Omicron variant

COVID-19 Omicron variant – hopeful signs of peaking in the U.S. and Europe; supply disruptions continue from zero tolerance policy in China

In a recent post, I reviewed vaccine equity issues around the COVID-19 pandemic and recent developments including a new low-cost vaccine being produced in India and available to be produced in many countries with no licensing costs. See January 11, 2022:  WTO efforts to address the COVID-19 pandemic — the January 10, 2022 General Council meeting and some current developments of interest, https://currentthoughtsontrade.com/2022/01/11/wto-efforts-to-address-the-covid-19-pandemic-the-january-10-2022-general-council-meeting-and-some-current-developments-of-interest/.

The omicron variant has wreaked havoc in Europe and in the U.S., though there are signs of the huge surge in cases starting to ebb. See, e.g., European Centre for Disease Prevention and Control, COVID-19 situation update worldwide, as of week 2, updated 20 January 2022 (data for last two weeks of 2021 not available; huge surge from omicron reflected in curve; dark blue is Europe, light blue is the Americas). The following chart shows new cases worldwide.

COVID-19 situation update worldwide, as of week 2, updated 20 January 2022

Distribution of COVID-19 cases worldwide, as of week 2 2022
The ECDC data show the U.S. being the first country to record more than 10 million infections in a fourteen day period (10.586 million; weekly data from the ECDC actually show 12.52 million cases reported in the U.S. in the first two weeks of 2022). The huge surge in Europe in the last several months is spread across many countries. France has been particularly hard hit with new cases numbering in the hundreds of thousands per day for nearly every day in January (highest, 464,679 on January 19 with declines since then). See ECDC, Data on the daily number of new reported COVID-19 cases and deaths by EU/EEA country 20 January 2022, https://www.ecdc.europa.eu/en/publications-data/data-daily-new-cases-covid-19-eueea-country.

In the United States, there is a note of optimism as the national number appears to be coming down. The decline is significant in some states where omicron was first identified but cases are still increasing in other parts of the country. See, e.g., NBC News, ‘An optimistic trend’: Covid cases are falling, but U.S. isn’t out of the woods yet, January 22, 2022, https://www.nbcnews.com/health/health-news/omicron-wave-covid-cases-finally-peaked-us-rcna13103 (“Cases are already falling in parts of the Northeast, Walensky said. ‘We are starting to see steep declines in areas that were first peaking, so areas of the Northeast — New York, Rhode Island, Connecticut — are really starting to come down.’ Shea said that cases in the rest of the country and deaths, which lag behind cases, are expected to trail shortly after. The big dropoff in cases in large states like New York can make the nationwide average look lower, even though cases are still rising in many states, but she expects all states to hit their peaks soon after Northeastern states.” 

Supply chain problems that have plagued the world for many months now and led to both shortages and large inflationary pressures may continue in part because of China’s zero-tolerance COVID policy has resulted in more shutdowns ahead of the approaching winter olympic games. See, e.g., New York Times, Supply Chain Woes Could Worsen as China Imposes New Covid Lockdowns, January 16, 2022, https://www.nytimes.com/2022/01/16/business/economy/china-supply-chain-covid-lockdowns.html (“Companies are bracing for another round of potentially debilitating supply chain disruptions as China, home to about a third of global manufacturing, imposes sweeping lockdowns in an attempt to keep the Omicron variant at bay.”).

Many countries, including the U.S. and EU, are reviewing supply chain issues to improve resiliency and reduce risks. Both the U.S. and EU for example have been looking at legislation to bolster semiconductor chip manufacturing. See, e.g., World Economic Forum, ‘There’s no digital without chips’: New European Chips Act announced, 20 January 2022 (“European Commission President Ursula von der Leyen has announced a new European Chips Act”), https://www.weforum.org/agenda/2022/01/theres-no-digital-without-chips-new-european-chips-act-announced/; Reuters, U.S. House bill on China competitiveness, chip investment, coming soon – Pelosi, January 21, 2022, https://www.reuters.com/world/us/pelosi-says-us-house-will-soon-introduce-competitiveness-bill-2022-01-21/.

