As the U.S. gears up to end its federal public health emergency for COVID-19, the World Health Organization just declared an end to the global health emergency. WHO Director-General Tedros Adhanom Ghebreyesus announced the declaration on Friday, following a meeting of the organization’s COVID-19 emergency committee the day before.
The world is at a point of transition from considering COVID-19 an unexpected emergency to considering it a part of our daily lives, a disease that we’ll be dealing with in the long term.
The WHO will have fewer resources for an international response to COVID-19, such as coordinating between countries and sharing data at a global scale.
The WHO will also have less authority when it comes to issuing international guidance to control COVID-19 spread.
There will be fewer incentives for countries to accelerate vaccines, treatments, and tests for COVID-19.
The declaration does not mean that COVID-19 is “over.” We have plenty of long-term issues to deal with here: millions suffering from Long COVID, continued COVID-19 waves around the world, potential new variants, healthcare worker shortages, and declines in childhood vaccination rates, to name a few. Tedros may set up a new committee to make recommendations on long-term COVID-19 management, according to Branswell’s article.
In fact, the WHO recently publicized the impacts of Long COVID: Tedros delivered a PSA explaining that one in ten coronavirus infections leads to some form of Long COVID, and suggesting that “hundreds of millions of people will need longer-term care.” Shifting out of the emergency phase of our global COVID-19 response should be a call to action for scientists and health experts to now focus on Long COVID needs.
Still, a lot of people might interpret the WHO’s declaration as an announcement that they no longer need to worry about COVID-19. Some mainstream publications that have covered the change haven’t done a great job of conveying the nuances here, and I’ve already seen some misinterpretation on social media.
COVID-19 may not be an emergency at this point. But we’re probably going to be living with it for the rest of our lives, and there’s a lot of work left to do.
China is currently facing a massive COVID-19 surge, after ending many of its stringent “zero COVID” policies in December. Some estimates suggest that the country is experiencing over a million new cases each day, and widespread travel over the Lunar New Year later this month will likely prolong the surge.
Among U.S. media outlets covering the situation, a common topic is China’s lack of reliable COVID-19 data. For example: “The country no longer tallies asymptomatic infections or reliably reports COVID deaths—employing not the distortion of statistics but their omission,” writes Dhruv Khullar in The New Yorker.
Articles like Khullar’s accurately describe how difficult it is to understand the scale of COVID-19’s impact on a country without accurate data. But they fail to explain that this is far from a uniquely Chinese problem. In fact, many of the same claims that writers and health experts have made about China could also apply to the U.S., albeit on a different scale.
Some examples:
Without widespread PCR testing, officially-reported case counts are likely significant underestimates of true infections.
Public health agencies are no longer doing widespread contact tracing or attempting to track asymptomatic cases.
Unchecked spread of the virus could contribute to the development of new variants that evade prior infections and/or vaccinations, but such variants will be hard to quickly identify due to low testing rates.
This Twitter thread, from the writer and podcast host Artie Vierkant, shows the similarities pretty clearly:
Brief thread of how basically every article about covid in China right now (left) exceptionalizes things that are also existing, huge problems in the US and internationally (right) pic.twitter.com/hnaCBTf6G0
Don’t get me wrong—the current surge in China is an immense tragedy. But we can’t talk about it in a vacuum, or ignore the very similar problems plaguing the U.S. and many other countries. Poor COVID-19 data is, unfortunately, a global issue right now.
As China rolls back on COVID-19 safety measures, its rising case load is likely to shoot up further. Chart from Our World in Data.
China has rolled back some of its most rigorous COVID-19 safety policies, essentially moving away from its “zero COVID” strategy, following recent protests. I am no expert on China’s political or health policies here, but I did want to share some reflections on what this rollback could mean for global COVID-19 data, citing from Katherine Wu’s recent story in The Atlantic.
First of all, it’s important to note that we don’t have much information about coronavirus variants circulating in China. According to the global database GISAID, China has submitted a total of just 667 Omicron sequences—compared to nearly two million from the U.S. The country’s most recent sample was submitted on November 29, almost two weeks ago. Some reports, like this one in the Global Times, suggest that Omicron BF.7 is the dominant variant in Beijing, but the pattern could be different in other parts of the country.
Without more data, it’s hard to say for sure. And this is concerning because, if a new variant evolves in China as the virus spreads more widely there in the coming weeks, it could take more time for the rest of the world to learn about it than if a new variant emerged in other countries. Quick responses and international collaboration have been crucial in responses to new variants over the last two years; the global scientific community needs to be prepared to study and adapt to any new variant that might come out of China.
At the same time, China’s case data are going to become less reliable as the country reduces its clinical testing. Daily case numbers have already appeared to drop, per Our World in Data, but this could be a product of less testing for asymptomatic people (and/or data delays) rather than a surge actually turning around. I also noted that Our World in Data does not have any testing numbers for China more recent than April 2022.
China is already more limited at sharing COVID-19 data than other countries. But if case numbers become less reliable, it will get harder for international health experts to keep tabs on how bad China’s surge is getting. And it could get very bad: one modeling analysis, published in Nature in May, found that an unchecked Omicron wave in the country could lead to demand for intensive care units at 15.6 times the country’s current capacity—and 1.55 million deaths.
Based on its current healthcare system, China is not prepared for a massive national surge of severe COVID-19 cases. It’s probably even less prepared for the massive surge of Long COVID cases that could follow. This has implications for global health, economics, and more.
Even without a spike in severe disease, a wide-ranging outbreak is likely to put immense strain on China—which may weigh heavily on its economy and residents for years to come. After the SARS outbreak that began in 2002, rates of burnout and post-traumatic stress among health-care workers in affected countries swelled. Chinese citizens have not experienced an epidemic of this scale in recent memory, Chen told me. “A lot of people think it is over, that they can go back to their normal lives.” But once SARS-CoV-2 embeds itself in the country, it won’t be apt to leave. There will not be any going back to normal, not after this.
In the program—which is a collaboration between the agency’s Travelers Health Branch, biotech company Ginkgo Bioworks, and airport wellness company XpresSpa Group—travelers at four major airports can volunteer to be swabbed right after they get off the plane. The travelers’ test results are pooled by country of origin, meaning that analysts at Ginkgo combine their samples and PCR-test them together.
In addition to test positivity, Ginkgo also sequences the samples to identify variants spreading around the world. The program has included about 60,000 people between November 2021 and September 2022, according to the CDC. It’s now expanding to add more airports, with the CDC and Ginkgo working together to select international flights that should be targeted for testing.
