we're kind of at really early phases with Omicron.
--:-- Andrew Joseph: I guess there are two main reasons for concern. The first is like some very limited epidemiological data from South Africa that seems to indicate Omicron is starting to pull ahead even of Delta in terms of transmission. South Africa is likely to see 10,000 new COVID-19 cases daily by the end of the week. And like the data is very fuzzy and there are possible reasons that could explain why that appears to be the case even without a transmission advantage, but that's one.
--:-- Andrew Joseph: The second is just the genetics of this virus. The virus acquired just like a huge number of mutations really quickly. More than 30 mutations, say scientists, in the spike protein alone. And that's the protein that our immune systems are trained by vaccines to recognize and target. So the fear is that the more changes in the spike protein, the less well our bodies can sort of recognize the spike. And some of those individual mutations have been associated with some ability to get around the immune response. So it's kind of a combination of just the genetics of the virus and also some of the early data out of South Africa.
--:-- Andrew Joseph: Do we know how this thing got so mutated? So when most people get COVID, they clear the virus within a few days. And, you know, that's kind of it. And, you know, the virus kind of picks up mutations as it replicates in your body and as it spreads. But like it's pretty sort of even mutation rate kind of over time. But what can happen is someone with a compromised immune system can get what's known as like a chronic COVID infection.
--:-- Andrew Joseph: And this is different than long COVID, which is symptoms well after you clear the virus. This is actually a chronic infection. So the virus is still in your body. And because you have a compromised immune system, you're having trouble clearing it. But what that allows is for the virus to just sort of keep replicating and keep replicating. And your body basically incubates the virus. And so that allows it to develop these mutations quite quickly compared to sort of normal transmission.
--:-- Andrew Joseph: And so it thought that maybe someone with a compromised immune system contracted COVID basically allowed the virus to mutate in their body for an extended amount of time and then passed it on and set this off. And is the theory that this happened somewhere in the south of Africa?
--:-- Andrew Joseph: So the cases have primarily been identified so far in Botswana and South Africa, but it's really hard to say for sure where it might have come from. Sure, it might have come from some country in Southern Africa, But Botswana and South Africa have relatively strong sequencing networks. They're just sequencing more infections than a lot of countries there. But, you know, as we've seen really quickly, this virus moves. So it's really hard to say with any sort of sense of certainty where it came from.
--:-- Sean Rameswaram: That being said, though, there have been all these travel restrictions placed on a number of nations in Southern Africa, right?
--:-- Andrew Joseph: Yes. On Friday, the U.S. announced that actually effective today, Monday, it would be restricting travel from South Africa, Botswana, and six other countries with some exemptions for U.S. citizens and residents. The White House said this is being done out of an abundance of caution in light of the new COVID variant and on the advice of the CDC.
--:-- Sean Rameswaram: Obviously, like a lot of other countries in Europe and Asia and Australia have also imposed travel restrictions. And some countries, like I think the list was growing, but I think Japan and Israel and maybe Morocco have kind of shut off all travel for some amount of time.
--:-- Andrew Joseph: Travel restrictions are tricky because the evidence throughout the pandemic has sort of shifted how experts view travel restrictions. And it's thought that they can slow the arrival of new variants, for example, but not block them forever. And like as we've seen, like the number of countries reporting Omicron is growing like by the hour.
--:-- Sean Rameswaram: But there is like kind of a sense out there among scientists and public health advocates. You know, South African scientists did an incredible job of recognizing this early, characterizing this virus and sort of getting it onto like the world's radar. But even as countries are praising what South Africa did, they're then penalizing them by sort of cutting them off economically without providing any extra support or even vaccine supplies necessarily.
--:-- Andrew Joseph: There's always a fear that like if countries that report new variants then get penalized economically, like maybe that provides a disincentive to be transparent, which is what South Africa was here.
--:-- Sean Rameswaram: Do we know how dangerous Omicron is going to be?
--:-- Andrew Joseph: Based on what some doctors have said, people appear to have mild infections. This morning, I already saw three cases, all three children, mild cases, easily treated at home. But it seems like that's mostly in younger people who generally have milder infections to begin with. And like, who knows that maybe they had a prior infection. And so there's some amount of protection with them.
--:-- Andrew Joseph: So it's like no one knows what's going to happen when this virus gets into older people. And so I think that's one of the many open questions. It would be great if the virus had changed in a way that makes it less virulent, but it's too early to say.
--:-- Sean Rameswaram: And is it also too early to know whether the vaccines we have will be effective against the Omicron variant?
--:-- Andrew Joseph: So vaccines can lose basically some ability to protect people from infection without losing much of a step at protecting people from severe disease, hospitalization and death. And we've already seen that to an extent with other variants, including Delta. You know, people know there are breakthrough infections that are happening. But with Omicron, it's just not really clear what level of immune escape there might be.
--:-- Andrew Joseph: And just like to remind people, it's not like vaccines aren't 100 percent protective or zero percent protective. Like there's a huge range in the middle. So it's possible that maybe in the face of Omicron, we're all more vulnerable to getting infected, but we're still protected from those serious outcomes. But it's also possible that, you know, maybe more breakthrough infections lead to serious outcomes. It's, you know, it's possible that there's that level of immune escape. Again, that is truly speculative.