While discussions continue around trade and health issues at the WTO including what, if any, temporary waiver from TRIPS obligations or other actions to improve vaccine production may be needed, data available on vaccine production and shipments continue to suggest that the issue is not necessary for a resolution to the COVID-19 pandemic. See, e.g., WTO-IMF COVID-19 Vaccine Trade Tracker, Last updated: 17 January 2021, https://www.wto.org/english/tratop_e/covid19_e/vaccine_trade_tracker_e.htm (showing total supply to the end of December at 11.5 billion doses; exports of 4.4 billion doses, with rapidly increasing shipments to low income and lower-middle income countries in the last few months of 2021). Several tables from the latest WTO-IMF COVID-19 Vaccine Trade Tracker are copied below.

“3. Imports

“Imports are defined as the number of doses received from producing economies, mirroring the information provided in the exports section. This definition does not take into account imports of vaccine substances in bulk form to be used in ‘fill and finish’ sites.”

Income Group ImportsNumber of doses (million)Doses per 100 peoplePopulation (million)
Low income234.034.5678.4
Lower middle income1,482.149.52,994.7
Upper middle income1,748.559.72,930.4
High income935.675.41,241.6
Note: as of 31 December 2021

ContinentNumber of doses (million)Doses per 100 peoplePopulation (million)
Asia2,372.551.04,652.6
South America682.7157.3434.0
Africa638.546.51,371.7
North America460.577.7592.8
Europe217.829.0750.8
Oceania28.365.543.2
Note: as of 31 December 2021

With more vaccines being reviewed by the WHO and individual countries, production of vaccines in 2022 will exceed volumes produced in 2021. Exports will also increase as trends in the second half of 2021 show have been happening.

While different sources look at vaccinations for individual countries and territories, attached is an excel spreadsheet of data from the World Health Organization for data available as of January 20, 2022. There are countries not covered by the WHO data (e.g., Taiwan) and others for which there is no World Bank 2022 income designation. I have added the categories of the World Bank GNI per capita income (low income, lower-middle income, upper-middle income, high income) to the WHO table. At the end of the WHO listing I have broken the data out by income group. For those countries/territories with no World Bank designation, they are listed “na”. For countries or territories in the World Bank list but not shown on the WHO list, I have included the name of the country/territory at the end of the income grouping.

As reviewed in prior posts, for groups and organizations focuses on vaccine equity, it is important to understand the causes of the very large differences in vaccines/100 people shown within at least the low income, lower-middle income and upper-middle income categories. For example, Rwanda (97.195 vaccinations/100 people), Mozambique (54.492 vaccinations/100 people) are low income countries. But their experience in vaccine access is much different than many other low income countries (most under 30 vaccine doses/100 people, many under 20 or 10/100 people, one less than 1/100 people). Medical infrastructure and many other factors are certainly important components in improving vaccine access to many low income countries. See GAVI, World leaders launch call for renewed support for vaccination in 2022 as part of the global fight against COVID-19, https://www.gavi.org/news/media-room/world-leaders-launch-call-renewed-support-vaccination-2022-part-global-fight (” Specifically, COVAX leaders called for at least US$ 5.2bn in new funding: US$ 3.7 billion to fund a 600 million dose Pandemic Vaccine Pool to address uncertainties and related uncovered risks, such as boosters, additional coverage, new variant vaccines if required, and to make sure there is reliable supply for the poorest countries. In addition, catalytic delivery funding of US$ 1 billion is requested to support getting doses into arms rapidly and safely without undermining routine immunization activities. A further US$ 545 million is needed to cover ancillary costs such as syringes, transport and insurance for donations.”).

The same is true for lower-middle income countries with Cambodia and Mongolia recording 189.643 and 164.686 vaccine doses/100 people respectively while Nigeria, Cameroon and and Zambia report just 9.007, 3.859, and 5.665 vaccine doses/100 people respectively. Seventeen countries have reported more than 100 vaccine doses/100 people while 9 have reported 20 vaccine doses/100 people or fewer.

The same is true for upper-middle income countries where the range of vaccine doses/100 people range from 32.258 for Equitorial Guinea to 283.945 for Cuba.

