Suddenly, life was almost back to normal. Perhaps not so ‘suddenly’ in Brazil, with its more than 615,000 killed by covid-19 and a long saga for the distribution of vaccines. But the fact is that, in countries like Europe and the United States, the high rates of immunization brought some comfort. In recent weeks, Brazil became part of this bubble. Here, even began the debate on the release of masks in open places.
Only it was just a bubble. And if there’s anything the coronavirus pandemic has taught, it’s that there are no security bubbles in the world. At some point, the imbalance in vaccine coverage between the countries would take a toll: while some countries exceed 75% of the population immunized, such as Portugal, France and Canada, others have less than 1%, such as Nigeria and the Democratic Republic of Congo, according to data from the Our World in Data project, at the University of Oxford.
Therefore, the emergence of the Ômicron variant, initially in Botswana (but today there are indications that it was circulating in Europe before being detected in Africa), has served to encourage scientists and health professionals to reinforce that vaccination should be a collective strategy .
And this is true both for the macro plan – with countries more or less vaccinated – as for the individual plan. And that’s where every corner of Brazil comes in, also with different realities. In the country, there are already six confirmed cases of Ômicron, whose first studies indicate that it is more transmissible than the previous ones. In Bahia, there were no records of suspected cases of Ômicron until Friday (3), according to the State Health Department (Sesab).
“This new strain has characteristics that distinguish it from the original form of the virus. These are extremely worrying characteristics, because it has more mutations, 32 being in the S protein, and a greater capacity for dissemination. This will probably bring enormous difficulties in managing it, but we need to have studies for definitive conclusions”, explains the immunologist and pediatrician Celso Sant’Anna, professor of Medicine at UniFTC and at the Federal University of Bahia (UFBA).
In fact, it remains to be seen whether Ômicron can cause more serious infections, is more lethal, or even escapes the protection of existing vaccines. In South Africa, where it was first identified by genomic surveillance projects, the new strain is already dominant and has caused a new wave of infections. Altogether, the strain has more than 50 mutations, something that has not been registered before with Sars-cov-2.
In two days – between 24th and 26th of November – the World Health Organization (WHO) changed the classification of ‘micron from variant under monitoring to ‘concern variant’, alongside the already known Alpha, Beta, Gamma (which originated in the Brazil) and Delta, responsible for the worst waves so far.
It is not unusual for viruses to mutate. On the contrary: they are part of the replication process of any of them. Viruses even have mutation cycles. Some, like DNA, are more stable and replicate less – like adenoviruses, which cause diseases like conjunctivitis and pneumonia. RNA ones, like flu and covid-19, are less stable.
In the case of the Ômicron variant, much remains to be investigated. It was initially sequenced by researchers in South Africa in November. The identification would be that it appeared in Botswana, also on the African continent. However, this week, the Netherlands confirmed cases of the new strain in its territory before tests that detected 14 infected passengers on flights arriving from South Africa, indicating that it has been circulating in Europe for longer. It is not yet known whether the infected people had contact with people who had been in African countries where the lineage was registered.
According to biomedical and neuroscientist Mellanie Fontes-Dutra, coordinator of the Covid Analysis Network, there are signs that the micron has emerged from a prolonged infection of a possibly immunosuppressed patient.
“This makes sense because, in these patients, the immune system is suppressed and this gives the virus an opportunity to acquire more and more mutations each time it makes copies of itself. It may be linked to high transmission”, it says.
Most virus mutations do not matter, nor do they follow in the ‘populations’ of viruses that will be formed. Only a part of these changes ends up leading to new strains. Among these, only a portion can bring some adaptation to the virus. In Fiocruz’s Genomic Panel, Bahia has just over 1.8 thousand genomes of samples of Sars-cov-2 sequenced, while Brazil has just over 78 thousand. Since August, the delta variant represents the majority – or the total – of the sequencing made
“Transmission is the problem because it is the opportunity for the virus to infect so many people at the same time that it will manage, from these mutations, to acquire some important adaptation. That is why vaccines are important: in addition to controlling transmission, they are able to suppress the frequency of these mutations”, emphasizes Mellanie.
In places where virus transmission is uncontrolled, the chance of mutations ends up being greater. “Although we do not know exactly when and where it appeared (the omicron variant), this reveals a major problem of inequality in the distribution of vaccines in places with low vaccination coverage”, he adds.
Since the announcement of omicron, countries like the United States and members of the European Union have closed borders to countries in the southern region of Africa. Brazil also suspended flights with tickets to ten countries on the continent, including South Africa, Mozambique and Angola. Others, like Japan and Israel, have not accepted visitors from any country.
For specialists, the measures also show the inequality in the distribution of immunizations against covid-19. In the assessment of epidemiologist and biomedicalist Joilda Nery, PhD in Public Health and deputy director of the Collective Health Institute at Ufba, this situation is a reflection of the capitalist social and economic model of access to health, which includes vaccines and medicines.