--:-- Sean Rameswaram: The studies that can help answer that question are being launched right now, and they involve growing the virus in the lab and testing them against antibodies pulled from people's blood who've been vaccinated or had a prior infection. So those studies will take a few weeks to come through, unfortunately.
--:-- Sean Rameswaram: Well, maybe we'll have you back when we have some answers, Andrew. Thank you so much. I'm sorry, I don't have more from answers, but we just kind of have to wait and see. We also have to see what Omicron does, like, continuing in South Africa to see if it really does seem to be out-competing Delta there. And what will help answer the question of whether it's more transmissible is also what it does in other countries. If it's able to establish toeholds and spread in other countries over Delta, that would show that it really maybe is more transmissible.
--:-- Sean Rameswaram: The second this variant dropped, people were saying, of course there's a new big bad variant in Africa now. This is what happens when the West hoards vaccines. We're going to ask our guy Umair Irfan if vaccine hoarding is to blame for Omicron in a minute.
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--:-- Sean Rameswaram: Omicron. Umair Irfan, Vox, the second we heard about Omicron, people were saying this was inevitable because the West was hoarding all the vaccines. Is that true? Is that what happened here?
--:-- Umair Irfan: That's not entirely true. We do expect that in general, as long as the virus spreads, there is a greater chance of mutation. And the more spread there is, the greater those odds. But, you know, South Africa is one of the more vaccinated countries on the continent. About 41% of adults in South Africa have received at least one jab. That goes down to 35% for people who are fully vaccinated. Mobile vaccination sites are being set up next to welfare offices and supermarkets all over the country. The idea? Take the vaccine to the people. You know, they've been a bit ahead of the curve there.
--:-- Umair Irfan: But if you look across the rest of the continent, we're looking at roughly 10% of the population is being vaccinated. And that leaves a huge swath of vulnerable people where this virus can continue spreading. The vaccination rates in Africa are ridiculously low. I mean, it's not just a problem that's limited to Africa, of course. You know, some of the poorest countries in the world in general are suffering from low vaccination rates.
--:-- Umair Irfan: There are more than 50 countries that have about less than a quarter of their population vaccinated. Whereas, you know, wealthy countries that have about twice the population of low-income countries have about 50 times as many doses available to them. So way out of proportion with their population in terms of what they have available to them. And that huge resource inequity is a problem not just for humanitarian reasons, but it creates situations where we can end up perpetuating the pandemic.
--:-- Sean Rameswaram: Let's talk more in detail about why the global vaccine rollout has been slow and uneven, especially for poorer countries, starting with this idea that the West is hoarding. Is that true? I know we've talked on the show before about this COVAX initiative to get the vaccine out to poor countries.
--:-- Umair Irfan: Well, COVAX was this idea where countries would pull resources and help distribute the vaccines more evenly across the board. The World Health Organization program is aiming to deliver 2 billion doses to people in 190 countries by the end of the year. And it started with a lot of promise and there was a lot of good intentions behind it. But it struggled to get funding to actually purchase the vaccines to begin with. And so by the time they actually had the money lined up, a lot of the first batches of vaccines that were being manufactured by manufacturers were already spoken for.
--:-- Umair Irfan: Bilateral deals that were made by the U.S., by the U.K., also the European Union. And they basically bought up the vaccine market. So there was little left over for COVAX to actually distribute to poorer countries. And so a lot of COVAX administrators are saying that they would like wealthier countries to kind of give up some of their spots earlier in line to help them actually get the doses that they already paid for.
--:-- Sean Rameswaram: Sounds like you're talking about the United States when you mentioned third doses and kids getting the vaccine. What is President Biden doing about this?
--:-- Umair Irfan: Well, certainly the United States has expanded its exports of vaccines and is donating to other countries. You know, President Biden has set a target of helping every country vaccinate about 70 percent of its population by fall of 2022. Put another way, for every one shot we've administered to date in America, we have now committed to do three shots to the rest of the world.
--:-- Umair Irfan: But if you're looking at the current vaccination rates in some countries, you know, if we continue on the same path, some of the poorest countries may not get to, you know, that level of vaccination until 2023. You know, the U.S. has pledged about 1.1 billion doses. And, you know, other countries have pledged millions more. And, you know, some of the manufacturers are doing tiered pricing schemes to help make it cheaper for countries to buy them.
--:-- Sean Rameswaram: But a lot of this is ad hoc and piecemeal. And that makes it really hard for countries to actually anticipate when they'll be able to receive vaccines. And then, of course, you run into other hurdles that we see around the world. Misinformation, hesitancy, just all sorts of pushback on vaccines for various reasons.
--:-- Umair Irfan: That isn't just an American thing. That's not just an American thing. It's a problem that's, you know, around the world and it manifests in different ways for different reasons. But it's certainly a problem. You know, we need to get as many people vaccinated as possible. And if we hit a stubborn plateau that means there will still be a population of people that can get infected and make other people sick and also create the risk of coming up with new variants that will undermine what little progress we already made.