Earlier this week, I talked to bioinformatics experts Andy Rothstein and Casandra Philipson, who work on the CDC travel surveillance program at Concentric (Ginkgo’s COVID-19 testing initiative), to learn more about how the program works. Swati Sureka from Ginkgo’s communications team also took part in the interview.
Here are a few key insights I learned from the conversation:
Travelers who volunteer to be tested don’t actually receive individual results back from Ginkgo, due to the company’s pool testing method. But they receive free at-home tests that can provide individual results.
Despite a relatively small sample size, the surveillance program tends to match global coronavirus variant trends from GISAID (a global repository of variant sequences).
The CDC uses data from this program as a complementary surveillance system, in coordination with the agency’s domestic variant surveillance, wastewater testing, and other systems.
Along with expansions to more airports, the Concentric scientists are working on testing wastewater from airplanes as another way to pull COVID-19 data from international travelers.
The experts named BQ.1 and BQ.1.1 as the most concerning variants they’re following right now, though the program has also picked up XBB.
This interview has been lightly edited and condensed for clarity.
Betsy Ladyzhets: I wanted to start by asking about the backstory behind the traveler-based genomic surveillance program. I’ve read a bit about it, but I’m curious to hear from you guys about how it got started and choices that have been made as you’ve expanded the program.
Andy Rothstein: Gingko has long recognized that biosecurity is an integral component to the growing bio-economy, even before COVID. But when spring 2020 came around, Ginko as an organization rapidly responded with a large commitment to the sequencing effort across the country… That really showed that there was an opportunity to grow a biosecurity business unit within Gingko, which became Concentric.
We built a K through 12 testing program, where we implemented this novel approach of pooled testing. We could have kindergarteners basically swabbing their noses in the classroom, everyone could put it one tube, it simplified the process, and we were able to get those results out quickly. But we really recognized that this is just one interface that can be a part of the biosecurity infrastructure.
We saw that travelers were this really important sentinel for bringing in new things like variants or tracking lineages. And we could combine the pooled testing approach with our sequencing capability at Ginkgo. Then, we got in contact with XpresSpa [now XpresCheck], which was pivoting their business model as well, because no one was going in the airports for manicures and massages. We approached them, as well as the CDC branch that deals with travel histories, quarantining, and things like that. We came to them to launch a pilot program in September 2021 as a proof of concept to say like, “Is this an interface that could provide valuable insights for public health and the CDC?”
We didn’t really know whether or not the pilot would work out. But we were one of the first to detect Omicron coming into the country in November [2021]. The program has now expanded, as of August 2022, into a two year program. And we’ve consistently been able to show that there’s real value in early warning, early detection through this novel interface.
Casandra Philipson: Gingko is an organism engineering company, we know that we’re going to be living with engineered organisms in the future. I think, because of that our founders have always had this prerogative to be able to have an early warning system or anomaly detection system for threats, whether or not they’re natural or manmade. And we have a lot of really smart people who had previous experience, in, like, Department of Defense surveillance exercises in the past. So I think there was an interest in early warning signals.
It’s also hard to be able to do surveillance in other countries, at least at that early, pandemic phase. And so this was a really easy way to have access to things that were coming in from other countries, that we otherwise wouldn’t have had access to.
BL: Yeah, that makes a lot of sense. I’m curious, building off of that, how is the CDC using the data that comes out of this program? Is it mostly about new variants? Or are there other things they’re kind of doing with it?
AR: CDC has a lot of complimentary surveillance systems ongoing, especially for SARS-CoV-2, that they’ve built up, whether it be clinical or whether it be wastewater. This is a novel interface for them to be detecting new things coming into the country. And so we really help source and, I guess, consolidate what is coming into the country and whether or not it’s a bad thing, or part of the existing evolution of SARS-CoV-2.
We work in tandem with them weekly, to not only optimize this program, but also give insights into the data that’s coming out. The [travel surveillance page of the] COVID Data Tracker has been a good culmination of all of this work that we’ve been doing. We can broadcast that publicly and show, almost side-by-side, here’s what’s happening in United States; here’s what’s happening, potentially coming into the United States.
BL: I did want to ask more about that new page on the COVID tracker, because I’m curious what you would want the average viewer to take from those charts. What should folks be getting out of both the test positivity rate and the variants?
AR: The first part is this test positivity rate. What we’ve seen is that, as testing declines in countries around the world, whether that’d be the appetite for testing or the funding for testing, we have a new sentinel to see what, potentially, the positivity looks like around the world. There’s been a number of times that we, in our program, have matched positivity rates in a country of origin [for a group of travelers]. Then as testing stopped [in that country], we still are picking up a positivity rate. For the public that is looking at this chart, it’s an opportunity to see into the window: What’s the global picture of what’s coming into this country?
Positivity is the first lens of data. The next is that we actually sequence, and we are understanding what is the breakdown or the frequencies of different variants coming into the country. You can see how what’s happening on [the CDC’s U.S. variant surveillance page] is lining up with the frequencies in our program. And because we’re finding new things, we end up sort-of being ahead of the curve in terms of what those frequencies might end up being in the United States.
BL: So you’re talking about comparing the CDC’s variant proportions estimates versus the travel estimates.
AR: Yeah, exactly. And the wastewater estimates… Not everybody is necessarily going and seeking testing when they’re sick with COVID, they might be doing an at-home test. So we’re using all of those [data systems] in a complementary sense to find, like, what’s a holistic picture of the SARS-CoV-2 coming in and outside of the United States?
BL: I also wanted to ask about, so like, if I’m a traveler coming into the U.S. at one of these airports where you have this program, how is it advertised? And what do people learn about it when they decide to volunteer to get tested?
AR: We have these pop-up testing booths, in collaboration with XpresCheck. They’re our on-the-ground infrastructure to basically be recruiting folks coming off of international flights. All the international flights go into one bottleneck where you’re going to leave the terminal, and you have an opportunity to see this booth that has some information about like, testing for public health, with the CDC logo—basically recruiting folks to come in. Folks that volunteer, they swab their noses and then we are pooling [tests] by those countries. We also have been giving them free, individual tests to take home.
We’re not collecting or giving back individual testing data to [the volunteers]. But we are showing that this is a part of the public health program. What we’ve found, through survey results, is that participation has really been increased by the fact that people feel like they’re being a part of this public health program and they want to help. We have great recruiters on the ground.
BL: So people don’t get their individual results, but you said they get an at-home test that they can use?
AR: Yeah. And then they can get their individual results [from that test]… They don’t get the pooled result.
BL: Are the data that you’re getting from this program linked to any other data? Because I know one big concern with variants is like, is a new variant going to be more severe? Is it going to be more likely for people to be hospitalized? So is there any capacity to link the tests that you’re doing with, say, hospitalization records?
