SARS-CoV-2 has infected more than 278 million people worldwide, with at least 5.4 million deaths recorded by the World Health Organization as of December 26, 2021. The omicron variant (B. 1.1.529) worryingly is spreading rapidly.
Some countries view infection as net harm and implement strategies ranging from suppression to elimination. They seek to maintain low infection rates through a combination of vaccination, public health measures and financial support measures (more vaccines). Other countries have implemented mitigation strategies that aim to prevent health systems from being overwhelmed by the development of population immunity through a combination of infection and vaccination. These countries are relying on a vaccine-only approach and appear willing to tolerate high levels of infection as long as their health systems can cope.
The high transmissibility and degree of immune escape of the delta and omicron variants means that sustained protective population immunity is unlikely to be achieved with current vaccines based on the original strain.
Compared to delta, omicron is much more likely to infect those who were vaccinated or exposed to previous SARS-CoV-2 variants, suggesting significant immune escape.
Widespread transmission brings a degree of unpredictability to the pandemic response. High transmission risks more rapid adaptation of SARS-CoV-2, with outcomes including increased transmissibility (seen with α, delta, and omicron), increased antibody immune escape (β and omicron), or increased pathogenicity (delta and α).
There are other drawbacks to a vaccine-only strategy. Countries that tolerated high transmission have seen increases in Covid and all-cause mortality , shortages of health workers and repeated lockdowns to control increases in case numbers. Countries that suppressed transmission early saw reduced mortality and less economic damage.
While vaccination greatly reduces the risks of serious illness and death, long Covid remains a concern. Disruption to education as a result of staff and student illness, and/or repeated lockdowns due to lack of control of the virus, are likely to have a lasting impact on the well-being and prospects of the next generation.
High levels of transmission also create a negative feedback loop, whereby important public health measures such as test, trace, isolate and support systems are overwhelmed, making them less effective and fueling transmission further.
For all these reasons, a Vaccines Plus approach must be adopted globally. This strategy will slow the emergence of new variants and ensure they exist in a low-transmission environment where they can be controlled through effective public health measures, while allowing everyone (including the clinically vulnerable) to live their lives more freely.
We welcome the World Health Organization’s recent guidance on the use of masks for community and healthcare purposes, but believe more can be done to suppress transmission without negatively affecting economic or social activity. Accordingly, we call on the World Health Organization and national governments to:
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Vaccines-plus is affordable and attainable
It is the policy advocated by WHO Director-General Tedros Adhanom Ghebreyesus in his statement on December 14, 2021: "I need to be very clear: vaccines alone will not get any country out of this crisis. Countries can and must prevent the spread of Omicron with measures that work today. It’s not vaccines instead of masks, it’s not vaccines instead of distancing, it’s not vaccines instead of ventilation or hand hygiene. Do it all. Do it consistently. Do it right. "
Footnotes
Trisha Greenhalgh, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; Stephen Griffin, Leeds Medical Research Institute, School of Medicine, University of Leeds, UK; Deepti Gurdasani, Queen Mary University of London, United Kingdom; Adam Hamdy, independent researcher, Mauritius; Aris Katzourakis, Department of Zoology, University of Oxford, UK; Martin McKee, London School of Hygiene and Tropical Medicine, UK; Susan Michie, Department of Clinical, Health and Educational Psychology, University College London, United Kingdom; Christina Pagel, University College London, United Kingdom; Alice Roberts, Professor of Public Engagement in Science, University of Birmingham, UK; Kit Yates, Center for Mathematical Biology, Department of Mathematical Sciences, University of Bath, UK
Conflicts of interest: Martin McKee, Susan Michie, Christina Pagel and Kit Yates are members of Independent SAGE. Nothing more stated.
