Omicron reminds us of the priorities
Virologists have constantly warned that new mutants will keep appearing, so here we are with Omicron. The surprise, this time again, is how governments are reacting. They have learned a lot over the last two years, but, sadly, they still make mistakes.
Early on, no one knew anything and most governments reacted too late and perhaps also too strongly. This is classic behavior in the face of uncertainty, not necessarily mistaken ex ante. The result was that many hospitals were overwhelmed and that stern lockdowns provoked a deep recession. Yet, they were right on two counts: the aim was to keep hospitals able to cope, not to minimize infections, and unprecedentedly large transfers were required to soften the economic blow. Subsequent waves were met a little bit faster with less extreme measures. This improvement was down partly to lessons learned, partly to general public hostility to tight lockdowns, and partly to the gradual spread of vaccinations. The strategy of keeping the lid on further waves with lighter measures and continuing fiscal transfers was expected to tidy us to the stage where herd immunity would relegate Covid to a normal sickness.
This reassuring view did not hold for long, though. The Delta variant implied that herd immunity now requires that a much larger share of population to be protected, through vaccinations or infection. The devastating impact on India and then all over the world showed that the pandemic cannot be fought at the national level. Herd immunity is a global concept. Omicron is a reminder that the accumulation by the better-off countries of stocks of vaccines is a losing strategy. That lesson has not yet been taken on board as the immediate reaction of the better-off countries has been to close borders. We do not yet know when and where Omicron appeared, but it was probably present around the world by the time it was identified. By that time, most countries that had adopted the zero-Covid strategy explicitly (islands, small and big, and self-styled China) had recognized that it was doomed (not China, though). Closing borders is not just useless, it is also costly and, more importantly, it is another signal that governments fail to grasp the global nature of pandemics.
Most governments now want to be seen as reacting promptly, which is good. Closing borders is appealing because it demonstrates that governments care about their citizens. They don’t, really. It reinforces the dangerous feeling that ‘we are invaded’, which is true, but it misses the point that mutants will emerge and spread as long as global herd immunity is not reached. Can governments do better? In an ideal world, by now we would have enough vaccines to inoculate the whole world. We are not there yet and, importantly, anti-vaccination sentiment seems deeply entrenched in the less well-off countries, especially in Africa.
So, we seem to have reached an impossible situation. Large parts of the world will not be anywhere close to herd immunity, providing the virus with the opportunity to mutate, with the risk that reinfection will become the standard elsewhere. New vaccines can probably be designed but they always will be lagging, unless a universal vaccine can be discovered. While research to this end should be strongly encouraged, other measures must be developed simultaneously.
The aim should be to produce enough vaccines and to combat anti-vaccination sentiment. It is striking that the global shortage of mNRA vaccines, arguably the only worthwhile ones, persists one year after they started to be available. This is a big money issue, with nationalist undercurrents. Why do China and Russia, among others, still not produce mNRA vaccines? Surely, they can develop such vaccines on their own or buy licenses to produce them. Is it face-saving? Is it a question of price? Is it a question of trust, the fear that they will not play by the rules of licensing and become rogue competitors? Suspending royalty payments sounds like a great idea, but it is not that simple. History is not over yet. Research labs have much more work to do, not just for Covid. They will keep innovating only if they have the certainty that they can patent their discoveries. True, the shareholders of Pfizer and Moderna have been ripping huge profits, but this is matter to be tackled by their tax authorities. Anyway, the costs of vaccines are just a portion of the total costs of vaccination campaigns, probably not the key obstacle. After all, the poor countries seem to spend quite a bit of money on weaponry.
That low vaccination rates mostly occur in relatively poor countries suggests an easy and cheap solution. Imagine that each sub-Sahara African citizen is offered $100 if she accepts to be vaccinated. The total cost would run up to $ 112 billions, if we count everyone, including children, well-off people, the already vaccinated people, so the bill stands to be smaller but let us ignore this issue. This amount represents 0.2% of developed countries’ GDP. A new wave, possibly the consequence of a new variant, stands to reduce their GDP by at least 1% of GDP. Spending a fraction of that in order to achieve global herd immunity looks like a very good deal, and it would be a good deed too.
The better-off countries too are some way from herd immunity. Many of them are inching toward formal or informal mandatory vaccination. Enforcement of the mandate is likely to be tricky and politically contentious. The alternative strategy is to provide non-pecuniary incentives by narrowing the range of activities allowed for the non-vaccinated people. Pecuniary incentives have been tried in some countries but the amounts on offer were too small to deliver sizeable results. Increasing these incentives enough could be costly and opposed by the vaccinated people. If the Omicron variant proves to be even more contagious, but not more lethal, than the Delta variant, a plausible solution is to rely on infections to raise the proportion of inoculated people. In this scenario, the governments would only ‘strongly suggest’ distancing measures and let the epidemic run its course. ICU absorption limits could be reached, though, in which case lockdowns for the unvaccinated could be imposed, as is already the case de facto in some countries.
At the same time, the better-off countries should honestly assess their vaccine needs and transfer excess inventories to countries that need them most. They could keep on ordering new vaccines, including new generation vaccines, for contingencies, but they should realize that the best protection of their citizens currently involves mass vaccination in the less well-off countries. And, please, stop closing down borders.