AR: I think it’s a great idea, a great direction. Right now, we haven’t been linking those clinical data… We can try to look at the data within our program, and then contextualize it [using other sources] on what might be happening, in the United States or in origin countries.
But we’ve also been really excited about expanding our passive detection through wastewater. We’ve done an R&D project where we were looking at wastewater testing off of aircraft. So, that’s another complimentary data set off of the aircraft itself to help get a more holistic picture—not everyone is going to be using the bathroom [on the plane], but not everyone is going to be volunteering in this program.
BL: Testing the wastewater off the airplane seems like a great idea, I would not have thought of that.
AR: Yeah, we’re really excited about the opportunity to do something along those lines, since folks aren’t always going to volunteer to swab their nose.
We’re pooled testing by country, so we know that folks are coming from specific places. We can also—they can volunteer to give us any past travel history, so that we can try to link those data on our own. But there’s no systematic way to link [our results] to clinical data.
CP: Our sweet spot is microbes and viruses. So we actually don’t collect individual data that would allow us to associate an individual with their health record at all. I just wanted to emphasize that.
BL: That makes sense. I know that [linking datasets] is something that is very challenging to do, even with established health systems. I was just curious.
Swati Sureka: I can add one thing, just in terms of the knock-on benefits of the program. Say we do get early warning of an emerging variant that could potentially be of concern, that we don’t know on the global stage yet. We work directly with the CDC on getting them access to those [test] samples so that they can do direct viral characterization. Because, with emerging variants, it’s hard to get your hands on samples of it to be able to conduct research on how the virus behaves. I think that’s one of the side benefits, being able to actually pull those samples and share them directly with the CDC.
BL: Are there any variants that you’re all particularly watching right now? Like, I know, there’s been a lot of news about XBB, that’s spreading in East Asia. From your perspective, what are you seeing as concerning hotspots at the moment?
AR: Yeah. This is a big part of what our team does: as this data comes in, understanding what might be the trends happening globally. We have repeatedly shown that we can do early warning, [our data are] some of the first to identify a variant of concern. We can look and say, like, there’s certain mutations that we know, either from past variants or in predictive space, that [indicate this new variant is] going to be a problem for immune escape.
Variants that I think we’ve been really keeping an eye on and telling our CDC partners about are BQ.1 and BQ.1.1, which have been split out by CDC in the last couple of weeks. Our program was one of the first to identify and actually designate this BQ.1 variant. So we saw, early on, that it had characteristics because of its mutational profile [allowing it to] take hold. We continue to watch that.
The United States has been, pretty much, a few weeks to a month behind trends that we see in Western Europe. So I think it’s been pretty clear that BQ.1 is going to be something to watch for, as it sort of expands in its frequency… We also see XBB in our program, we’ve seen it as well. I think it’s going to be an interesting new chapter of SARS-CoV-2 evolution where we have potentially co-circulating variants of concern that have different dynamics in different parts of the world.
BL: Yeah, it’s very interesting… One other thing I wanted to ask you about is sample size. It seems like, from the data on the CDC dashboard, that you’re working with a small number of airports and a limited sample, compared to the number of international travelers coming into the U.S. So how do you think about analyzing that, and potentially expanding the sample?
AR: Definitely part of our plan is to ramp up the number of samples that we can get, as well as the number of airports that we might be operating out of.
But I think it’s just remarkable to talk about this program, when you see such a small sample size, and we’re still able to find new things and match GISAID, or global variant frequencies. It highlights, even with a small sample size, that the way that we’ve designed the program and the way our CDC counterparts think about where we’re going to be, what flights are we going to be choosing—that has been really, really successful so far. You always want more samples in science, but I think we’re working with what we have, and we’re excited to be expanding.
BL: That makes sense. So you’re able to say, “We want to send people to these flights, because this country has concerting variants right now,” that kind of thing?
AR: Yeah. Our CDC counterparts are tapped into both the CDC-wide conversations about variants and the global, WHO conversations about variants. So they’ll give us indications when there might be something to think about. And, again, this program is super nimble in its ability to pivot. When we think we want to focus on certain regions of the world, [we can recruit from specific flights].
It’s nice to be working in airports that have these direct flights and these long-haul flights. But thinking about how we prioritize is definitely—the CDC folks are thinking about this, and we sort-of help support them.
BL: The last main thing I wanted to ask about is, obviously in the U.S. and globally, we’re seeing so much less PCR testing now than we had at earlier points in the pandemic. How are you and—to any extent that you can talk about it—how are partners at the CDC thinking about making sure that we’re collecting a lot of samples from diverse settings, and looking in different places, looking at wastewater, and just continuing to keep track of what variants are circulating?
AR: I think back to, finding novel places to sample things. Like, the fact that we’ve invested and tried to build capability to do aircraft wastewater testing is just adding a complementary [data layer]. We’re going to have this layered interface or layered system where we might have some PCR tests, we might have wastewater, we might have sequencing, we might not have sequencing.
We’re figuring out, how do we just keep adding and keep building on this biosecurity infrastructure. I mean, the worst thing that could happen from this is we build all this and then no one uses it again, until something pops up. We’re really invested in finding new and novel ways to sample and to detect, and eventually sequence if we can get more robust data, like on variants.
BL: That makes sense. I wonder to what extent it can one day be useful for other viruses, too. I know we’re in a bad flu moment right now, or at least the beginnings of maybe a more intense flu season this year. And I know experts always talk about, like, “Can we read the tea leaves from the Southern hemisphere?” So that makes me think, “Okay, could we actually sample people who are coming in? And see if they have the flu, and not just COVID?” Or other things of that nature?
CP: This is something that keeps me up at night. Without being too forward-looking, absolutely, I would say, there are some commercial products out there right now—like from Illumina, which is a massive sequencing behemoth, they’ve just released some new sequencers on their end. They have this panel of, like, 66 viruses that you can detect in one panel. I think we’re gonna see more of that from many different types of partners who are looking at surveillance.
Moving beyond SARS-CoV-2, could samples be used for that? We’ve seen lots of publications that definitely prove that’s true. I think it’s right on cue, hopefully, with where we’re all headed.
BL: Yeah, I hope so. Well, those were all my main questions. Is there anything else you all think would be important for me to know about the program?
Swati Sureka: Stepping back, seeing how this [program] has played out over the past year, I’ve just been floored by, like, tens of thousands of people who have mobilized and participated and given samples in service of public health. For me, as a person who works in the communications space, I think we often hear a lot of these narratives of like, “People aren’t gonna do anything” or take any measures that they’re not forced to do.