Provenance and Peer Review: Not commissioned, not peer reviewed
On behalf of the full list of signatories:
World Federation of Public Health Associations, signing in an institutional capacity; Nisreen Alwan, University of Southampton, UK; Raymond Agius, University of Manchester, UK; Haitham Ahmed, AdvantageCare Physicians, New York, USA; Simon Ashworth, Imperial College Healthcare NHS Trust, UK; Charlotte Augst, National Voices, UK; Simon L. Bacon, Department of Health, Kinesiology and Applied Physiology (HKAP), Concordia University; Emil J. Bergholtz, Department of Physics, Stockholm University, Sweden; David Blanchflower, Dartmouth College and University of Glasgow, UK; Arnold Bosman - Director Transmissible BV; Nissaf Bouafif ép Ben Alaya, National Observatory for New and Emerging Diseases, Ministry of Health; Head of the Department of Preventive Medicine, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Katherine Brown, Great Ormond Street Hospital and University College London, UK; Matthew Butler, Cambridge University Hospitals, UK; Molly Byrne, Health Behavior Change Research Group, Faculty of Psychology, National University of Ireland, Galway, Ireland; Roberto Cacciola, Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Danielle J. Cane, London School of Hygiene and Tropical Medicine, London, United Kingdom; Fidelia Cascini, Dipartimento di Scienze della vita e sanità pubblica, Catholic University of the Sacred Heart, Rome, Italy; Mohamed Chahed, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; KK Cheng, Applied Health Research Institute, University of Birmingham, UK; Anthony Costello, Institute of Global Health, University College London, United Kingdom; Andrew Conway Morris, University of Cambridge and European Society of Intensive Care Medicine, UK; Roz Davies, CEO of Thrive by Design, UK; Colin Davis, School of Psychological Sciences, University of Bristol, UK; Brendan Delaney, Imperial College, London, UK; Denise Dewald, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; David Drew, retired NHS consultant paediatrician, UK; John Drury, School of Psychology, University of Sussex, UK; Andrew Ewing, Department of Chemistry and Molecular Biology, University of Gothenburg; Swedish Academy of Sciences, Sweden; David Fisman, professor of epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Sharon Friel, Australian National University, Australia; Malgorzata Gasperowicz, Faculty of Nursing, University of Calgary, Canada; David Robert Grimes, Dublin City University and University of Oxford, Ireland; Zubaida Haque, Independent SAGE, United Kingdom; William A Haseltine, ACCESS Health International, United States; Orla Hegarty, School of Architecture, Environmental Planning and Policy, University College Dublin, Ireland; Simon Hodes, Bridgewater Surgeries and Cleveland Clinic, London, United Kingdom; Eilir Hughes, West Wales, United Kingdom; Zoë Hyde, Western Australian Center for Health and Aging, University of Western Australia, Australia; Lisa Iannattone, University of Montreal, Canada; Alejandro R. Jadad, Center for Global eHealth Innovation, Toronto, Canada; Neena Jha, Hertfordshire, United Kingdom; José Luis Jiménez, Department of Chemistry and Cooperative Environmental Sciences Research Institute, University of Colorado, Boulder, CO, USA; John Johnson, Eastern Health, Melbourne, Australia; Abraar Karan, Division of Infectious Diseases and Geographic Medicine, Stanford University, United States; Kamlesh Khunti, University of Leicester, UK; Najwa Khuri-Bulos, University of Jordan; Associate Professor, Pediatric Infectious Disease, Vanderbilt University, Nashville, USA Woo Joo Kim, Division of Infectious Diseases, Guro Hospital; Director, Chung Mong-koo Vaccine Innovation Center, College of Medicine, Korea University, Seoul, Republic of Korea; Matthew J Knight, West Hertfordshire Hospitals NHS Trust, UK; Kim L. Lavoie, Department of Psychology, University of Quebec at Montreal; Tom Lawton, Bradford Institute of Health Research; Bradford Teaching Hospitals NHS Foundation Trust, UK; Jeffrey V Lazarus, Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain; Anthony