1-21-2022-WHO-COVID-vaccine-data-low-income-countries.xlsx

Postponement of the WTO’s 12th Ministerial Conference, continued efforts to increase vaccinations

With the discovery of a new COVID-19 variant in Africa last week, a designation by the World Health Organization that the new variant (“Omicron”) was a “variant of concern”, surging infections in Europe, and reintroduced travel restrictions and quarantine requirements for visitors from certain countries, it was not surprising that the WTO Members decided to postpone the 12th Ministerial Conference which had been set to start on November 30 in Geneva. See World Health Organization, Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern, 26 November 2021, https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern; WTO News Release, General Council decides to postpone MC12 indefinitely, 26 November 2021, https://www.wto.org/english/news_e/news21_e/mc12_26nov21_e.htm.

The spate of new travel restrictions ranged from restrictions on countries in southern Africa where early cases had been identified or where transborder movement was likely, to blanket blockage of entry of foreign travelers from any country (e.g., Israel, Japan and Morocco). Countries from Australia to Canada to various countries in Europe including the United Kingdom as well as Israel, Hong Kong and some countries in Africa have confirmed cases of the new Omicron variant. See, e.g., New York Times, Tracking Omicron and Other Coronavirus Variants, updated November 29, 2021, https://www.nytimes.com/interactive/2021/health/coronavirus-variant-tracker.html (” So far it has been detected in South Africa and Botswana, as well as in travelers to Australia, Austria, Belgium, Britain, Canada, Czech Republic, Denmark, Germany, Israel, Italy, the Netherlands, Portugal and Hong Kong.”). Government official in South Africa called the restriction unwarranted. See, e.g., BBC, Covid: US joins EU in restricting flights from southern Africa over new coronavirus variant, 27 November 2021, https://www.bbc.com/news/world-59427770 (“South African Health Minister Joe Phaahla told reporters that the flight bans against the country were ‘unjustified’.”). Many pointed to the continued inequitable access of vaccines in Africa as the cause of the development of a new variant. See, e.g., The Guardian, Larry Elliott, The Omicron variant reveals the true global danger of ‘vaccine apartheid’, 28 November 2021, https://www.theguardian.com/business/2021/nov/28/the-omicron-variant-reveals-the-true-global-danger-of-vaccine-apartheid.

The WHO on November 29, 2021 is reported to have indicated that the Omicron variant poses a “very high” risk. See, e.g., New York Times, The W.H.O. says Omicron poses a ‘very high’ risk globally as questions about the variant remain. November 29, 2021, https://www.nytimes.com/live/2021/11/29/world/omicron-variant-covid#the-who-says-omicron-poses-a-very-high-risk-globally (“The World Health Organization warned on Monday that global risks posed by the new Omicron variant of the coronavirus were ‘very high,’ as countries around the world rushed to defend against its spread with a cascade of border closures and travel restrictions that recalled the earliest days of the pandemic.”). One can expect continued international efforts to limit the spread of the Omicron variant until greater information is known on the variant and whether it reduces the effectiveness of existing vaccines.

With the postponement of the 12th Ministerial Conference, there will likely be a slowdown in fact in negotiations by WTO Members on topics such as the fisheries subsidies agreement, an outcome on trade and health including any resolution of the proposed waiver of TRIPS obligations to address the COVID-19 pandemic, ongoing agriculture negotiations, various Joint Statement Initiatives (a number of which appear completed already), actions on climate change, an agenda for discussing WTO reform, etc. While the Director-General and the Chair of the General Council have urged continued work and WTO Members have indicated a desire to continue to work to reduce differences, it is hard to imagine that any existing momentum doesn’t get lost at least until Members are approaching the date of the rescheduled Ministerial (which has not yet been announced). See, e.g., WTO News Release, General Council decides to postpone MC12 indefinitely, 26 November 2021, https://www.wto.org/english/news_e/news21_e/mc12_26nov21_e.htm (“WTO members were unanimous in their support of the recommendations from the Director-General and the General Council Chair, and they pledged to continue working to narrow their differences on key topics like the WTO’s response to the pandemic and the negotiations to draft rules slashing harmful fisheries subsidies. The Director-General and Amb. Castillo urged delegations to maintain the negotiating momentum that had been established in recent weeks. ‘This does not mean that negotiations should stop. On the contrary, delegations in Geneva should be fully empowered to close as many gaps as possible. This new variant reminds us once again of the urgency of the work we are charged with,’ the DG said.”).

