In May 2021, Australia’s Chief Medical Officer, Professor Paul Kelly, described how Covid vaccines were our “pandemic exit ticket”. Vaccination, he said, would give Australians “a life with more certainty”.
More than a year later, Australia’s vaccination rate against Covid-19 is among the highest in the world.
Yet daily deaths from the virus remain in the double digits. Hospitals are overwhelmed, care homes for the elderly and the most vulnerable are grappling with outbreaks, and there is again debate over whether more social restrictions, including mask mandates, are necessary to curb the spread of the virus.
Infectious disease expert and director of the Doherty Institute, Professor Sharon Lewin, said: “Last year I certainly didn’t think we would be in this position.”
“I really thought that with very high vaccination rates and what we knew about Covid vaccination and protection against diseases of other variants, that would put us in a very good position.
“But I think what we’ve learned, particularly over the last four to six weeks here in Australia, is that the virus really has a lot of new tricks that weren’t intended.”
His latest trick is Omicron, a variant that produced the BA.4 and BA.5 subvariants, which now dominate new infections in most parts of the world.
These variants are immune evasive; whether this immunity comes from vaccination or from infection with other variants and sub-variants. They are also highly infectious; between 10 and 20 times more, Lewin says, than the original strain first identified in Wuhan, China, in late 2019.
“BA.4 and BA.5 are so contagious that these infections are very difficult to control because there are so many of them,” she said.
“The infectiousness of Omicron and the limited ability of vaccines to protect against infection [though they do protect against severe disease and death], means that you have a high number of cases, which has a significant impact on the functioning of society. This includes the impact on the health care workforce, on our transportation workforce, and on all sorts of industries that we need just to run the country.
“Even if it is only a very small percentage of those who end up in hospital, it is still a large number overall, and the same is true with regard to the long Covid which may potentially give us a heavy burden of disease over time.
“It is this evolution of the virus in this way that has surprised virologists, evolutionary biologists and vaccinologists.”
“We should expect more variants”
Part of the reason variants like Omicron have emerged so quickly is due to the virus spreading out of control in vulnerable populations. People with weakened immune systems are more likely to remain infected with Covid-19 for several weeks or months, increasing the chances of the virus mutating.
These prolonged infections have been seen particularly in patients with advanced, untreated HIV – a serious problem in sub-Saharan Africa, where the Omicron variant was first detected in November, thanks to the continent’s strong surveillance systems. .
In an opinion piece for Nature magazine, researchers argued that vaccine equity – along with access to HIV treatment in Africa and tackling stigma – could help the world see less of Covid variants emerge.
In January 2021, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “the world is on the brink of catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods. in the poorest countries of the world”.
He expressed concern that high-income countries were buying the bulk of the vaccines, while other countries were being left behind.
“Not only does this me-first approach leave the world’s poorest and most vulnerable people at risk, it is also doomed to fail,” he said. “Ultimately, these actions will only prolong the pandemic, the restrictions necessary to contain it, and the human and economic suffering.”
Prof Penny Moore, virologist with the National Institute of Communicable Diseases in South Africa, said it was not just a lack of protection for vulnerable immunocompromised people – many of whom do not even realize they have been infected with Covid because that they are asymptomatic – and of a lack of equitable access to health care, including vaccines and antivirals for HIV and Covid-19 which are problematic in his country.
“We have to deal with vaccine hesitancy,” she told attendees at a meeting of leading infectious disease experts in Sydney on Thursday, hosted by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine.
“It’s new to us, we’ve never had this problem before and we certainly have it now. We just can’t get people to get vaccinated against Sars-CoV-2 [Covid-19] and that’s something we have to deal with.
“On the African continent, we do not manufacture vaccines. This has massively contributed to the fact that we don’t have vaccines to deploy against Sars-CoV-2 and many others. [diseases]. We have to manage this as a global community.
Until those issues are resolved, expecting more variants “is a no-brainer,” Moore said.
“Yes, we should expect more variants, unfortunately. We will definitely embrace these new variants when we continue to have this high level of community streaming.
Lewin said this reality means Australians will have to come to terms with periodically returning to public health measures such as social distancing and masks as a way of life for the foreseeable future.
“I’m not saying we need masks forever, but when infections get big we need a quick response,” she said. “We have to remove the emotion from wearing the mask. I was just in Singapore and Korea and everyone was wearing a mask and that was okay. These countries were bustling with activity, but people wore masks all the time. We have to recognize that it is necessary, just when we have rising numbers.
Australia is also not effectively using the tools at its disposal, such as vaccine boosters and antivirals that protect immunocompromised and elderly people from serious illness and death, she said.
“We’ll also have better tools, there’s no doubt about that,” she said. “We will have better vaccines. We will have better antivirals. We will see improvements in the way we deal with Covid, so I don’t think it’s all going to be catastrophic at all. »
But the future of the pandemic is more uncertain than it seemed even a few months ago, she said.
“I probably would have been more confident trying to make a prediction late last year about what might happen, but now it’s very hard to predict,” Lewin said.
“What is certain is that Covid is not going to go away. We will have it next winter, and it will be there next year.
“We have to plan for the worst and hope for the best.”