While the huge surge in COVID infections has been facilitated by Omicron evading the first line of defence – our antibodies, the news is good about our second line of defence.
The toughest job you can give a vaccine is to prevent infection in the first place. For that to happen, all the defences must be lined up and ready for action. Antibodies, which are immune substances in the bloodstream, are that first line of defence. Omicron’s mutations allow it to evade the antibodies and get in.
The second line of defence are white blood cells themselves – the T and B cells which have the memory to recognise the coronavirus and then mount an attack (with T cells). That’s what protects us against severe disease. Research in a few labs around the world have shown that even with Omicron, the T cell response is largely preserved.
The good news is that for the virus to resist the T cell response, it needs to mutate a lot more than it ever has. Not impossible but much harder.
The other good news is that boosters seem to restore some protection against infection at least for a few weeks.
Fourth vaccine dose
Most countries currently offering a fourth vaccine dose are prioritising people who are immunocompromised. This includes the United Kingdom and United States.
On 3 January 2022, Israel began offering fourth doses to all adults over 60, medical workers, and nursing home residents, making it the first country to offer fourth doses to this wider group of people. Germany has also indicated that it plans to administer a fourth dose to a wider section of its general population in the coming months to tackle the Omicron variant. This is controversial as it may not be necessary and risks losing a bit of vaccine effectiveness, for complex reasons to do with the immune system having a bias towards its first experience of vaccines and not recognising new vaccines as well. That’s theoretical but if you don’t need a fourth dose, it’s best to hold back for the moment.
The UK’s Joint Committee on Vaccination and Immunisation (JCVI) has said it is waiting for more data on waning immunity and effectiveness of vaccination in reducing hospital admission before it decides on offering a fourth jab to a wider group of people. Similarly, the US Centers for Disease Control and Prevention has not yet recommended fourth doses for the wider public. “We’re going to take one step at a time, get the data from the third boost, and then make decisions based on scientific data,” said the White House chief medical adviser, Anthony Fauci, on 29 December.
Australian authorities will closely monitor the data from home and overseas.
Booster hesitancy
This may still be an issue for some patients in 2022.
Australia is one of leading countries when it comes to being vaccinated against COVID. A national average of 92% of people over the age of 16 double vaccinated is a remarkable achievement.
However, for a variety of reasons, it is highly unlikely we will achieve these same high levels with the booster vaccines in 2022.
International evidence to help with patient conversations
In early December 2021, British researchers found that at 15 weeks after the second dose, for Omicron, Pfizer effectiveness had dropped from 88 per cent to 34 per cent. While Astra had dropped from 76 per cent to almost 0 against symptomatic disease.
Recent data from the UK Health Security Agency on hospital admissions after Omicron infection and vaccine effectiveness analysis show 72% protection after two doses for up to six months, rising to 88% within two weeks of a booster shot.
Peter Openshaw, an immunologist and professor of experimental medicine at Imperial College London, who was not part of the study, said it added to the “now overwhelming evidence” that three doses provide good protection against severe COVID-19 disease caused by Omicron.
Minimising the potential spread of COVID-19
While many practices have successfully managed COVID-19 risk to-date such as offering telehealth services, mandatory COVID tests, mask wearing and using hand sanitisers before entering the premises, practices in some parts of Australia haven’t had to deal with this due to low or no community transmission.
The Omicron variant is highly transmissible, and practices should have plans and procedures in place to minimise the risk to patients, especially vulnerable patients. Patient education may also be needed in some communities, especially in those areas with little or no previous COVID-19 cases.
Masks, rapid antigen tests, distancing, ventilation and hand hygiene
Based on previous success, these should be actively encouraged as we learn more about the Omicron variant.
Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO) issued a warning about the transmissibility of the new variant and that Omicron is spreading at a rate we have not seen with any previous variant.
“I need to be very clear: vaccines alone will not get any country out of this crisis. It’s not vaccines instead of masks, distancing, ventilation or hand hygiene. Do it all. Do it consistently. Do it well.”
Combined Flu and COVID-19 protection
Novavax announced in November 2021 it is undertaking phase 1 and 2 clinical trials combining a flu vaccine with its COVID-19 vaccine. This would be a really good way of maintaining good levels of immunity moving into the future.
How practices can prepare now for the challenging year ahead
Over the past two years, practice teams across Australia have done a remarkable job adapting to the evolving pandemic, and no doubt this will continue in 2022.
Noting the important information above and what 2022 could look like, practices are encouraged to think about the following questions now to make it easier for you and the team:
- How will you manage the rollout of the third and potentially a fourth vaccine? (if your practice is involved)
- How will you manage the vaccine boosters as well as the influenza shot? (if your practice is involved)
- What can you do now to make it easier to identify and schedule patients on management plans and/or requiring routine assessments?
- If your practice is in an area that has previously had little or no positive COVID-19 cases, are you prepared for the more transmissible Omicron variant and what this could mean for your practice?
- Are you ready to address any patient concerns about having vaccine boosters?
- Are you ready to address any parent’s concerns about getting their young children vaccinated?
- Do you have access to the necessary resources, if required?
