Omicron may reach millions before vaccines do – but that doesn't mean race to vaccinate the world is over

The pandemic is accelerating. It’s estimated that there could be 3 billion new infections globally over the next three months thanks to the highly infectious omicron variant.

Large outbreaks are ongoing across Europe and North America and cases are also rising in many other countries. Omicron has now reached most corners of the world – including where COVID vaccine coverage is low. The African continent, for example, has recently reported a significant rise in daily reported new cases.

The global vaccine roll-out is continuing apace too, with hundreds of millions of doses manufactured each month. The World Health Organization’s target is for 70% of the population in every country to be vaccinated by the middle of 2022. However, with omicron spreading so quickly and widely, there’s a real chance that the virus will reach many before a vaccine does. Across Africa, 85% of people have yet to receive a single vaccine dose.

Given this, and that some research suggests omicron appears to cause less severe disease than earlier variants, is there now less of a need to get people vaccinated? Some might see it this way. But the answer is: no. Even though omicron means that plenty of people will now catch the virus before they’re vaccinated, the worldwide vaccine roll-out needs to press on. Here’s why.

Vaccines needed for good immunity

First, omicron is still dangerous – and especially to people who are unvaccinated. Studies suggesting omicron is less severe have been based in countries with relatively high levels of pre-existing immunity, such as the UK and South Africa.

Indeed, British data gathered since the emergence of omicron suggests that unvaccinated people are eight times as likely as those who’ve had their jabs to be hospitalised. As of January 12, 2022, there are around 20,000 people in UK hospitals with COVID, indicating it’s certainly not a mild disease for everyone.

Of the billions of new infections that are predicted to happen, many won’t be averted. But it’s important to still try to protect the unexposed.

Some immunity will be generated in people by all of these new infections, and this infection-acquired immunity should provide them with some protection against COVID in the future, at least in the short term. However, given omicron emerged so recently, little is known about the strength or durability of the immune response to it.

But we do know that with past variants being double vaccinated offers greater protection against subsequently getting COVID than a prior infection – and that being infected and vaccinated offers particularly high protection. Even if lots of unvaccinated people get COVID, past experience suggests it’s still a very good idea for them to take a vaccine as well.

Helping to stop the spread

Alongside lockdowns, masks and social distancing, vaccines are also a key measure for lowering the number of new COVID cases. Although vaccines principally protect against severe COVID illness, they also lower the chances of someone getting infected and transmitting the virus.

Keeping cases lower makes managing outbreaks more straightforward when they do occur. The costs of allowing cases to spiral can be seen in the UK, where many hospitals have declared critical incidents, citing a lack of staff and beds to safely deliver usual standards of care. We should be doing everything we can to avoid similar things happening in other countries – particularly those that might not have the same medical resources as a western nation.

Uncontrolled outbreaks also pose a higher risk of a new variant of concern emerging. There’s no reason to believe that this particular novel coronavirus has finished shape-shifting just yet.

Vaccine hoarding still an issue

Some countries, such as the UK, have advanced vaccine booster programmes, and it looks like the third dose will be highly protective against omicron. But the aim should be to have advanced vaccination programmes across the world.

The frantic pace of vaccination across much of Europe will likely ease during the spring of 2022. It’s imperative that surplus doses, of which the G7 has more than a billion, must be donated to lower-income countries. Those donations should be of vaccines well ahead of their expiry date, allowing recipient countries the time to direct them to places of highest need.

A global wall of immunity is surely much better than a small number of national walls. Vaccine inequity helps no one.

The end of the pandemic is an imprecise point in time. There is no fixed number or metric that will define it. Nevertheless, we’ll likely look to the World Health Organization for a declaration, or a series of statements, that infer closure on the emergency phase of the pandemic response. Around that time, there may be more of an opportunity to stop, think about and plan for how we can best prevent or mitigate future pandemics.

Vaccine equity – achieved, perhaps, by creating numerous vaccine-manufacturing sites across sub-Saharan Africa – must be central to those discussions. This will minimise the sort of selfishness displayed by the vaccine-hoarding richer countries during this pandemic, and will leave the world in a better position ahead of the “next time”. After all, recent public health emergencies – such as influenza, Sars, Ebola, Zika and now COVID – tell us that there almost certainly will be a next time.

Before that, however, we should do all we can to get vaccine doses to those countries that still have large numbers of unvaccinated people. In the short term, and despite the impact of omicron, vaccinations remain the key tool that must underpin our route out of the pandemic.

Michael Head has received funding from the Bill & Melinda Gates Foundation and the UK Department for International Development.