People are inherently self-interested in all of these narratives that we hear. And it’s been really impressive to watch the participation that we’ve seen from travelers who want to help public health and want to help stop the spread, want to help pick up new variants. I don’t want to lose that thread of things.
BL: Totally. I can just envision, if you’re coming off a long flight, you just want to get through customs and get home. Taking a few extra minutes to get swabbed is not nothing.
AR: Yeah. And you could be doing that and say, “Oh, it doesn’t matter.” But we’re consistently seeing how helpful this data is, to inform all these complementary systems for building a biosecurity infrastructure. It’s really important data as we move forward.
BL: Yeah. When folks sign up, do you give them a link to the dashboard?
AR: Now we do. Now we can, right, it’s now live. It’s been really nice to have that public-facing thing, so that folks know where their efforts are going towards.
While Ukraine’s COVID-19 cases appear to have gone down in recent days, the country is (obviously) not prioritizing COVID-19 reporting during an invasion. Chart via Our World in Data.
When Russian troops began attacking Ukraine, the country was just recovering from its worst COVID-19 surge of the pandemic. To state the terrifying obvious: war makes it much harder to control a pandemic.
Here are a few reports on this situation from the past week:
In addition to COVID-19, Ukraine “has been trying to control a polio outbreak since October,” reports Dana Varinsky at NBC News. About 13% of Ukrainian children under age six had not received their polio shots as of 2020, and are vulnerable to a re-emergence of this disease. Global health experts are highly concerned about the potential impacts of both COVID-19 and polio on Ukraine and neighboring countries.
While data on Ukraine’s cases show a decrease in recent weeks, these numbers are pretty unreliable.Our World in Data reports a steep decline from 860 new cases per million on February 12 to zero new cases in the last couple of days. This is unsurprising for a country with pressing issues to deal with than data reporting. “These numbers are going to have to be taken with some sort of salt, understanding it may be underreported, or in many ways not reported at all,” public health expert Sonny Patel told NBC.
Meanwhile in the U.S., hospitals are considering a potential increase in Russian cyber threats, POLITICO reports. Earlier in March, the U.S. Cybersecurity and Infrastructure Security Agency issued a warning to hospitals and other healthcare organizations saying they should prepare for Russian cyberattacks. “No “specific or credible” threats have been made yet, but health care organizations are concerned, given Russia’s cyber warfare history,” according to reporter Ben Leonard. (The full story is paywalled, but a summary is available in POLITICO’s newsletter.)
Over the past year, we’ve seen more and more examples of COVID-19 surges intersecting with other disasters. This includes violence in Palestine last summer, as well as hurricanes, wildfires, and the Texas winter storm here in the U.S. To me, these horrible convergences make it clear that healthcare systems in the U.S. and around the world need a lot more investment to be resilient in these times of crisis.
In January, COVAX set a goal that many global health advocates considered modest: delivering 2.3 billion vaccine doses to low- and middle-income countries by the end of 2021. COVAX (or COVID-19 Vaccines Global Access) is an initiative to provide equitable access to vaccines; its leadership includes the United Nations, the World Health Organization (WHO), and other organizations.
Despite COVAX’s broad support, the initiative has revised its vaccine delivery projections down again and again this year. Now, the initiative is saying it’ll deliver just 800 million vaccine doses by the end of 2021, according to the Washington Post, and only about 600 million had been delivered by early December.
Considering that most COVID-19 vaccines are two-dose series—and boosters will likely be necessary to combat Omicron—those doses are just a drop in the bucket. According to Bloomberg’s vaccine tracker: “The least wealthy 52 places have 5.6% of the vaccinations, but 20.5% of the world’s population.”
Why this access gap? Many scientists and advocates in low- and middle-income nations blame vaccine manufacturers and rich countries like the U.S., I found when I reported a story on this topic for Popular Science.
“We basically have artificial scarcity of vaccine doses,” says Robbie Silverman, a vaccine advocate at Oxfam America. The pharmaceutical companies control “where doses are produced, where they’re sold, and at what price.” The world’s vaccine supply is thus limited by contracts signed by a small number of big companies; and many of those contracts, [Fatima Hassan, health advocate from South Africa] says, are kept secret behind non-disclosure agreements.
While rich countries claimed to support COVAX, the Washington Post reports, “they also placed advance orders with vaccine manufacturers before COVAX could raise enough money to do so.” This practice pushed COVAX to the back of the vaccine line—and then, when rich countries decided they needed booster shots, that pushed COVAX to the back of the line again. India’s spring 2021 surge didn’t help either, as the country blocked vaccine supplies produced at the Serum Institute of India from being exported to other nations.
According to Our World in Data, low-income nations have administered about 60 million doses total, while high-income nations have administered more than 300 million booster shots. At times this winter, there were more booster shots administered daily than first and second doses in low-income countries.
Even taking booster shots into consideration, there should be enough vaccine supplies produced by the end of this year to vaccinate 40% of the world’s population by the end of this year, meeting WHO targets, according to STAT News’ Olivia Goldhill. The world is on track to manufacture about 11 billion vaccines in total this year, Goldhill reports, while about 850 million doses are needed to get all countries to a 40% vaccination benchmark.
But again, rich countries pose a problem: the countries currently focused on administering booster shots have stockpiled hundreds of millions of doses, and are unwilling to send their stockpiles abroad. From STAT News:
“That number can be redistributed from what high-income countries expect to have by the end of this year. So it’s not an overall supply challenge,” said [Krishna Udayakumar, founding director of Duke’s Global Health Innovation Center]. “It’s very much an allocation challenge, as well as getting high income countries more and more comfortable that they don’t need to hold on to hundreds of millions of doses, for contingencies.”
The vaccine shortage for low-income countries is less than the surplus vaccines within the G7 countries and the European Union, according to separate analyses from both Duke and Airfinity, a life sciences analytics firm that is tracking vaccine distribution.
While leaders in the U.S., the U.K., and other nations with large stockpiles maintain that they can both administer booster shots at home and send doses for primary series shots abroad, their true priorities are clear. The U.S., for example, has pledged to donate 1.2 billion doses to other countries, but about 320 million—under one-third—of those doses have been shipped out so far.
Another challenge is the type of vaccines being used in wealthy nations, as opposed to low- and middle-income nations. Wealthy nations have been particularly eager to horde Pfizer and Moderna’s vaccines, which are more effective against Omicron and other variants of concern. On the other hand, many low-income nations have relied on Sputnik, CoronaVac, and other vaccines which are less effective.
“We’re now entering an era of second-class vaccines for second-class people,” Peter Maybarduk, director at the DC-based nonprofit Public Citizen, told me in October, discussing these differences in vaccine effectiveness. As Omicron spreads around the world, this concern is only growing.
