On Nov 24, South Africa alerted the world to the latest SARS-CoV-2 variant, omicron (B.1.1.529). The omicron variant distinguishes itself from previous variants by harbouring in its genomic sequence 49 mutations (30 of which occur within the spike protein)—a jump from the 13 mutations found within the delta variant (B.1.617.2). More mutations does not intrinsically mean that a variant is more dangerous, but almost immediately omicron generated concern within the global health community regarding its transmissibility and ability to evade both vaccine-induced and natural immunity. The report of the new variant has caused national governments to react with the reintroduction of non-pharmaceutical measures and ramped up vaccine booster programmes in the hope of delaying the spread of omicron. Controversially, however, for some governments the immediate response was to issue travel bans against South Africa. The UK was the first to adopt such a proposal, and was swiftly followed by the USA, Israel, and others.
The bans are, ostensibly, aimed at preventing the spread of the omicron variant. The political rationale appears logical: governments want to provide a sense of security to their citizens, and a ban on travel appears a straightforward solution to do so. However, WHO advises against blanket travel bans, arguing that they do not succeed in preventing international variant spread. Instead, WHO states that such restrictions would have a detrimental impact on the targeted countries. By restricting travel from these areas, the economies of these countries will be harmed, and this in turn will hurt their ability to combat the pandemic. South Africa, therefore, is being punished for being the first country to raise the alarm.
The travel bans do not even appear to be effective in their aims. As of Nov 29, omicron cases have been detected in eight EU countries, as well as in Australia, Canada, the UK, and other regions. Most notably, Dutch health authorities identified the variant in samples taken on Nov 19 and Nov 23 (before the formal discovery of the variant). WHO official guidance also warns that travel bans might do more longer-term damage than their possible shorter-term benefit: punishing the country that discovers the variant could unintentionally discourage countries from sharing genomic data on new variants in the future. Inhibition of this crucial data sharing could be disastrous. Omicron is the latest variant but is unlikely to be the last. We cannot risk disincentivising nations from alerting the world to new variants. In fact, globally, we would benefit from upscaling genomic surveillance.
The COVID-19 Data Explorer on Our World in Data shows an uneven distribution of global surveillance of SARS-CoV-2 variants worldwide. Some regions, such as Denmark and Hong Kong, are sequencing at least half of their COVID-19 cases, searching for mutations. Most countries sequence zero cases, suggesting potential for global blind spots for variant emergence. South Africa, which has sequenced only 0·8% of its cases but discovered two variants (beta [B.1.351] and omicron), potentially provides a template for the national surveillance of infectious agents. In May 2020, the Network for Genomic Surveillance in South Africa—a collection of laboratories, scientists, and academics institutions—was launched with the aim of sequencing SARS-CoV-2 samples to inform public health response in South Africa. The Network, writing in The Lancet Microbe in October, 2020, outlined their principles for the creation of such a network.
Increased global genomic surveillance of variants requires both international collaboration and the sharing of resources and expertise. And although recent results regarding the distribution of vaccines worldwide have not been encouraging, a special session of the World Health Assembly provides some hope. Convening in Geneva between Nov 29 and Dec 1, numerous world leaders met to discuss recommendations for improving global pandemic response. The most notable outcome was the agreement to develop an accord to govern pandemic response, including a commitment to the equitable distribution of diagnostics, drugs, and vaccines.
In addition to resources, countries will need assurances that they can report all findings without fear of reprisal. The genesis of variants, such as omicron, are (in part) the result of our unequal response to COVID-19. The large portions of the global population that remain unvaccinated present the greatest risk for mutations and evolution of SARS-CoV-2. So, while these people remain without a vaccine, the least we can do is stop penalising the countries that bring the consequences of our inaction to light.
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