South Africa

VACCINE INEQUITY

The Omicron variant, knee-jerk reactions and travel bans

US President Joe Biden speaks about the Omicron Covid-19 variant in the Roosevelt Room of the White House in Washington, DC, on Monday, 29 November 2021. Biden cautioned Americans against panicking over the new coronavirus variant recently identified in South Africa, and urged them to instead get vaccinated or obtain booster shots. (Photo Oliver Contreras / Bloomberg via Getty Images)

The US and South Africa tangle over new travel restrictions because of Covid-19. How did this come about?

For Covid, what was past was definitely prologue, and it has set the table for what has followed this time around. Back before Covid’s grip on the planet was really gathering speed and impact, it was not immediately clear what would or could help contain the virus, or even how serious it was. (Unless, of course, you had previously watched that eerily prescient film, Contagion.

Nevertheless, early on, if you were the Chinese government (and putting aside their foot-dragging reluctance to give unfettered access to international experts to gain the best possible understanding of the disease), you effectively shut down the country, locked everyone into their homes and sealed off points into and out of their nation. This can be done if there is an authoritarian government whose writ is unshakeable and virtually absolute in such matters, but for most other nations, politics gets in the way.

If one were a resident of any one of several European nations, those trace-and-track mechanisms first kicked in, but then, as it became impossible to limit the spread to just specific hot spots, various versions of lockdowns came into play, despite the economic hardships they caused. 

Some nations like Australia and New Zealand essentially tried to shut out the rest of the world, given their insular geography, but simultaneously limited domestic imposition of the harshest possible lockdown measures. This was on the assumption that if Covid didn’t land with the airlines as a microscopic stowaway, they would be safe, and other people, well, they would have to muddle forward. Like so many other human conditions, the French have a phrase for this: chacun à son goût (to each their own)

As the respective countries of Western Europe came under virtual sieges by the virus, their public healthcare systems began to come under extraordinary pressures, as in Italy. 

Meanwhile, the United States suffered through policy confusion, historical amnesia about previous pandemics and then a form of deliberate ignorance — despite the growing body of information coming available, but only after it was clear the virus was already entrenched in America.

The Trump administration frequently vilified real science and medical advice, instead relying on snake oil salesmen and other mendicants peddling quack remedies. These ranged from the idea the virus would simply disappear in the summer sun and with the gentle breezes, to shining ultraviolet light inside the body, taking massive doses of an anti-malarial drug or swallowing a pill used to kill parasitic worms in farm animals, or even hinting about injecting bodies with kitchen cleansers. (South Africans should certainly be familiar with this kind of flailing, desperate madness based on their own bitter experiences with promises of beetroot extracts and Virodene as effective tools against HIV/Aids.)

Paradoxically, the Trump administration did — finally — figure out that an extensive government/private partnership building on a decade of research and development to deal with other coronaviruses could make serious progress on Covid-19, really quickly, when paired with massive computer modelling of the necessary mRNA formulation. This happened despite the fact the upper reaches of the Trump administration could never shake off subliminal feelings the virus was not the threat the medical community insisted it was.

But because of a constant belittling of the science and the researchers, the Trumpian message nourished and abetted resistance to public health measures advocated by nearly every specialist, as well as feeding a growing campaign of avoidance to the very vaccinations that had been successfully developed towards the latter part of 2020.

A significant part of this resistance to the injections, masks, physical distancing and the closure of high-risk venues — like most of the nation’s schools and sports grounds — began coming together with other right-wing and libertarian political movements. 

These ideas increasingly coalesced with the deviously false idea that Donald Trump had actually won the 2020 presidential election. By then, the death toll from Covid had passed the number of American war dead in the First and Second World Wars, plus the Korean and Vietnam conflicts. By now it has moved beyond the 700,000 mark. In contrast to the earlier victims, new Covid fatalities now largely come from the ranks of those who have declined the vaccines.

omicron travel bans vaccine inequity
United Airlines planes on the runway at Newark Liberty International Airport on 30 November 2021. Stocks in the travel and airline industry have fallen as fears grow over the spread and severity of the Omicron Covid-19 variant detected in South Africa. (Photo: Spencer Platt / Getty Images)

Nevertheless, various campaigns across the nation have finally pushed the total of those vaccinated among the adult population well beyond 50% and new policies are coming on-stream to vaccinate children and teenagers, as well as to provide booster shots to adults. Despite this, the anti-vaccination movement remains active, and numbers of politicians, most usually Republicans in the South and Midwest who must surely know better, continue to feed the idea that social distancing, masking, vaccines and so forth are part of a pernicious plot to destroy the nation. 

