Within a week of the new Omicron variant of the COVID-19 virus being reported to the World Health Organization, global leaders on December 1, agreed to start negotiations to create an international agreement on cross regional cooperation to manage pandemics of the future. The WHO took the initial steps towards a “pandemic treaty”, aimed at strengthening future global response against pandemics.
In a consensus decision aimed at protecting the world from infectious diseases crises, the World Health Assembly agreed to establish an intergovernmental negotiating body to draft and negotiate a convention, agreement, or any other international instrument under the Constitution of the WHO to strengthen pandemic prevention, preparedness, and response. The special session of the World Health Assembly is only the second ever held by the WHO’s governing body till date. The First special session of the WHA was held in November 2006, to accelerate the procedure to elect the Director-General after the untimely death of the then DG.
The recent special session was requested by WHO members after a series of critical reviews that exposed the weaknesses in dealing with the COVID-19 pandemic. In May, the Independent Panel for Pandemic Preparedness and Response recommended a pandemic framework convention using the powers of the WHO Constitution to be facilitated by WHO to address gaps in the international response.
The meeting was held amid the emergence of the Omicron variant from which the WHO has warned of “very high” global risk. “The emergence of the highly mutated omicron variant underlines just how perilous and precarious our situation is,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said at this special meeting. Further, he called the decision historic in nature, vital in its mission, and representative of a rare opportunity to strengthen the global health architecture to protect and promote the well-being of all people.
The news has been welcomed by advocates for building a global system to address the inequity and supply constraints that have emerged during the pandemic. Those advocating for a legally binding treaty believe that voluntary mechanisms have been of little help. A binding treaty or agreement between nations in the form of an accord or treaty has the potential to set out high-level, agreed principles to strengthen solidarity, equity, and one health for all, they believe. They also believe in the need for reinforcement of legal commitments to share data, virus samples and technology, and to ensure an equitable distribution of vaccines.
There has been growing emphasis on strengthening national and international capacities for implementing the International Health Regulations (IHR), better data management, a better mechanism for managing essential health commodities, and a sustained mechanism for sharing pathogen samples. The pandemic is believed to have been caused by fundamental weaknesses in the global health architecture, complex and fragmented governance, inadequate financing, and insufficient systems and tools.
The decision of having a global pandemic treaty marks the beginning of lengthy negotiations aimed at achieving consensus among the WHO’s 194 member countries. The agreement calls for negotiators to deliver the result of their deliberations in May 2024. Under the decision adopted by the special session, the intergovernmental negotiating body will hold its first meeting by 1 March 2022 to agree on ways of working and timelines and its second by 1 August 2022 to discuss progress on a working draft. It will also hold public hearings to inform its deliberations, deliver a progress report to the 76th World Health Assembly in 2023 and submit its outcome for consideration by the 77th World Health Assembly in 2024.
However, even as a new set of international pandemic rules might help nations contain the next outbreak more quickly, it is also feared that asking political leaders to commit to legally mandated cooperation rules in the midst of a crisis rather than looking out for their own national interests, may not be met with the same enthusiasm from all countries.
Growing concerns over the Omicron variant
Meanwhile, researchers are racing to track the concerning rise of the new B.1.1.529 variant of the SARS-CoV-2 coronavirus. Termed Omicron, the variant is currently spreading quickly across South Africa. It was first identified in Botswana early last month. As per WHO, the variant has been detected in 38 countries as on December 3.
On 26 November 2021, the WHO designated Omicron as a variant of concern on the advice of its Technical Advisory Group on Virus Evolution (TAG-VE). This decision was based on the evidence presented to the TAG-VE that Omicron has several mutations that may have an impact on how it behaves, for example, on how easily it spreads or the severity of illness it causes. The variant contains more than 30 changes to the spike protein that recognizes host cells and is the main target of the body’s immune responses. Many of the changes have been found in variants such as Delta and Alpha and are linked to heightened infectivity and the ability to evade antibodies.
The epidemiological situation in South Africa shows that in the recent weeks, infections have increased steeply, coinciding with the detection of B.1.1.529 variant. The first known confirmed B.1.1.529 infection was from a specimen collected on 9 November 2021. It is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. The number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiologic studies are underway to understand if it is because of Omicron or other factors.
Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron. There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.
Effectiveness of natural and vaccine induced immunity against Omicron
Preliminary evidence suggests there may be an increased risk of reinfection with Omicron ie, people who have previously had COVID-19 could become reinfected more easily with Omicron, as compared to other variants of concern, but information is currently limited.
Th WHO is working with technical partners to understand the potential impact of this variant on our existing vaccines. Vaccines remain critical to reducing severe disease and death, including against the dominantly circulating Delta variant. Current vaccines remain effective against severe disease and death. The Director General of the Indian Council of Medical Research, Dr Balram Bhargava highlighted that at present it is premature to comment on the effectiveness of the vaccines against the new variant of concern — and that the Indian scientists have to isolate the Omicron variant, culture, and test it in laboratory settings to ascertain the effectiveness.
The widely used RT-PCR tests continue to detect infection, including infection with Omicron, as seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests. Current treatments will be assessed to see if they are still as effective given the changes to parts of the virus in the Omicron variant.
Cases of Omicron continue to be detected in India keeping authorities on alert
Several states in India have stepped up vaccination, surveillance, and containment measures as the country has detected 21 cases of the Omicron variant as on December 6.
The first two cases were reported in Karnataka, followed by one in Jamnagar (Gujarat) and another in Maharashtra. Later, on December 5, seven cases were reported in Maharashtra’s Pune district, of which six belonged to the same family. In Jaipur, nine cases of the Omicron variant were confirmed — all of whom had attended the same wedding. In Delhi, a man in his 30s was found to be infected with the new variant and admitted to the Lok Nayak Jai Prakash Narayan hospital. As on December 2, the symptoms presented in both the Karnataka patients were mild.
The Union Ministry of Health issued revised ‘Guidelines for International arrivals’ on November 28. The updated guidelines require all travelers (irrespective of COVID-19 vaccination status) coming to India from countries identified as ‘countries at-risk’ to mandatorily undergo post-arrival COVID-19 testing at airport on arrival in addition to pre-departure COVID-19 testing undertaken 72 hours before the departure. Passengers found positive in these tests will be isolated and treated as per the clinical management protocol besides their samples will also be taken for whole genome sequencing at identified INSACOG network laboratories to determine the presence of SARS-CoV-2 variants (including Omicron). Passengers found negative must be in home isolation for 7 days, followed by repeat testing on 8th day of arrival in India, followed by 7 days of self-monitoring. Further, 5 percent of the travelers coming from countries which are not in the ‘at risk category’ will also be tested on random basis at the airports for COVID-19.
Samples of all individuals testing positive for Covid-19, either at airports under home isolation or during random sampling, will also be sent for Whole Genomic Sequencing at
States have also been advised for rigorous surveillance of international passengers, enhanced testing, monitoring the hotspots of COVID -19, ensuring augmentation of health infrastructure, including undertaking samples for whole genome sequencing.
The WHO recommends that countries should continue to implement the effective public health measures to reduce COVID-19 circulation overall, using a risk analysis and science-based approach. The precautions and steps to be taken remain same as before. It is essential to mask yourself properly, take both doses of vaccines (if not yet vaccinated), maintain social distancing, practice hand and respiratory hygiene, and maintain good ventilation to the maximum possible.
While governments continue to closely follow the evolving nature of the pandemic, strict adherence to COVID appropriate behavior and getting the Covid-19 vaccination remain the mainstay for managing COVID-19 at the community level.