Need to sharpen India’s Omicron strategy

The Omicron variant of the coronavirus has now spread into more than a hundred countries worldwide and it stands poised to unseat the Delta as the dominant variant in certain parts of the world. As of December 27, India had seen 578 Omicron cases across nearly 19 states and UTs, and a fresh wave of the epidemic is being anticipated, fuelled largely by this runaway variant. Multiple states have thereby instituted fresh measures, such as gathering restrictions and night curfews.

While hard evidence on the diminished severity of Omicron is still deficient, and its apparently lower virulence could be an insignia of widespread though varying levels of pre-existing immunity, some interesting observations and predictions could be arrived at. Viruses gain a survival advantage from, and thereby often tend to drift towards, lower virulence and higher transmissibility in the population. While the initial epidemiological presentation of this could be alarming, it could augur the early stages of its end as a calamitous global pandemic.

As witnessed in South Africa, the wave inspired by Omicron is likely to be a contracted one, rising and falling sharply, and also largely under-detected — leaving in its wake a fresh round of disease-induced immunity.

This, however, doesn’t remotely imply that our guard should be let down. An onrushing Omicron wave can spell another onslaught on our health system, which has incompletely recovered from the two closely successive previous shocks. A sharp rise in cases could bring a torrent of hospitalisations despite the overall profile of a mild disease. While the experience of the preceding Covid-19 waves has indeed rendered us more prepared to counter an upcoming wave, we must understand that health systems as a whole need time to recuperate between stresses, and tend to progressively weaken without it.

There is emerging evidence globally on the benefit of booster doses in dampening Omicron, notwithstanding its paucity nationally. The evidence on the general effectiveness of boosters is also well established, particularly for the vulnerable sections, as demonstrated by countries such as Israel.

For India, which is looking at an imminent Omicron wave, where a good chunk of the population is yet to be fully vaccinated, and with a likely under-prepared supply chain, booster as an overarching public health strategy goes out of the question. Such a programme would also need to be backed by substantive evidence of a major public health benefit of boosters in the context of the circulating variants, which can justify its opportunity costs. Carefully weighed but speedy decisions to allow boosters to certain vulnerable sections are indeed merited, even as we continue to expand the regular Covid-19 vaccination.

The Prime Minister’s recent announcement to this effect, allowing ‘precaution doses’ for frontline workers, healthcare workers and the elderly co-morbid, should be welcomed. However, the technical difficulties in targeting the elderly co-morbid possessing a doctor’s prescription must be kept in mind and a blanket approach involving the entire eligible elderly population may be more efficient.

Moving forward, erratic decisions, such as the erstwhile liberalised vaccination strategy, need to be avoided with respect to boosters as they may fuel vaccine inequity and provide little public health advantage, if not veritably counterproductive results.

Another important area is the pace of regular Covid-19 vaccination. While we have recorded tremendous strides in this respect in the recent past, we must not forget the rule of the diminishing rate of gains over time. The uptake of any public health intervention is always rapid in the early stages, when the easily accessible and favourably disposed sections get approached largely by default. It is in the later stages that the inaccessible and hesitant populations are left to be reckoned with and the progress slows down. Certain states, including some progressive ones like Maharashtra, show a slowed vaccine uptake, particularly with the second dose.

The level of full vaccination coverage will have a significant bearing on the rollout of a full-fledged booster strategy, which might be merited in the future, regardless of Omicron. In this regard, there is indeed some good news, as some recent surveys indicate that vaccine hesitancy has dwindled since the rise of Omicron. India should use this opportunity and plug any supply sided, operational or communicational gaps with dispatch to rapidly expand the regular Covid vaccination.

Health communication is likely to remain a major element of our prevention efforts. The rise of Omicron has quickly elicited measures like night curfews as knee-jerk reactions with dubious efficacy.

However, little has been done so far to shape and tailor our public health communication and discourse to suit the changed needs of Omicron. Cliched exhortations on masking and social distancing continue to be floated in the name of risk communication, just like during the second wave.

It is important to note at this point that positive health behaviours inculcated during the first wave have only tended to diminish in intensity subsequently, owing to widespread pandemic fatigue. This warrants that the communication strategy be more nuanced and fine-tuned in light of existing and emerging evidence.

For example, a disproportionate chunk of Omicron cases is among the fully vaccinated. This could indicate that the fully vaccinated, for obvious reasons, are indulging more freely in risky behaviour, such as not wearing masks and flouting social sdistancing norms. While they may be less prone to severe disease, they can perpetuate and spread infection.

Similarly, health communication with respect to the diminished severity of Omicron, which is still weakly backed by hard evidence, is largely indiscriminate and has been allowed to take its own course without regard to the adverse impact it could have on the collective health behaviour. Only a robust and thoughtful communication strategy can tackle these.

One way or another, Omicron is likely to prove to be a momentous turn in the story of the Covid-19 pandemic. We must continue taking lessons. There is no room for complacency.