Wealthy countries have hoarded mRNA vaccines, so we urgently need to learn how well viral vector vaccines, like AZ & Sputnik, and inactivated virus vaccines, like China's CoronaVac, protect against Omicron.
The more the coronavirus spreads across the world, particularly in regions with less immunity from vaccines, the more it can mutate and create new variants. Delta and Omicron provide clear examples, demonstrating the need to vaccinate the world in 2022.
And there are some reasons to hope that this goal may be feasible. COVAX’s global supply forecast shows major jumps in vaccine supplies in the first three months of 2022. At the same time, vaccine companies are increasing their production capacity, and donations from the U.S. and other countries are expected to kick in. In South Africa, an mRNA vaccine hub is working to train African companies to manufacture COVID-19 vaccines similar to Pfizer and Moderna’s, without violating patents.
Still, additional variants—and the need for additional booster shots—could be a major hurdle, as vaccine companies continue to prioritize wealthy nations. These companies continue to refuse to share their intellectual property with other manufacturers, even as they make patents for COVID-19 antiviral drugs widely available. And, once vaccines are delivered, getting them from shipments into arms will be a challenge.
On Thanksgiving, my Twitter feed was dominated not by food photos, but by news of a novel coronavirus variant identified in South Africa earlier this week. While the variant—now called Omicron, or B.1.1.529—likely didn’t originate in South Africa, data from the country’s comprehensive surveillance system provided enough evidence to suggest that this variant could be more contagious than Delta, as well as potentially more able to evade human immune systems.
Note that the words suggest and could be are doing a lot of work here. There’s plenty we don’t know yet about this variant, and scientists are already working hard to understand it.
But the early evidence is substantial enough that the World Health Organization (WHO) designated Omicron as a Variant of Concern on Friday. And, that same day, the Biden administration announced new travel restrictions on South Africa and several neighboring countries. (More on that later.)
In today’s issue, I’ll explain what we know about the Omicron variant so far, as well as the many questions that scientists around the world are already investigating. Along the way, I’ll link to plenty of articles and Twitter threads where you can learn more. As always, if you have more questions: comment below, email me, (betsy@coviddatadispatch.com), or hit me up on Twitter.
Where did the Omicron variant come from?
This is one major unknown at the moment. South Africa was the first country to detect Omicron this past Monday, according to STAT News. But the variant likely didn’t originate in South Africa; rather, this country was more likely to pick up its worrying signal because it has a comprehensive variant surveillance system.
Per The Conversation, this system includes: “a central repository of public sector laboratory results at the National Health Laboratory Service, good linkages to private laboratories, the Provincial Health Data Centre of the Western Cape Province, and state-of-the-art modeling expertise.”
1) My gut feeling from hearing of Omicron cases in Botswana, ex-Malawi, ex-Egypt (2 now it seems) and in South Africa is, that the variant was flying under the radar in undersequenced countries for some time until Botswana and South Africa detected it and sounded the alarm.
Researchers from South Africa and the other countries that have detected Omicron this week are already sharing genetic sequences on public platforms, driving much of the scientific discussion about this variant. So far, one interesting aspect of this variant is that, even though Delta has dominated the coronavirus landscape globally for months, Omicron did not evolve out of Delta.
Instead, it may have evolved over the course of a long infection in a single, immunocompromised individual. It also may have flown under the radar in a country or region with poor genomic surveillance—which, as computational biologist Trevor Bedford pointed out on Twitter, is “certainly not South Africa”—and then was detected once it landed in that country.
This extremely long branch (>1 year) indicates an extended period of circulation in a geography with poor genomic surveillance (certainly not South Africa) or continual evolution in a chronically infected individual before spilling back into the population. 4/16 pic.twitter.com/8mEI46VFMn
Omicron seems to be spreading very quickly in South Africa—potentially faster than the Delta variant. Based on publicly available sequence data, Bedford estimated that it’s doubling exponentially every 4.8 days.
An important caveat here, however, is that South Africa had incredibly low case numbers before Omicron was detected—its lowest case numbers since spring 2020, in fact. So, we cannot currently say that Omicron is “outcompeting” Delta, since there wasn’t much Delta present for Omicron to compete with. The current rise in cases may be caused by Omicron, or it may be the product of a few superspreading events that happen to include Omicron; we need more data to say for sure.
Still, as Financial Times data reporter John Burn-Murdoch pointed out: “There’s a clear upward trend. This may be a blip, but this is how waves start.”
2) This is coinciding with a wider rise in cases in South Africa.
Again, currently we’re talking about small numbers (both of B.1.1.529 and of cases in SA overall), but there’s a clear upward trend. This may be a blip, but this is how waves start. pic.twitter.com/sn9IIKtzUm
Another major cause for concern is that Omicron has over 30 mutations on its spike protein, an important piece of the coronavirus that our immune systems learn to recognize through vaccination. Some of these mutations may correlate to increased transmission—meaning, they help the virus spread more quickly—while other mutations may correlate to evading the immune system.
Notably, a lot of the mutations on Omicron are mutations that we simply haven’t seen yet in other variants. On this diagram from genomics expert Jeffrey Barrett, the purple, yellow, and blue mutations are all those we haven’t seen on previous variants of concern, while the red mutations (there are nine) have been seen in previous variants of concern and are known to be bad.
Took a look at the spike mutations in B.1.1.529 this evening, and colour coded them (details below)…there is…not much green.🧵 pic.twitter.com/yNHM55oTTH
Some of these new mutations could be terrible news, or they could be harmless. We need more study to figure that out. This recent article in Science provides more information on why scientists are worried about Omicron’s mutations, as well as what they’re doing to investigate.
How many Omicron cases have been detected so far?
As of Sunday morning, genetic sequences from 127 confirmed Omicron cases have been shared to GISAID, the international genome sharing platform. The majority of these cases (99) were identified in South Africa, while 19 were identified in nearby Botswana, two in Hong Kong, two in Australia, two in the U.K., one in Israel, one in Belgium, and one in Italy.
According to BNO News, over 1,000 probable cases of the variant have already been identified in these countries. Cases have also been identified in the Netherlands, Germany, Denmark, the Czech Republic, and Austria. Many of the cases in the Netherlands are connected to a single flight from South Africa; the travelers on this flight were all tested upon their arrival, and 61 tested positive—though authorities are still working to determine how many of those cases are Omicron.