Much government attention will return to expanding production and distribution of vaccines to countries with low vaccination rates while governments and the WHO seek answers to the questions surrounding the Omicron variant — is it more easily transmissible? Is it more severe in its consequences to those who become infected? How effective are existing vaccines in protecting people from the new variant? And many developed countries will continue to push booster shots to those who are already vaccinated in light of the declining efficacy after six months for the main vaccines used in Europe and the U.S.

In prior posts, I have reviewed some of the challenges in understanding vaccine equity in light of different levels of vaccination in countries of similar economic development. See, e.g., November 23, 2021:  WTO-IMF COVID-19 Vaccine Trade Tracker provides useful information in analyzing vaccine equity, https://currentthoughtsontrade.com/2021/11/23/wto-imf-covid-19-vaccine-trade-tracker-provides-useful-information-in-analyzing-vaccine-equity/; November 22, 2021:  Trade and Health at the WTO’s 12th Ministerial Conference, https://currentthoughtsontrade.com/2021/11/22/trade-and-health-at-the-wtos-12th-ministerial-conference/. Many actions have been taken which are increasing the volume of vaccines available around the world, including adding capacity for at least fill and finish in Africa and other parts of the world. Greater efforts at donations and filling contracts with COVAX are happening and will increase in 2022.

Interestingly, on November 29, 2021, there was a joint statement from the African Union, Africa Centres for Disease Control and Prevention, CEPI, GAVI, UNICEF and the WHO on one aspect of getting vaccines to low income countries and others — donations from other countries. See Joint Statement on Dose Donations of COVID-19 Vaccines to African Countries, 29 November 2021, https://www.who.int/news/item/29-11-2021-joint-statement-on-dose-donations-of-covid-19-vaccines-to-african-countries. While donations to date have been a small part of total vaccine doses available throughout the world, there are a series of challenges to ensuring donations provide the maximum benefit going forward. See UNICEF, COVID-19 Vaccine Market Dashboard, visited November 29, 2021, https://www.unicef.org/supply/covid-19-vaccine-market-dashboard (8.856 billion total doses delivered to countries and territories around the world, including 4.535 billion through bilateral/multilateral agreements; 163.3 million from donations; 560.1 million through COVAX and 3.574 billion unknown (but appearl largely from internal production for particular countries). The UNICEF data also looks at donations more granularly and the data are significantly larger than the summary data above (701.8 million donated doses of which 381.3 million are facilitated doses and 470.5 million are delivered doses).

The Joint Statement is copied below because of the importance of donated doses for low income countries in 2022.

“Building on lessons learned from our collective experience with dose donations over the past several months, the African Vaccine Acquisition Trust (AVAT), the Africa Centres for Disease Control and Prevention (Africa CDC) and COVAX wish to draw the attention of the international community to the situation of donations of COVID-19 vaccines to Africa, and other COVAX participating economies, particularly those supported by the Gavi COVAX Advance Market Commitment (AMC).

“AVAT and COVAX complement each other’s efforts to support African countries to meet their immunisation targets, recognising the global goal of immunising 70% of the African population. Dose donations have been an important source of supply while other sources are stepping up, but the quality of donations needs to improve.

“AVAT and COVAX are focused on accelerating access to and rollout of COVID-19 vaccines in Africa. Together we are rapidly expanding supply to the continent, and providing countries with the support to be able to utilise the doses they receive. To date, over 90 million donated doses have been delivered to the continent via COVAX and AVAT and millions more via bilateral arrangements.

“However, the majority of the donations to-date have been ad hoc, provided with little notice and short shelf lives. This has made it extremely challenging for countries to plan vaccination campaigns and increase absorptive capacity. To achieve higher coverage rates across the continent, and for donations to be a sustainable source of supply that can complement supply from AVAT and COVAX purchase agreements, this trend must change.

“Countries need predictable and reliable supply. Having to plan at short notice and ensure uptake of doses with short shelf lives exponentially magnifies the logistical burden on health systems that are already stretched. Furthermore, ad hoc supply of this kind utilises capacity – human resources, infrastructure, cold chain – that could be directed towards long-term successful and sustainable rollout. It also dramatically increases the risks of expiry once doses with already short shelf-lives arrive in country, which may have long-term repercussions for vaccine confidence.