All of this has set the scene for what has happened with the newest strain of the virus, the Omicron variant. As the Biden team has taken hold of his country’s Covid policy, they have been moving towards increasing levels of mandatory vaccination policy for federal workers, the military, healthcare specialists and even employees of companies that are contractors with the government, although a number of judges have issued stays on parts of these policies. 

In response to complaints internationally that American (and Western European) stockpiling (or hoarding, if one prefers) of vaccines has meant that third world nations must make do with the scraps in the way of vaccines, the Biden administration has pledged a billion doses through various international consortia and initiatives. By now, the Biden administration has delivered 275 million of the pledged vaccines. 

Meanwhile, as far as South Africa was concerned, after initial scarcities in vaccines and much hand-wringing about ineptitude in handling the roll-out, the country’s health sector has succeeded in sourcing a sufficient supply for its projected needs and has even had to delay further orders. 

But various problems inhibit this country’s delivery of the shots into actual arms, including, as with many other nations, a significant degree of vaccine hesitancy over a fear of the vaccine’s contents or because of religious objections, and the difficulty in getting vaccines and people together across a vast country. 

There are also those stringent requirements, at least in the case of the Pfizer vaccine, for ultra-cold storage and carefully controlled supply chains, conditions not easily met in the South African landscape. Over the past year and a half, a variety of nationwide policies, including lockdowns, curfews, bans on the sale of liquor and mask mandates have been imposed, but the spread of the virus continues to place strains on the health sector.

Throughout all of this, the country’s health and medical research sectors have been a key part of international efforts to gain fuller understanding of the virus, to test vaccines, and to monitor the virus’ spread, virulence, and mutations (and any differences in vaccine efficacy). Because of this engagement, South African specialists seem to have been the first to identify the newest variant, now christened Omicron (after skipping a whole collection of Greek letters of the alphabet for some reason). The South Africans quickly released their full workup of the variant’s genetic makeup, and its differences from earlier variants, to other scientists in the world (compare this to the reluctant Chinese response at the beginning of this mess), but that is where the troubles began.

Initially reported in the news as the “South African variant”, it was being seen as something that had evolved there rather than having been first identified there by public health specialists. There is no clarity yet as to where it began and, in a way, it really doesn’t matter. This is what viruses do. They mutate, and newer, more transmissible versions quickly replace earlier versions, especially if the newest iteration is not 100% fatal for those who catch it.

By American Thanksgiving Day on 26 November, the entire apparatus of those involved in dealing with Covid in America became part of a prolonged electronic huddle over what to do with this newest variation. Was it a massive new public health risk, a matter of increasing concern, or simply one more nasty bit of a long trail of nasty bits since early 2020? 

Just a few days after knowledge of the variant became public, Dr Anthony Fauci, the government’s point person on the disease, was on the airwaves urging people not to panic.

omicron travel bans vaccine inequity
Travellers arrive for flights at Newark Liberty International Airport on 30 November 2021 in Newark, New Jersey. The US and a growing list of other countries have restricted flights from southern African countries due to the detection of the Covid-19 Omicron variant last week in South Africa. (Photo: Spencer Platt / Getty Images)

As CBS News reported, “President Biden’s chief medical adviser said it’s going to take some time — perhaps a couple of weeks — to ‘get a good handle’ on the newly discovered strain. ‘We should not be freaking out,’ Fauci told CBS Mornings on Monday. ‘We should be doing the things that we know work when you’re dealing with a pandemic virus. It’s not the time to panic. We should be concerned, and our concern should spur us to do the things that we know work,’ he said, stressing the need for people to get vaccinated and then get their booster shots.”

CBS went on to note, “The new variant, first reported by South Africa just last week, is spreading quickly and has been reported in at least 14 nations, including Canada. This is the first coronavirus mutation to be labeled a ‘variant of concern’ by the World Health Organization since the Delta variant emerged and went on the dominate the world, including the U.S. Fauci said the high number of mutations found in the new variant and where they were found suggests Omicron ‘would be more transmissible and also suggests that it might evade some of the immune parameters that we have’, such as antibody and plasma treatments as well as existing vaccines. ‘It appears to be spreading very readily and has a transmission advantage,’ Fauci said, noting that his assessment was based on early information provided by South African scientists.”