The U.K. Health Security Agency announced on Saturday that it had confirmed two Omicron cases in the country. Both of these cases, like those in Israel and Belgium, have been linked to travel—though the Belgium case had no travel history in South Africa. “This means that the virus is already circulating in communities,” Dr. Katelyn Jetelina writes in a Your Local Epidemiologist post about Omicron.
After South African scientists sounded the alarm about Omicron, cases were detected in Botswana, Australia, Hong Kong, Israel, the U.K., and other countries. Chart via GISAID, screenshot taken about 11:30 AM NYC time on November 28.
Luckily, Omicron is easy to identify because one of its spike protein mutations enables detection on a PCR test—no genomic sequencing necessary. Alpha, the variant that originated in the U.K. last winter, has a similar quality.
How does Omicron compare to Delta?
This is another major unknown right now. As I mentioned earlier, Omicron is spreading quickly in South Africa, at a rate faster than Delta spread when it arrived in the country a few months ago. But South Africa was seeing a very low COVID-19 case rate before Omicron arrived, making it difficult to evaluate whether this new variant is directly outcompeting Delta—or whether something else is going on.
(Note that a couple of the tweets below refer to this variant as “Nu,” as they were posted prior to the WHO designating it Omicron.)
A short list of what NO ONE knows about the Nu (B.1.1.529) variant:
– We DON'T KNOW if it spreads faster than delta – We DON'T KNOW where it originated – We DON'T KNOW if it bypasses immunity/causes more severe disease
We also don’t know if Omicron could potentially evade the human immune system, whether that means bypassing immunity from a past coronavirus infection or from vaccination. However, vaccine experts say that a variant that would entirely evade vaccines is pretty improbable.
Every single coronavirus variant of concern that we’ve encountered so far has responded to the vaccines in some capacity. And the variants that have posed more of a danger to vaccine-induced immunity (Beta, Gamma) have not become dominant on a global scale, since they’ve been less transmissible than Delta. Our vaccines are very good—not only do they drive production of anti-COVID antibodies, they also push the immune system to remember the coronavirus for a long time.
But remember that our immune system has more than just neutralising antibodies in store, so none of this tells us just how much this variant is going to escape immunity and if it will mostly affect protection from infection or also severe disease.
It’s also worth noting here that, so far, Omicron does not appear to be more likely to cause severe COVID-19 symptoms. Angelique Coetzee, chairwoman of the South African Medical Association, announced on Saturday that cases of the variant have been mild overall. Hospitals in South Africa are not (yet) facing a major burden from Omicron patients.
What can scientists do to better understand Omicron?
One thing I cannot overstate here is that scientists are learning about Omicron in real time, just as the rest of us are. Look at all the “We don’t know yet.”s in this thread from NYU epidemiologist Céline Gounder:
1/ FAQs I'm getting re: Omicron variant:
Q: Is Omicron more infectious than Delta? A: We don't know yet. Possibly. Or it could be "hitching a ride" with lax behavior or super spreading. pic.twitter.com/SWtUB8BjeQ
Gounder wrote that we may have answers to some pressing questions within two weeks, while others may take months of investigation. To examine the vaccines’ ability to protect against Omicron, scientists are doing antibody studies: essentially testing antibodies that were produced from past vaccination or infection to see how well they can fight off the variant.
At the same time, scientists are closely watching to see how fast the variant spreads in South Africa and in other countries. The variant’s performance in the U.K., where it was first identified on Saturday, may be a particularly useful source of information. This country is currently facing a Delta-induced COVID-19 wave (so we can see how well Omicron competes); and the U.K. has the world’s best genomic surveillance system, enabling epidemiologists to track the variant in detail.
How does Omicron impact vaccine effectiveness?
We don’t know this yet, as scientists are just starting to evaluate how well human antibodies from vaccination and past infection size up against the new variant. The scientists doing these antibody studies include those working at Pfizer, Moderna, and other major vaccine manufacturers. Pfizer’s partner BioNTech has said it expects to share lab data within two weeks, according to CNBC reporter Meg Tirrell:
What vaccine makers are saying about B.1.1.529:
-Moderna notes it's shown it can get into clinic (human trials) within 60 days; question is regulatory process from there. Manufacturing new doses could take a few months.
If BioNTech finds that Omicron is able to escape immunity from a Pfizer vaccination, the company will be able to update that vaccine within weeks. Moderna is similarly able to adjust its vaccine quickly, if lab studies show that an Omicron-specific vaccine is necessary.
Even if we need an updated vaccine for this variant, though, people who are already vaccinated are not going back to zero protection. As microbiologist Florian Krammer put it in a Twitter thread: “And even if a variant vaccine becomes necessary, we would not start from scratch… since it is likely that one ‘variant-booster’ would do the job. Our B-cells can be retrained to recognize both, the old version and the variant, and it doesn’t take much to do that.”
What can the U.S. do about Omicron?
On Friday, the Biden administration announced travel restrictions from South Africa and neighboring countries. The restrictions take effect on Monday, but virus and public health experts alike are already criticizing the move—suggesting that banning travel from Africa is unlikely to significantly slow Omicron’s spread, as the variant is very likely already spreading in the U.S. and plenty of other countries.
At the same time, travel restrictions stigmatize South Africa instead of thanking the country’s scientists for alerting the world to this variant. Such stigma may make other countries less likely to share similar variant news in the future, ultimately hurting the world’s ability to fight the pandemic.
What IS clear is that knee-jerk reactions like banning flights may be politically palatable, but will do little to slow the spread of this variant.
In the coming days more countries will identify cases. And there’s a good chance it’s already spreading here and in other places. https://t.co/YSbrSe0EdO
So what should the U.S. actually be doing? First of all, we need to step up our testing and genomic surveillance. As I mentioned above, Omicron can be identified from a PCR test; an uptick in PCR testing, especially as people return home from Thanksgiving travel, could help identify potential cases that are already here.
We also need to increase genomic surveillance, which could help identify Omicron as well as other variants that may emerge from Delta. In a post about the Delta AY.4.2 variant last month, I wrote that the U.S. is really not prepared to face surges driven by coronavirus mutation:
We’re doing more genomic sequencing than we were at the start of 2021, which helps with identifying potentially concerning variants, but sequencing still tends to be clustered in particular areas with high research budgets (NYC, Seattle, etc.). And even when our sequencing system picks up signals of a new variant, we do not have a clear playbook—or easily utilized resources—to act on the warning.
I’ll raise you one: BY THE TIME YOU DETECT ONE VARIANT ANOTHER IS ALREADY CIRCULATING UNDER THE RADAR SOMEWHERE SO WITH A MIX OF SURVEILLANCE LAGS, LOW VACCINE UPTAKE, INEQUITABLE VACCINE ACCESS WE ARE WILL BE CHASING VARIANTS ENDLESSLY.