--:-- Sean Rameswaram: It's not just a matter of vaccine hoarding. It's also like a matter of vaccine shipping, right? And vaccine infrastructure. Right.
--:-- Umair Irfan: Well, at the outset, no country was really doing a great job of vaccinating. Like the U.S. struggled to get vaccines out to a lot of people. We had doses getting spoiled. We had people getting vaccines out of turn and we had a lot of misinformation floating around. And so it's difficult even in the best of circumstances, even with the most resources. Now, if you're in a country with a poor health care system, with poor information and limited access to supplies, all those things just get more difficult and more problematic.
--:-- Sean Rameswaram: The U.S., of course, produces vaccines. The rest of the world does not. And so they're counting on imports of vaccines from other countries like the U.S., like Western Europe, like India, these countries that do manufacture vaccines at scale. But that leaves them vulnerable to supply chain shocks, things like problems at shipping ports where they have a hard time getting supplies in.
--:-- Umair Irfan: And it's not just the vaccines themselves, but the raw materials used to make them. Those are also bottlenecks. So like while some countries are now lifting export restrictions on the vaccines themselves, they still have restrictions on things like the glass that's used to make the vaccine vials, the rubber stoppers, the syringes. So a lot of the ingredients that go into making an effective vaccine supply chain are also being constrained in other ways.
--:-- Sean Rameswaram: I mean, talking about getting these vaccines to people in 2022 or even 2023, it just feels like we're going to be seeing so many more variants and mutations and we're just not going to put an end to this thing anytime soon.
--:-- Umair Irfan: Can the so-called international community do more to speed this up? I mean, one big thing countries can be doing is, of course, you know, lifting the restrictions and export bans on many of the materials and the vaccines themselves, you know, make them more freely available to other countries so they can purchase them, make more donations available.
--:-- Umair Irfan: But it's not just the vaccines themselves. You need to have people on the ground trained to administer the vaccines. You need to have better infrastructure to identify people who are at risk and get them the vaccines first and also information about correcting the misinformation that's out there as well. So there's no one lever that's going to solve this problem. You know, you need to have multiple approaches to actually getting the vaccination rate up.
--:-- Sean Rameswaram: Even countries with the most resources struggle with this, and the struggle is just going to get worse in countries that have less resources. Could vaccine manufacturers be doing more to help share access to the vaccine, to help get shipments to countries that need them?
--:-- Umair Irfan: There's been some talk about lifting intellectual property restrictions on vaccines and licensing it to other countries. India and South Africa have led the campaign, arguing it will help poorer nations vaccinate quicker. But Pfizer and BioNTech, who developed a COVID vaccine together, say a waiver won't boost global stocks anytime soon.
--:-- Sean Rameswaram: But again, the manufacturer is not the only limitation here. If people refuse to get vaccinated, you know, if they are misinformed or if they have some degree of hesitancy that isn't addressed, then having all the doses available really doesn't solve the problem either.
--:-- Umair Irfan: You know, we've been leaning really hard on this technology-focused approach that, you know, if we get the vaccine that's highly effective out there, we can ultimately solve the problem. But clearly, that's not the case. You know, we still need to be able to address people's social concerns. We still need to address a lot of underlying inequities in our health care system and also just allaying people's concerns. Some of it's well-founded. Some of it is not. And just being able to parse that, it's all very difficult.
--:-- Sean Rameswaram: And it shows that, you know, relying on technology alone doesn't solve the problem. Do you think the arrival of Omicron might galvanize countries to kind of be more vigilant about the spread of mutations or even about COVID in the first place, especially countries that are sort of ready to put this in the rear view?
--:-- Umair Irfan: Yeah, I mean, it shows that, you know, we can't turn our backs on the virus, that, you know, we cannot allow it to be spreading unchecked. We cannot take our eyes off the ball here, that, you know, surveillance is important. Vigilance is important. You know, this is the this is the only way we're going to stay ahead of this. And it also shows that, you know, we can't lean on any one particular approach. You know, a single focus on just vaccinations means that we're going to be missing dangerous changes that could be out there.
--:-- Sean Rameswaram: So you want to keep your eye out for any potential threats and be able to adapt to them before they become too dangerous.
--:-- Umair Irfan: Umair Irfan, thank you.
--:-- Sean Rameswaram: My pleasure.
--:-- Sean Rameswaram: Umair Irfan, you can find his reporting at Vox.com. Earlier in the show, you heard from Andrew Joseph at Stat News. You can find his reporting at statnews.com.
--:-- Sean Rameswaram: Our show today was produced by Miles Bryan with help from Will Reed, engineered by Afim Shapiro, edited by Matthew Collette, and fact-checked by Laura Bullard. Special thanks to Stephen Sondheim. Somebody crowd me with love. Somebody force me to care. Somebody make me come through. I'll always be there, as frightened as you, to help us survive. Being alive, being alive, being alive. Thank you.
