The omicron variant threatens to widen an already yawning gap in access to Covid shots as scientists prepare for the possibility retooled vaccines will be needed and affluent countries race ahead once again.
Omicron is emerging just as vaccine supplies destined for lower-income nations have begun to pick up. Wealthy governments early in the pandemic locked up the biggest share of initial doses, leaving vast parts of the planet behind.
Now the goal is to avert another bout of inequity. Already, the U.K. is moving swiftly to secure messenger RNA shots tailored to omicron and other potential variants if they're developed as part of new deals with Pfizer and Moderna. The recent discovery of the variant in the U.S. may spark similar action.
"That is the big concern, a repeat of what happened in the last year and a half," said Ellen 't Hoen, director of Medicines Law & Policy, a Netherlands-based research group. "If it's not this variant, then there will be another one."
Even if vaccines maintain their potency, health groups pushing to protect vulnerable regions are under rising pressure. About 100 nations haven't hit a World Health Organization target of vaccinating 40% of their populations, and more than half are at risk of falling short by the end of 2021. Scientists worry that vaccine disparities and the continued spread of the virus will breed more dangerous strains that pose a risk to both rich nations and poor.
"Inequity derives from scarcity, and when there's scarcity those with resources will use their resources to meet their own needs first," said Richard Hatchett, head of the Coalition for Epidemic Preparedness Innovations. "So the question would be -- if this proves to be a really dangerous variant -- will countries rush to secure supplies?"
CEPI is discussing the potential deployment of modified vaccines with other partners in Covax, the global vaccine distribution program, he said. Covax is in a more advantageous position than it was early in the crisis when it was still being formed, and any shortage of shots shouldn't last as long this time, but the concern "is real," he said.
"If the data suggests we really do need to be introducing an omicron vaccine, we're going to be wanting to move as quickly as we can to secure doses to reduce the inequity that could otherwise potentially emerge," he said.
There's little evidence so far that the newly discovered variant will erode the protection provided by current vaccines, and they'll likely fend off severe cases, the World Health Organization's chief scientist said Wednesday. Yet Moderna Chief Executive Officer Stephane Bancel rocked markets earlier this week when he said the surprising number of mutations in omicron suggests new shots would be needed to ward off infections. Many questions remain.
Vaccine makers aren't waiting for answers. They've already begun work to adapt their shots, with Pfizer and BioNTech saying they will be ready with a vaccine targeting omicron in 100 days, if necessary. Pfizer expects data on how well its inoculation holds up within two to three weeks.
Omicron could spark a new chase for limited supplies, and there won't be enough doses produced for a global rollout until late next year, according to Airfinity Ltd. In a best-case scenario, 6 billion doses could be produced by October 2022, the London-based data firm estimates. But rich governments will try to corner the market, said Shabir Madhi, a vaccinologist from the University of the Witwatersrand who led trials of both AstraZeneca's and Novavax's shots in South Africa.
"We can look at wealthy countries' behavior in the past," he said. "It would be highly surprising that they've developed some sort of social conscience."
That could lead to further delays in the effort to overcome the vaccine divide, according to Thomas Bollyky, director of the global health program at the Council on Foreign Relations.
"It will create a source of demand for vaccine manufacturing that was expected to shift at some point to meeting global needs," Bollyky said. "Should we need to develop a modified vaccine to address this new variant, there's the potential that some of that capacity will be devoted to producing those vaccines, presumably initially for high-income countries."
It's a scenario that could play out repeatedly as the coronavirus continues to evolve. Some researchers foresee that vaccine updates could be needed if the inoculations slowly become obsolete over time due to variants.
Facing that threat, groups behind WHO-backed Covax are calling for an array of steps to boost vaccination rates. Donations from wealthy governments have trickled out and only one country, Switzerland, had answered a call to defer to Covax in the supply queue as of Nov. 24.
More than 90 million donated doses have been delivered to Africa via Covax and the African Vaccine Acquisition Trust, and millions more via direct arrangements between countries and manufacturers. Yet most of those immunizations have arrived with little notice and short shelf lives, making it difficult for already-stretched health systems to use them, health groups said earlier this week.
Health officials have urged countries and manufacturers to commit to providing supplies in a more predictable and reliable way. Donations should come with essential components, such as syringes, to avoid additional costs and delays, and at least 10 weeks until expiration when they arrive, they said.
One potential glimmer of hope is that China's increased supplies to lower-income nations will spur other countries to follow, Bollyky said. Chinese President Xi Jinping pledged to direct another 1 billion doses of vaccines to African countries. But health advocates expressed doubts about significant change on the access front.
"This is going to happen over and over again," said John Amuasi, a global health and infectious disease specialist at the Kumasi Center for Collaborative Research in Tropical Medicine in Ghana. "Somehow we ignore this very basic science and focus on getting the West as vaccinated as possible, thinking that's going to help us, and it's clear it doesn't work this way."
Wealthy governments need to take the initiative, providing generous financing and insisting on the ability to determine where supplies go and how intellectual property is shared, according to the 't Hoen. Omicron could have been a catalyst to push countries and drug companies to boost immunization globally, but this wouldn't be the first time the world has turned its back on lower-income regions, she said.
"The HIV access crisis should have been a turning point," she said. "The beginning of this outbreak should have been a turning point. Will the world learn? I don't know."
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Bloomberg’s Janice Kew and Alex Tribou contributed to this report.