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Vaccine hoarding will prolong COVID-19 pandemic, warns WHO panel, mulls early Omicron data

Early laboratory data on the effectiveness of existing vaccines against the Omicron COVID-19 variant is useful, but it is still unclear how effective they will be at treating severely sick patients, a UN health agency panel said on Thursday.

The development follows reassurance from the World Health Organization (WHO) that available vaccines “hold up very well” in protecting people from the worst forms of coronavirus sickness for six months or more, with a “minor, modest reduction” thereafter, among over-65s or those with underlying medical conditions.

“The neutralization data has an underpinning, but it’s really the clinical data that are going to be most influential about how to manage an Omicron situation,” said Dr Kate O’Brien, Director, Department of Immunization, Vaccines and Biologicals at WHO.

Speaking to journalists during a scheduled briefing, she explained that early “signals” were emerging from neutralization studies “about what the direction might be…but we certainly need more that what has come out at this point”.

The results of further studies are expected by the end of this week, but before any new recommendations linked to Omicron can be made by SAGE, Dr O’Brien insisted that what was really needed was the clinical data, “the performance of the vaccine, in people against clinical disease or infection. So, although the neutralization data give us a sort of direction of travel it doesn’t answer the specific question that SAGE will have and frankly, that we all have, which is the performance of the vaccines against clinical disease and against infections, so that is the critical piece of data.”

On the issue of herd immunity and so-called “breakout infections” among individuals already vaccinated, Dr O’Brien said that collective immunity remained out of reach, partly because the vaccines in circulation today, for all their efficacy, were “not performing at the level where the concept of herd immunity is likely to be something that can be achieved”.

This was at least in part because of the lack of universal vaccine coverage which has seen wealthier countries benefit from immunization campaigns, while poorer nations have suffered a dearth of lifesaving jabs, Dr O’Brien noted.

“It’s not surprising that when as vaccination coverage increases just by virtue of the fact that there frankly are more people who are vaccinated, you will see more numbers of breakthrough events among people are vaccinated; that does not mean the vaccine is not working, it simply means that a greater and greater number of people have actually been vaccinated.”

As Omicron spreads, the WHO official highlighted that those most at risk remained the unvaccinated, who represented 80 to 90 per cent of those who have fallen seriously ill from coronavirus.

The risk that the pandemic will not being snuffed out if countries decide to hold on to their COVID-19 vaccines, rather than sharing them under the WHO-partnered COVAX equitable distribution scheme.

“Countries have been waiting, they’ve been waiting and waiting and waiting; it’s going to come, it’s going to come, it’s going to come, and now it is starting to come, and we have to make sure that it continues,” she said.

“As we head into whatever the Omicron situation is going to be, there is risk, that the global supply is again going to revert to high-income countries hoarding vaccines to protect, you know, in a sense, in excess their opportunity for vaccination and a sort of ‘no-regrets’ kind of approach.”

This lack of global solidarity is “not going to work, it’s not going to work from an epidemiologic perspective,” Dr O’Brien said. “It is not going to work from a transmission perspective unless we actually have vaccines going to all countries, because where transmission continues, that’s where the variants are going to come from.”

It also remained “perplexing” that some countries were inconsistent in trying to reduce COVID-19 transmission, Dr O’Brien said. “On the one hand, (nations were) pursuing a sort of no-holds-barred approach to the vaccines, at the same time not using masks, handwashing, crowds, all of the other measures that we know are highly effective at reducing transmissions.”

Among its recommendations on vaccines, the SAGE panel of experts repeated its earlier advice that the best approach was to use the same type of vaccine for the first two doses where possible, rather than a mix-and-match approach combing different jabs.

This was not always possible in countries where there was insufficient supply or where communities were hard-to-reach, the experts explained.

For frontline medical staff, Dr Cravioto provided clarity on providing a third dose of COVID-19 vaccine: “In the case of a health worker, it depends very much with what vaccines they have been immunised,; if they have been immunised with an inactivated vaccines, then, yes, they should be part of receiving as soon as possible a third dose of the vaccine.”

Dr Cravioto noted that in many lower-income countries, these health workers had received vaccines that had not received Emergency Use Listing status from the WHO. These include CanSino “and that vaccine would also require a second dose …since we feel that there’s not enough the protection afforded by the first dose”, he said.

On the Johnson & Johnson single-shot vaccine, Dr Cravioto noted that one dose was still considered to provide full immunity.

He added that for those countries that had decided to distribute a second dose, “this can be given two to six months after first one, and in a sense, we still feel that lengthening the interval between these two doses is the best way to go. So, the closer you can get to six months - especially in those that are over 65 years of age - the better response you might have to this second dose.”

ends

WHO - SAGE COVID-19 Presser

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