We also need to get more people vaccinated, in the U.S. and—more importantly—in the low-income nations where the majority of people remain unprotected. In South Africa, under one-quarter of the population is fully vaccinated, according to Our World in Data.
What can I do to protect myself, my family, and my community?
Also: Wear a mask in indoor spaces, ideally a good quality mask (N95, KN95, or double up on surgical and cloth masks). Avoid crowds if you’re able to do so. Monitor yourself for COVID-19 symptoms, including those that are less common. Utilize tests, including PCR and rapid tests—especially if you’re traveling, or if you work in a crowded in-person setting.
I’ve seen some questions on social media about whether people should consider canceling holiday plans, or other travel plans, because of Omicron. This is a very personal choice, I think, and I’m no medical expert, but I will offer a few thoughts.
As I said in the title of this post, we don’t yet know enough about this variant for it to be worth seriously panicking over. All of the evidence—based on every single other variant of concern that has emerged—suggests that the vaccines will continue to work well against this variant, at least protecting against severe disease. And all of the other precautions that work well against other variants will work against this one, too.
So, if you are vaccinated and capable of taking all the other standard COVID-19 precautions, Omicron is most likely not a huge risk to your personal safety right now. But keep an eye on the case numbers in your community, and on what we learn about this variant in the weeks to come.
If you’re worried about your risk from omicron, get vaccinated if you aren’t already. Continue to layer other precautions. And more than anything, follow the science and advocate for collaborative global health. Travel bans won’t do shit. Vaccines and global health equity WILL.
What does Omicron mean for the pandemic’s trajectory?
This variant could potentially lead to an adjustment in our vaccines, as well as to new surges in the U.S. and other parts of the world. It’s too early to say how likely either scenario may be; we’ll learn a lot more in the next couple of weeks.
But one thing we can say right now, for sure, is that this variant provides a tangible argument for global vaccine equity. If the country where Omicron originated had a vaccination rate as high as that of the U.S. and other high-income nations, it may not have gained enough purchase to spread—into South Africa, and on the global path that it’s now taking.
💉 7.8 billion COVID vaccine doses have been administered
👥 53% of world population with at least 1 dose
🌍 Total doses per 100 people High-income countries: 147 Upper-middle income: 146 Lower-middle income: 68 Low income: 7
If we had ensured that everyone had equal access to vaccination and really pushed the agenda on getting global vaccination to a high level, then maybe we could have possibly delayed the emergence of new variants, such as the ones that we’re witnessing.
I will end the post with this tweet from Amy Maxmen, global health reporter at Nature. The Omicron variant was a choice.
“Instead of solving the problem by vaccinating the world & cutting off new variants, rich countries seem prepared to fork over more money for boosters, & live in a state of endless fear,” Achal Prabhala told me back in JULY. https://t.co/Z1trCXN9Dp
This week, an antiviral pill for COVID-19 was authorized in the U.K. The drug, made by American pharmaceutical company Merck, is the first COVID-19 treatment in pill form to gain approval by any regulatory agency.
Some scientists have called this pill a “game-changer,” and for good reason. In Merck’s clinical trial, the drug approximately halved COVID-19 patients’ risk of hospitalization or death, compared to a placebo. The pill is designed for—and was tested on—adults who are particularly vulnerable to the virus, including seniors and those with preexisting conditions such as diabetes and heart disease.
The pill, formally called molnupiravir, works by interfering with the coronavirus’ ability to replicate itself, stopping it from reaching further into the body and causing severe symptoms. (This STAT News article includes a video that explains the process in more detail.) Adults who show mild or moderate COVID-19 symptoms can take the pill soon after they realize they’re infected, in order to improve their chances of recovery without a hospital stay.
In Merck’s clinical trial, patients started taking the pill five days after they began to experience COVID-19 symptoms. Each patient took four capsules, twice a day, for five days—adding up to 40 pills for a single patient.
The U.K. government has bought almost 500,000 courses of molnupiravir. The U.S. government has brought about 1.7 million courses, and our FDA is slated to consider the pill for emergency use authorization later this month. Several other countries including France, Australia, Malaysia, and Singapore also have contracts in place to purchase the pills.
But unlike other COVID-19 treatments and vaccines, molnupiravir may be more broadly available to people who don’t live in wealthy nations. Last week, Merck announced that it signed a voluntary licensing agreement with the Medicines Patent Pool, a public health organization backed by the United Nations that increases treatment access in over 100 low- and middle-income countries. As a result, a number of companies besides Merck will be able to manufacture and distribute their own versions of molnupiravir.
Still, some global health advocates have criticized Merck for making a deal with the Medicines Patent Pool rather than the World Health Organization’s COVID-19 Technology Access Pool, which would provide access to a broader group of countries. The current deal leaves out some middle-income countries that are particularly poised to manufacture versions of molnupiravir, including countries like Brazil and Peru that have seen high COVID-19 death tolls.
Recently, a new offshoot of the Delta variant has been gaining ground in the U.K. It’s called AY.4.2, and it appears to be slightly more transmissible than Delta itself. While experts say this variant doesn’t differ enough from Delta to pose a serious concern, I think it’s worth exploring what we know about it so far—and what this means for the future of coronavirus mutation.
How was AY.4.2 identified?
The U.K. national health agency first found AY.4.2 in July 2021, and has watched it slowly spread through the country since then. The agency formally designated this variant as a Variant Under Investigation (VUI) on October 22; at this point, about 15,000 cases had been identified across the country.
It’s worth noting here that the U.K.’s genomic surveillance system is incredibly comprehensive—considered to be the best in the world. The country sequences over 20,000 coronavirus samples a week; it’s consistently sequenced a large share of its COVID-19 cases since the beginning of 2021. And, since the country’s public health system integrates COVID-19 testing records with hospitalization records, primary care records, and other data, U.K. researchers are able to analyze other aspects of a variant’s performance, such as its ability to cause breakthrough cases or more severe disease.
It’s perhaps not a surprise that the U.K. noticed AY.4.2 so quickly. The country has an incredible sequencing system in place to monitor genetic changes in the virus, and researchers there have been among the global leaders in characterizing different mutations and forms of the virus. It’s possible that other Delta sublineages have similar growth rates to AY.4.2, but they’re in parts of the world where it will take longer for scientists to detect.
How does AY.4.2 differ from OG Delta?
AY.4.2 is transmissible enough that it is slowly pushing out the original Delta in some parts of the U.K. In late June, it comprised 0.1% of new U.K. COVID-19 cases; in late August, it was at 3.5%; and now it’s at 11.3%, as of the most recent data (the week ending October 24).
