In May 2021, Australia’s Chief Medical Officer, Professor Paul Kelly, described how Covid vaccines were our “ticket out of the pandemic”. Vaccination, he said, would give Australians “a safer life”.
More than a year later, Australia’s Covid-19 vaccination rate is among the highest in the world.
However, daily deaths from the virus remain in the double digits. Hospitals are overwhelmed, care homes for the elderly and the most vulnerable are struggling with outbreaks, and there is renewed debate over whether more social restrictions, including mask mandates, are needed to slow the spread of the virus.
Professor Sharon Lewin, an infectious disease expert and director of the Doherty Institute, said: “Last year, I definitely didn’t think we would be in this position.”
“I definitely thought that with very high vaccination rates and what we knew about vaccinating against Covid and protecting against the disease from other variants, we would be in a very good position.
“But I think what we’ve learned, especially over the last four to six weeks here in Australia, is that the virus really has a lot of new tricks that weren’t expected.”
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Their latest trick is Omicron, a variant that has 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 infection from other variants and subvariants. They are also highly infectious; Lewin says 10 to 20 times more than the original strain first identified in Wuhan, China, in late 2019.
“BA.4 and BA.5 are so infectious, that these infections are very difficult to control because they are so large in number,” he said.
“The infectivity of Omicron and the limited ability of vaccines to protect against infection [though they do protect against severe disease and death], it means that you have a high number of cases, which has a great impact on the functioning of society. That includes the impact on the health care workforce, on our transportation workforce, and on all kinds of industries that we need just to run the country.
“Even if it’s only a very small percentage of those who end up in hospital, it’s still a large number overall, and the same is true of long-term Covid, which can have a large disease burden 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 emerged so quickly is because of the virus’s uncontrolled spread in vulnerable populations. People with weakened immune systems are more likely to remain infected with Covid-19 for several weeks or months, increasing the chance for the virus to mutate.
New Covid variant is ‘significant new threat’ says Australia’s chief medical officer – video
Such prolonged infections have been seen especially 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 the journal Nature, the researchers argued that vaccine equity, along with access to HIV treatment in Africa and reduced stigma, could help the world to see fewer variants of Covid emerge.
In January 2021, WHO Director-General Dr. Tedros Adhanom Ghebreyesus warned that “the world is on the brink of a catastrophic moral failure, and the price of this failure will be paid in lives and means of life in the world’s poorest countries”.
We must plan for the worst and hope for the best Professor Sharon Lewin, Director of the Doherty Institute
He expressed concern that high-income countries were acquiring most of the vaccines, while other countries were lagging behind.
“This me-first approach not only puts the world’s poorest and most vulnerable people at risk, it’s also self-defeating,” he said. “Ultimately, these actions will only prolong the pandemic, the restrictions necessary to contain it, and the human and economic suffering.”
Professor Penny Moore, a virologist at South Africa’s National Institute of Communicable Diseases, said it’s not just a lack of protection for vulnerable immunocompromised people, many of whom don’t even realize they have they have been infected with Covid because they are infected. asymptomatic, and the lack of equitable access to health care, including vaccines and antivirals for HIV and Covid-19, which are a problem in their country.
“We need to deal with vaccines,” he told attendees at a meeting of leading infectious disease experts in Sydney on Thursday, held by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine.
“This is something new for us, we’ve never had this problem before and we certainly have it now. We just can’t get people to take Sars-CoV-2 vaccines [Covid-19] and that’s something we need to address.
“On the African continent, we do not make vaccines. This has contributed enormously to the fact that we do not have vaccines to implement against Sars-CoV-2 and many others [diseases]. We have to deal with it as a global community.”
Until those issues are fixed, expecting more variants “is a no-brainer,” Moore said.
“Yes, we should expect more variants, unfortunately. We will definitely be picking up these new variants as we continue to have this high level of community outreach.”
“The world is on the brink of a catastrophic moral failure,” WHO Director-General Dr Tedros Adhanom Ghebreyesus warned in 2021. Photo: Denis Balibouse/Reuters
Lewin said this reality means Australians will have to accept the periodic return 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,” he said. “We have to remove the excitement of wearing a mask. I was only in Singapore and Korea and everyone wore a mask and it wasn’t a big deal. Those countries were full of activity, but people wore masks all the time. We have to recognize which is necessary, just when we have a growing number.”
Australia is also not effectively using the tools at its disposal, such as vaccine boosters and antivirals that protect immunocompromised people and the elderly from serious illness and death, he said.
“We’re also going to get better tools, there’s no doubt about that,” he said. “We’re going to get better vaccines. We’re going to get better antivirals. We’re going to see improvements in the way we manage Covid, so I don’t think it’s all a doom and gloom.”
But the future of the pandemic is more uncertain than it seemed even months ago, he said.
“I probably would have been safer trying to make a prediction at the end of last year about what might happen, but now it’s very difficult to predict,” Lewin said.
“What is certain is that Covid is not going away. We will have it next winter, and it will be here next year.
“We have to plan for the worst and hope for the best.”