The emergence of the Omicron variant underscores the need for a fundamental reorientation of the policy response to the Covid-19 pandemic. Though Omicron was discovered in South Africa, it might be difficult at this stage to determine its geographical origin. It is quite likely that by the time Omicron was discovered, it might have already spread to many countries due in part to inadequate levels of genomic sequencing of Covid-19 positive test samples. We also do not have adequate information at this time on whether the emergence of the Omicron variant will prove to be as lethal as the earlier Delta variant, which caused havoc around the world and in India earlier this year. However, we do know that the Omicron variant can be detected only by genomic sequencing. It might potentially evade existing vaccines. In addition, the relatively large number of mutations in this variant might also mean that it might be more contagious than the previous variants like Delta. A more contagious variant might potentially increase the fatality rate by overwhelming public health infrastructure, even if it is less lethal.
We can identify some principal causes of emergence of new variants like Omicron. We know that viruses such as SARS-CoV-2 mutate continuously as they transmit and multiply among humans (and other hosts). The speed of transmission rises due to three proximate factors, namely, inadequate testing, non-observance of public health safety protocols such as masking, physical distancing in workplaces and other public/personal places etc. and less than universal vaccination. A combination of global geographical asymmetry in vaccination among countries due to inequality in vaccine production and distribution, coupled with premature reopening of economies, is conducive to wider transmission of SARS-CoV-2 and therefore for emergence of new variants. This might possibly create renewed waves of the pandemic. As we argued previously (in Nonlinear Dynamics and NIPFP working paper), a combination of non-pharmaceutical interventions as well as rapid vaccination might be required to stop the repeatitive waves of the pandemic.
So far, the primary policy response to the pandemic in high income countries has focused on large-scale vaccination of its own population (or ‘vaccine-nationalism’). This is accompanied by periodic imposition of non-pharmaceutical interventions like restrictions on economic activities in the form of lockdowns when there is a surge in infections,. These restrictions are withdrawn when there is a temporary reprieve in the number of infections. In our view, this strategy is flawed due to two reasons. Firstly, vaccine-nationalism has resulted in global inequality in production and distribution of vaccines. In high income countries, despite high vaccination rates, the percentage of population who are at least partially vaccinated has largely plateaued around 70 percent (partly due to domestic vaccine hesitancy), whereas in the group of low income countries as a whole less than 10 percent of population has received even a single dose of the vaccine. More than 50 countries have vaccinated less than 25 percent of their population. Vaccine inequity has ensured that around half of the global population, geographically spread around the world in the low and the lower-middle income countries continue to remain unvaccinated. This allows the virus to have a free run of transmission and mutation into new variants. Secondly, non-pharmaceutical interventions like lockdowns have not been accompanied by adequate public support to the incomes of the vulnerable sections of the society, forcing policymakers in most countries to prematurely lift these restrictions before the pandemic could be tackled globally. This has effectively allowed the virus to transmit across various regions of the world and mutate into new variants. We have seen several periodic waves of resurgence and retreat across the world. In other words, vaccine-nationalism is neither an insurance against another wave, nor a solution to the pandemic. Emergence of the Omicron variant is only the latest in this repeated pattern witnessed globally over the last two years.
It is evident that a policy response to the latest stage in the global pandemic should be two-pronged. In the short run, the immediate need is to contain the spread of Omicron in order to avoid large-scale loss of human lives and economic costs from another severe wave of the pandemic. This requires the identification and isolation of infected persons by mass testing and genomic sequencing, putting temporary brakes on withdrawal of non-pharmaceutical interventions, and ramping up public health facilities in preparation for another surge in infections, should it occur. All of these will require substantial public support through explicit budgetary allocations.
It is also important in the medium run, however, to reorient the overall strategy towards controlling the pandemic along two lines.
First, even though the science is clear on the need for rapid universal vaccination, there has been a complete global policy failure on this count. Such a rapid universal vaccination program is undermined by obstacles like the barrier of intellectual property rights resulting in hoarding of technology by a handful of pharmaceutical companies; and hoarding of actual doses of vaccines by a handful of high income countries far beyond their requirements. We propose that this problem might be addressed by bringing vaccine technology into public domain as an open source initiative. Open Source Pharma Movement, the CEPR initiative and the People’s Vaccine Alliance suggest some examples of how this can be done. The primary economic argument in favour of intellectual property rights is that it allows monopoly profits to an innovator to compensate for the risk of innovation. However, the success of open-source initiatives like Linux in the field of computer softwares have demonstrated that alternative models of innovation can also achieve rapid technical change. More importantly, in the context of a public health emergency where a substantial expenditure on development of vaccines has already been made by various governments, the risk of innovation has already been borne by governments. In this scenario, putting vaccine technology in the public domain has two advantages. Firstly, WHO reports 24 countries around the world have some capacity to produce vaccines. Open access to the technology would allow public expenditure to rapidly increase the global scale of production and distribution of affordable vaccines . Secondly, availability of vaccine technology in public domain would also allow faster future innovation. This might facilitate tweaks in vaccines if necessitated by emergence of newer variants like Omicron. In addition, all vaccine producers need to be assisted by publicly subsidised credit, public provision of support infrastructure and government backed advances on orders.
Second, till a global strategy for universal vaccination is in place, there is an urgent need to continue with non-pharmaceutical interventions so that the emergence of new variants does not outpace the rate of vaccination. However, such a strategy will be politically feasible only in the presence of adequate public income support, especially for the most vulnerable sections of the population.
We contend that both the aforementioned steps to reorient the policy response to the pandemic will require a global strategy, perhaps accompanied by a reconfiguration of international political economy. But we insist on our proposals since the benefits in terms of saving human lives and mitigating economic costs from repeated global waves of the pandemic far outweigh the economic and political costs of putting in place such an initiative.