“It’s a slow burner,” wrote U.K. epidemiologist Meaghan Kill in a Twitter thread last week. “But Delta is already *so* transmissible, it’s notable that AY.4.2 is increasing in that context.”
It’s a slow burner 🔥
But Delta is already *so* transmissible, it’s notable that AY.4.2 is increasing in that context
• Growth rate estimates: 17% advantage for AY.4.2 over Delta
— Meaghan Kall has moved to Bluesky (@kallmemeg) October 23, 2021
Kill and other scientists estimate that AY.4.2 is between 10% and 15% more transmissible than Delta. That’s a small enough difference that scientists are not panicking about this variant, in the same way that epidemiologists sounded the alarm when Delta itself was first identified in India earlier in 2021. (For context: Delta is 60% to 80% more transmissible than the Alpha variant.)
Still, AY.4.2 is worth watching as a signal of Delta’s continued ability to mutate and spread more readily. As Joseph points out in his STAT article, some experts hypothesized that Delta might be so contagious, the coronavirus basically could not mutate further in that direction. AY.4.2 suggests that we haven’t hit that upper limit yet.
Is AY.4.2 more likely to cause breakthrough cases?
This is one piece of good news that came out in the U.K. health agency’s most recent variant report, released this past Friday: AY.4.2 is not more likely to cause a breakthrough case than the original Delta variant. (Not thus far, anyway.) This is true for both symptomatic and asymptomatic infections, as well as different ages and vaccine types.
The AY.4.2 data in this U.K. report are based on a relatively small sample size—about 13,000 people infected with AY.4.2, compared to over 350,000 people infected with the original Delta variant. Still, it’s good news that the variant appears to simply be more transmissible, not more able to break through vaccine-induced immunity or cause severe disease.
“More likely (I believe) is a slightly increased biological transmissibility,” Meaghan Kill wrote in a Twitter thread about this news. “Growth rate & secondary attack rates are refreshed with new data and findings remain the same as last week.” She predicts that AY.4.2 may be able to replace the original Delta by summer 2022.
More likely (I believe) is a slightly increased biological transmissibility.
Growth rate & secondary attack rates are refreshed with new data and findings remain the same as last week.
— Meaghan Kall has moved to Bluesky (@kallmemeg) October 29, 2021
How much is AY.4.2 spreading in the U.S.?
AY.4.2 has been identified in over 30 countries, including the U.S. But here, OG Delta continues to dominate; this variant has been causing over 99% of new cases in the U.S. for well over a month, with a couple of other Delta sub-lineages (AY.1 and AY.2) briefly popping up without getting competitive. AY.4.2 is not yet accounted for on the CDC’s variant tracker, but other estimates indicate that it’s causing under 1% of new cases in the U.S.
“We have on occasion identified the sublineage here in the United States, but not with recent increased frequency or clustering to date,” CDC Director Dr. Rochelle Walensky said at a recent COVID-19 briefing, according to STAT.
Are we prepared for a surge of AY.4.2—or another coronavirus variant?
The U.S. does not have a great track record for dealing with COVID-19 surges—whether that’s New York City in spring 2020 or Delta hotspots in the South this past summer. We’re doing more genomic sequencing than we were at the start of 2021, which helps with identifying potentially-concerning variants, but sequencing still tends to be clustered in particular areas with high research budgets (NYC, Seattle, etc.). And even when our sequencing system picks up signals of a new variant, we do not have a clear playbook—or easily-utilized resources—to act on the warning.
To illustrate this point, I’d like to share a major project of mine that was published this past week: an investigation of the Delta surge in Southwest Missouri this summer. This project was a collaboration between the Documenting COVID-19 project at the Brown Institute for Media Innovation and MuckRock (where I’ve been working part-time for a few weeks now), and the Missouri Independent, a nonprofit news outlet that covers Missouri state government, politics, and policy.
Missouri Independent reporter Tessa Weinberg and I went through hundreds of emails, internal reports, and other documents obtained through public records requests. We found that, even though Missouri had ample warnings about Delta—wastewater surveillance picked up the variant in May, and hospitals noticed increasing breakthrough cases in June—the Springfield area was completely overwhelmed by the virus. Infighting and mistrust between state and local officials also hindered the region’s response to the Delta surge.
Our major findings (copied from the article) include:
Springfield hospital and health department leaders urged the state to take advantage of additional genomic sequencing assistance to address unanswered questions about the variant’s spread. The state declined, forcing Springfield officials to seek additional data on their own.
After days of preparation for an overflow hospital for COVID patients requested by Springfield officials, local leaders decided to forego the plan after the window of need had passed — setting off dueling narratives over the reason why in public while state officials seethed in private.
When local officials pleaded for more support in addressing the Delta surge, state officials questioned the value of directing more resources to the area and even wondered whether the overflow hospital request was fueled by motivations to “pay for an expansion of their private hospital.”
And read my Twitter thread with more highlights here:
today, my first big investigative story with the Documenting COVID-19 project was published at @MO_Independent. @Tessa_Weinberg and I explained how miscommunication and a lack of preparedness hurt SW Missouri's ability to address the Delta surge this past summer. (1/17) pic.twitter.com/gQZS0WFyYX
At the end of last week’s post on booster shots, I wrote that these additional doses take up airtime in expert discussions and in the media, distracting from discussions of what it will take to vaccinate the world.
But these shots do more harm than just taking over the media cycle. When the U.S. and other wealthy nations decide to give many residents third doses, they jump the vaccine supply line again—leaving low-income nations to wait even longer for first doses.
I explained how this process works in a new article for Popular Science. Essentially, the big vaccine manufacturers (Pfizer, Moderna, Johnson & Johnson, etc.) have created artificial scarcity of vaccine doses, by insisting on controlling every single dose of their products—rather than sharing the vaccine technology with other manufacturers around the world.
Then, out of this limited supply of doses, the big companies sell to wealthy nations first. The wealthy nations are “easier markets to service,” WHO spokesperson Margaret Harris told me, since they can pay more money and have logistical systems in place already to deliver the vaccine doses.
If a wealthy nation wants boosters, it’s in the vaccine companies’ best interests to sell them boosters—before sending primary series doses to other parts of the world. Or, as South Africa-based vaccine advocate Fatima Hassan put it: “Supplies that are currently available are diverted” for boosters. “Just to serve preferred customers in the richer North.”
The FDA and CDC authorized booster shots for Moderna, Johnson & Johnson, and mix-and-match regimens this week. Advisory committee discussions did not mention that, worldwide, three in five healthcare workers are not fully vaccinated.
COVID-19 Data Dispatch 