“Donations to COVAX, AVAT, and African countries must be made in a way that allows countries to effectively mobilise domestic resources in support of rollout and enables long-term planning to increase coverage rates. We call on the international community, particularly donors and manufacturers, to commit to this effort by adhering to the following standards, beginning from 1 January 2022:

Quantity and predictability: Donor countries should endeavour to release donated doses in large volumes and in a predictable manner, to reduce transaction costs. We acknowledge and welcome the progress being made in this area, but note that the frequency of exceptions to this approach places increased burden on countries, AVAT and COVAX.

Earmarking: These doses should be unearmarked for greatest effectiveness and to support long-term planning. Earmarking makes it far more difficult to allocate supply based on equity, and to account for specific countries’ absorptive capacity. It also increases the risk that short shelf-life donations utilise countries’ cold chain capacity – capacity that is then unavailable when AVAT or COVAX are allocating doses with longer shelf lives under their own purchase agreements.

Shelf life: As a default, donated doses should have a minimum of 10 weeks shelf life when they arrive in-country, with limited exceptions only where recipient countries indicate willingness and ability to absorb doses with shorter shelf lives.

Early notice: Recipient countries need to be made aware of the availability of donated doses not less than 4 weeks before their tentative arrival in-country.

Response times: All stakeholders should seek to provide rapid response on essential information. This includes essential supply information from manufacturers (total volumes available for donation, shelf life, manufacturing site), confirmation of donation offer from donors, and acceptance/refusal of allocations from countries. Last minute information can further complicate processes, increasing transaction costs, reducing available shelf life and increasing risk of expiry.

Ancillaries: The majority of donations to-date do not include the necessary vaccination supplies such as syringes and diluent, nor do they cover freight costs –  meaning these have to be sourced separately – leading to additional costs, complexity and delay. Donated doses should be accompanied with all essential ancillaries to ensure rapid allocation and absorption.

“AVAT, Africa CDC and COVAX remain committed to collaborate with donor countries, vaccine manufacturers and partners on ensuring these standards are upheld, as we continue to work together towards achieving Africa’s vaccination goals.”

The challenge of improving global vaccination rates is complicated. Supply is certainly a major issue. But countries who receive vaccines may also have problems ramping up administration of doses to their populations. While Africa has many low income countries (as classified by the World Bank), it also has countries at higher levels of income. For example, South Africa is an upper-middle income country according to the World Bank criteria but has a very low vaccination rate for an upper-middle income country. A recent New York Times article reviews that there have been significant increases in supplies to South Africa recently such that it has five months of doses on hand but is having trouble getting shots to people in need quickly enough. See New York Times, South Africa, where Omicron was detected, is an outlier on the least vaccinated continent. November 28, 2021, https://www.nytimes.com/live/2021/11/28/world/covid-omicron-variant-news (“South Africa has a better vaccination rate than most countries on the continent: Just under one-quarter of the population has been fully vaccinated, and the government said it has over five months’ worth of doses in its stores. But they are not being administered fast enough. Vaccinations in South Africa are running at about half the target rate, officials said last week. To prevent vaccines from expiring, the government has even deferred some deliveries scheduled for early next year.”).

Thus, as the world reacts to the discovery of a new variant and struggles to understand its implications, the WTO will struggle ahead in the hope of narrowing differences ahead of a further delayed Ministerial Conference, and the world will continue to pursue improved vaccine equity while dealing with increased uncertainty flowing from the Omicron variant.

The answer to the issue of vaccine equity is complex and, at least for the COVID-19 pandemic, not really dependent on a temporary waiver of TRIPs obligations for vaccines which would have no meaningful effect on supply availability through at least 2022. Production has been ramped up in many countries. The volumes available in 2022 should permit meeting the global objective of getting 70% of the world’s people vaccinated by next fall. But challenges remain in terms of internal capacities in many poorer countries to get their populations vaccinated, as well as misinformation on vaccines, the large level of vaccine hesitancy in developed countries and in developing countries, and the rise of new variants and what effect on existing vaccines they will have. Cooperation is needed in addressing all aspects of the issue. Time will tell whether improved cooperation is likely as we close out 2021 and start 2022.