“This distribution is organized just like this predatory model. No wonder the global North has this monopoly on vaccines and also controls the issue of patents, which we see not only with covid, but with diseases prior to the pandemic,” analyzes citing neglected tropical diseases. “People are still dying and getting sick from diseases that the pharmaceutical industry is not interested in investing in, because this global South is not a strong consumer market”, it says.
She criticizes what she called sensationalism in relation to African countries, given these measures taken to face a strain that may not even have arisen there. “This has a lot to do with the form of organization of the global North and South”, he reiterates.
On the other hand, the concern of different governments with closing flights originating in some countries in Africa can be explained by the fact that 62% of the reported cases of Ômicron in the world are in South Africa and Botswana, according to the World Health Organization (WHO) released it on Thursday. “The detection and timely notification of the new variant, by Botswana and South Africa, has saved the world time”, added the WHO regional director for the continent, Matshidiso Moeti. The organization emphasizes that the governments of these two countries are “doubling up measures to detect and control” the spread of the new variant.
Throughout the year, WHO has reinforced the need for the richest countries – in particular, the members of the G20 – to donate immunization to countries where vaccination has not advanced. Last Monday (29), the organization released a new position alongside authorities such as UNICEF and the Covax consortium (an initiative to distribute vaccines to poor countries) advocating that the immunization of 70% of the population of the African continent should be a global goal.
But it is necessary to go beyond donations, as biomedical and neuroscientist Mellanie Fontes-Dutra explains. “The donation would be an important point, but it is necessary to take into account the accessibility. There may be places of difficult access where it is necessary to make the immunizing agent reach the population”, he ponders.
Thus, initiatives like this must be accompanied by delivery strategies. “It’s no use just sending a bunch of vaccine there and it’s done. It often implies a distribution with greater capillarity, for a population that doesn’t always manage to go to an urban center”, he says.
The problem is that it doesn’t just happen between countries. Within a continental country, such as Brazil, it is possible that there are ‘islands of asymmetry’ with the distribution of vaccines, as highlighted by immunologist and pediatrician Celso Sant’Anna, from UniFTC and Ufba.
“These areas can be potential breeding sites for strains that are dangerous to our health. We will only be safe when we have more than 90% or 95% of the population vaccinated, including children, youth and adults worldwide”, evaluates the doctor.
For him, the moment requires a global effort to reach these countries as well. “It’s no use for Brazil to have 95% and the African continent to have less than 20%. The world needs to agree that it’s no use for Europe to think it’s living on an island and will manage to isolate itself from the rest of the world,” he adds.
And where does each one’s decision come in? It is precisely the fact that vaccination is not an individual strategy. Although immunizers offer some degree of individual protection to each person, in addition to preventing serious infections, they do better when the vaccinated population grows.
In this scenario, as researcher Mellanie Fontes-Dutra explains, the chance of the virus finding an unvaccinated person is very small. This is true both for the covid-19 vaccine, with all three doses, and for the periodic vaccination calendar.
“We will be able to track new cases and contacts and be able to isolate them in advance before generating a significant increase in transmission again. In addition to promoting protection in society, including those who are still susceptible, we also isolate transmission when we get to a very high coverage”, he completes.
Prevention measures must continue, experts argue
With unequal vaccination, the possibility of emerging new variants increases. Therefore, even though the location where you live has a high coverage of immunization against covid-19, the experts’ guidance is not to fail to adopt the other preventive measures against the virus.
“This is not the time to release the use of masks, not only indoors, but also outdoors. Even in open environments, if there is crowding, such as football stadiums or fairs, it is important to continue taking these measures while we do not reach higher rates “, defends biomedical and neuroscientist Mellanie Fontes-Dutra, coordinator of the Covid-19 Analysis Network.
Among the states that debated the release of masks in open spaces, the government of São Paulo announced last Thursday (2) that it had suspended the measure. The release was scheduled to take effect on the 11th, but the state’s scientific committee made the recommendation to back off after three cases of the omicron variant were confirmed there.
The concern of scientists and health professionals now is that abandoning the proven effective protective measures will result in all the progress achieved so far being lost.
“We have made advances in terms of reducing lethality also because of vaccination, but that could all fall apart. This also refers to low vaccination coverage – it’s no use having only taken the first dose”, reinforces epidemiologist Joilda Nery, PhD in Collective Health and vice-director of the Collective Health Institute of the Federal University of Bahia (UFBA).
Vaccination must continue to be combined with prevention strategies such as the use of masks, avoiding crowds and ensuring social distance. “If we enter into a false normality that we don’t need to wear masks because we are vaccinated and start to gather again without the proper coverage, we throw all our effort down the drain”, he adds.
In addition, she argues that special attention must be paid to borders. To date, Brazil has not adopted a vaccination passport for foreign visitors. “We have to carefully assess our low capacity for testing, because we also have silent cases. If we have a wide spread of masks, why not continue using them”, he reinforces.