By this point, the US, along with a growing list of nations, was already imposing travel restrictions on individuals coming from the southern African nations, even though the variant was already being reported well beyond that region. A key point here was that the Biden administration was clearly trying to demonstrate its nimbleness and adroitness in responding to this newest threat, in contrast to the way its predecessor had fiddled around through the first few months of the initial Covid outbreaks. 

An odd sideline was the Republican governor of Texas, Greg Abbott, who took to social media to claim South Africans with the disease were crossing illegally into Texas, although a glance at a map would show how wild a theory that really was. Abbott was apparently angling for Trump supporters, perhaps as an early play for the 2024 presidential nomination. 

Fauci further explained the rationale for these restrictions, saying, “The reason for the restriction on travel was to give us time to first understand it better and, second, to just intensify the things that we are already doing… get vaccinated for those who are unvaccinated. Absolutely get boosted if, in fact, you’ve already been vaccinated.”

Despite words ostensibly designed to calm incipient panic, not surprisingly, the travel restrictions have angered the South African government, which has argued that rather than publicly vowing to work together with South Africa on addressing the concerns raised by Fauci, the restrictions seemed to punish the country for being a responsible member of the international public health effort. In fact, such restrictions might even trigger responses by another country encountering a new variant to hide the information or only dribble it out slowly. (Cue that video of the history of China and its Wuhan virology lab back when all this started.)

Putting the best possible face on it, on Monday, a State Department spokesperson told the media, “On the advice of the President’s chief medical advisor and the Centers for Disease Control and Prevention, the administration will restrict travel from Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, and Zimbabwe starting today, November 29th, 2021. 

“The policy does not apply to U.S. citizens, lawful permanent residents, and certain other categories of travelers. These measures apply to foreign national travelers regardless of nationality based on the traveler’s physical presence in Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, or Zimbabwe. Current U.S. visa holders who have been present in Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, or Zimbabwe, including for transit during the 14 days prior to entry or attempted entry to the United States, will be subject to these entry restrictions.” 

She added that the decision did not dictate to commercial airlines whether or not they should cancel flights (although it obviously limited the number of passengers they would be carrying). Further, this restriction did not prevent Americans from travelling to the region “and foreign nationals from these eight countries can continue returning to these eight countries from the United States. Cargo shipments on passenger flights and cargo-specific flights may also continue”.

The core principle was that the president had “promised to take every measure necessary to keep Americans safe and defeat the pandemic, and this is a step recommended by US government medical experts and the Covid-19 response team. We are in close contact with public health officials in southern Africa and are working closely with them to understand more about the Omicron variant. 

“We value our longstanding public health cooperation with South Africa, and we also praise South Africa’s skilled scientists for the quick identification of this variant and South Africa’s government for its transparency in sharing this information, which can also serve as a model for the rest of the world.”

That reassurance probably has not totally taken the sting out of the decision to restrict travel, as far as the southern African governments are concerned, or their residents and citizens.

What this latest series of events has done, however, is to refresh the concern that as long as the governments across the African continent have only been able to vaccinate around 7% of their inhabitants, the region remains a perfect testing ground to breed new mutations of the Covid virus. In a better world, this should lead to a concerted international effort to get the rest of the people on the continent vaccinated, despite the obvious difficulties in many parts of Africa.

As the Associated Press noted, “The emergence of the new Omicron variant and the world’s desperate and likely futile attempts to keep it at bay are reminders of what scientists have warned for months: The coronavirus will thrive as long as vast parts of the world lack vaccines.

“The hoarding of limited Covid-19 shots by rich countries — creating virtual vaccine deserts in many poorer ones — doesn’t just mean risk for the parts of the world seeing shortages; it threatens the entire globe. That’s because the more the disease spreads among unvaccinated populations, the more possibilities it has to mutate and potentially become more dangerous, prolonging the pandemic for everyone. 

“The virus is a ruthless opportunist, and the inequity that has characterised the global response has now come home to roost,’ said Dr. Richard Hatchett, CEO of CEPI, one of the groups behind the UN-backed Covax shot-sharing initiative.”

In spite of the frustrations these travel restrictions have evoked on the part of many in Africa, this moment can also provide an incentive to deal more decisively with this virus, in the way another virus, polio, has been dealt with globally. Certainly this should be done before the history e-books of the latter part of the 21st century get to bracket this virus and the piecemeal efforts to deal with it together with the havoc of the killer influenza that swept through the world after World War 1. DM

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