Joseph Leonardi, Johns Hopkins Bloomberg School of Public Health, USA; Eyal Leshem, Faculty of Medicine, Tel Aviv University, Israel; Liz Lightstone, Imperial College Healthcare NHS Trust, London, UK; Peter V. Markov, London School of Hygiene and Tropical Medicine, London, United Kingdom; Jose M Martin-Moreno - Department of Preventive Medicine and Public Health and INCLIVA, University of Valencia, Spain; Petra Meier, University of Glasgow, United Kingdom; Jonathan Mesiano-Crookston, partner Goldman Hine LLP, Canada; Asit Kumar Mishra, NUI Galway, Ireland; Michael Moore, George Institute for Global Health; Sterghios A. Moschos, Cellular and Molecular Sciences, Northumbria University, United Kingdom; C David Naylor, University of Toronto, Toronto, Canada; Taylor Nichols, Sacramento, United States; David Nicholl, Sandwell and West Birmingham NHS Trust, UK; Ole F. Norheim, Department of Global Public Health and Primary Care, University of Bergen, Norway; Matthew Oliver, Alberta Association of Professional Engineers and Geoscientists, Edmonton, Alberta, Canada; Christine Peters, QEUH NHS Greater Glasgow and Clyde, UK; Deenan Pillay, University College London, United Kingdom; Dominic Pimenta, Richmond Research Institute, UK; Kashif Pirzada, McMaster University, Canada; Catherine Pope - Professor of Medical Sociology, University of Oxford, UK; Kimberly A Prather, University of California, San Diego, La Jolla, CA, USA; Geraint Preest, Pencoed, Wales, UK; Zeshan Quereshi, University of Cambridge, UK; Katrin Rabiei, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; James Ray, NHS England, United Kingdom; K. Srinath Reddy, Public Health Foundation of India, India; Walter Ricciardi, Università Cattolica del Sacro Cuore Rome, Italy; Ken Rice, School of Physics and Astronomy, University of Edinburgh, UK; Eleanor Robertson, NHS Greater Glasgow and Clyde, UK; Kim Roberts, Department of Microbiology, Trinity College Dublin, Ireland; Tomás Ryan, Trinity College Dublin, Ireland; Helen Salisbury, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; Gabriel Scally, Population Sciences, University of Bristol, UK; Robert T. Schooley, University of California, San Diego, United States; Vipul Shah, RP Shah Memorial Trust, Lucknow, India; Joshua Silver, Department of Physics, University of Oxford, UK; Natalie Silvey, Imperial School of Anesthesia, London, UK; Manoj Sivan, University of Leeds and Leeds Teaching Hospitals NHS Trust, UK; Luis Eugenio Souza, Federal University of Bahia; World Federation of Public Health Associations, Brazil; Anthony Staines, School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland; David Tomlinson, University Hospital Plymouth NHS Trust and Fresh Air NHS, UK; Collin Tukuitonga, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Charles Vincent, University of Oxford, Oxford, UK; Joe Vipond, University of Calgary, Canada; Robert West, Institute of Epidemiology and Healthcare, University College London, United Kingdom; Angela C. Weyand, University of Michigan School of Medicine, Ann Arbor, MI, USA; Hisham Ziauddeen, Department of Psychiatry, University of Cambridge, Cambridge. University Hospitals Plymouth NHS Trust and Fresh Air NHS, United Kingdom; Collin Tukuitonga, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Charles Vincent, University of Oxford, Oxford, UK; Joe Vipond, University of Calgary, Canada; Robert West, Institute of Epidemiology and Healthcare, University College London, United Kingdom; Angela C. Weyand, University of Michigan School of Medicine, Ann Arbor, MI, USA; Hisham Ziauddeen, Department of Psychiatry, University of Cambridge, Cambridge. University Hospitals Plymouth NHS Trust and Fresh Air NHS, United Kingdom; Collin Tukuitonga, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Charles Vincent, University of Oxford, Oxford, UK; Joe Vipond, University of Calgary, Canada; Robert West, Institute of Epidemiology and Healthcare, University College London, United Kingdom; Angela C. Weyand, University of Michigan School of Medicine, Ann Arbor, MI, USA; Hisham Ziauddeen, Department of Psychiatry, University of Cambridge, Cambridge.
