What happens when two nasty Covid-19 variants get together and share their most effective mutations? Omicron and delta have brought us closer to the answer, says Peter White, a virologist at the University of New South Wales who warns of the inevitability of a new Covid-19 "super strain."
He joined Stephanie Topp, a global public health expert at James Cook University in Townsville, Australia, and Bloomberg Opinion columnist David Fickling for a Twitter Spaces discussion on the implications of the newest coronavirus variant shaking up the world. Leading the conversation, which has been lightly edited for length and clarity, is Bloomberg Opinion columnist Anjani Trivedi.
Anjani Trivedi: Here we are again. Omicron. Were you surprised, Peter?
Peter White: No, I wasn't surprised because this is what viruses do. Viruses are built to change quickly. That's why every year we have to adjust the flu vaccine. Some viruses change quicker than others. We have to adapt as the virus adapts.
Trivedi: Why is it so difficult for scientists to work out, and for us to understand, how a virus actually works on its hosts?
White: Each of these viruses is somewhere in the order of 50 mutations different from the previous variant of concern. So the first thing we need to do is look at the mutations and where they are and what changes could be important. And then, what is the effect. You cannot tell from the sequence exactly what the virus is going to do.
Trivedi: Is there anything that we're able to conclude with any certainty right now about immune resistance and how contagious this specific variant is?
White: From what I've seen, it looks to be about the same severity as delta, and the fact that it's actually taken over Delta indicates that it's more transmissible. We're seeing quite a rapid spread of it across the globe. But it doesn't seem to be more severe. There's no more hospitalizations in South Africa compared to delta.
Trivedi: Many emerging economies really struggled through previous waves, India being a case in point. How has South Africa gotten so far ahead?
Stephanie Topp: They got there by making good decisions based on need. I would say that the imperative to manage and respond to the HIV epidemic in the 1990s and 2000s, has resulted in a great deal of investment in public health, human and material infrastructure. Developing or developed isn't particularly helpful context. We've also seen the United States of America struggle. A lot can be learned about the way public health and politics intersect, and the way that influences what is seen as a priority.
Trivedi: When we think about the resilience of these health systems, how does that translate into distribution of vaccines?
Topp: What we're talking about here is the fair and equitable distribution of these medical technologies. The reason we're failing the so-called self-interest test is because our global economy is not set up to protect the interests of global populations. It's set up to protect the interests of shareholders. So we lack vaccine equity today, because you see very tight knit relationships between governments and large corporations. That result in political choices to benefit a certain very small segment of the global community.
Trivedi: What are your thoughts on why the death toll hasn't been as bad in South Africa and in Sub Saharan Africa so far?
White: It's a much younger population. That's a major factor. I also think there'll be a big underreporting aspect to this. But I don't really know the answer to that question.
Trivedi: How do we tackle this issue of vaccine demand? Something like one in six people in the US have had Covid-19, and nearly 800,000 people have died. What does that mean for going forward, especially in the next few months?
Topp: This is where education and information — not just risk messaging — of a public health response becomes so critical. Because if people haven't heard about it before, then they are susceptible to misinformation. And in our incredibly hyper social-networked world, the capacity of misinformation to reach people before official information is ever-more present. And that abuts, I think, a growing mistrust of politicians who are in charge of delivering those messages.
Trivedi: What should we be watching out for in the next few months? What answers are you looking for in the data, especially with the new variant?
White: You've got to look at the severity of the new variant. The next thing you've got to ask is, "Does the vaccine cover us?" And the answer that we're seeing at the moment is, "Yes." But in the future, it might be, "No." And so I'll be asking Moderna and Pfizer: "Can you tweak your vaccine?" And they are doing this already. And then the thing I think people haven't realized is that we're going to see the largest-scale mutations, known as recombination in virology terms, between variants of concern. So if we mix the best bits of delta with the best bits of omicron, we might create a super new strain that could be better than both of them [at infecting or sickening people]. And so we need to be looking for these hybrid viruses, and they will pop up in the future. They will come.
Trivedi: If we're going to keep getting new variants, how does that work in terms of vaccines and gaining immunity?
White: Vaccines reduce the severity of the disease. The chances of you dying if you've been vaccinated are many, many times reduced. So it's much better to get the vaccine than it is to get the real virus because you could die. So you can still get the virus even if you'd double vaccinated, but you've got less chance of getting it and you're going to be less ill and you've got less chance of passing it on.
Trivedi: What happens with a super-strain when variants combine? How does that play out?
White: We would then be asking the vaccination companies to adjust their vaccines to give us the immunity that we need to protect us from that variant. And we should be able to do that.
Trivedi: Does this change the business model for pharmaceutical companies? This virus is going to keep changing, and they're going to have to keep adapting their vaccines.
David Fickling: For pharma companies, vaccines are a bit of a backwater. It's not a very attractive business. You have to go through a very, very stringent development process that's very capital intensive. And then you basically have no repeat business. [For many vaccines] you are protected for life. And you're having a price negotiation with a very large and powerful buyer (governments). And so you're not going to get a good profit margin compared to something like drugs against diseases of aging, heart disease and cancer in rich countries. That's actually what they want to be spending money doing. Drug companies have been quitting vaccine development. Now Covid has blown this open to a large extent. We've got the whole world being vaccinated once, twice, three times, and then again with boosters reformulations, potentially.
Trivedi: Quarantines, border closures, how effective are these measures from a public health standpoint?
Topp: No single public health measure by itself is sufficient to manage communicable disease. Things like border shutdowns, quarantines, masking, physical distancing and so forth can be effective but come with substantial and unquantified costs. The fact that we now have a medical technology that can mitigate the acute clinical consequences of this disease is an absolute gift. It's gobsmacking to me that we're not making every effort to utilize this to the best advantage. I mean, here is something that would enable us to very much recapture aspects of our daily lives that we value. The fact that we're not is deeply demonstrative of the pathologies now in our governance systems.
White: we need to learn how to live with this virus. And the only way to do that is to stop people dying through vaccination, and then try to find a sensible balance between lockdowns and being back to normal.
Trivedi: What do you think is the single largest challenge we face right now?
Fickling: It's recognizing the type of business that vaccines are. For companies to make a proper return on vaccines, there has to be an unlevel playing field that produces suboptimal public health outcomes. So I think governments actually need to recognize they have a much bigger role to play. We need to regard the vaccine businesses as something that's much better suited to a public-private system.
Topp: Until we recognize that our health systems mirror the same weaknesses that we see in society, the problems we're having in improving coverage and quality and access to technologies like vaccines are going to continue.
White: To stay ahead of this virus will require funding of proper research and proper surveillance systems. What we don't have now is a proper antiviral [treatment]. We're close. In less than a year, we will have proper drugs targeting the virus and they will work well. And when we get those, are the rich countries going to keep them like they did with other viruses?