Europe must come together to confront omicronBMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o90 (Published 13 January 2022) Cite this as: BMJ 2022;376:o90
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- Health professionals and researchers from across Europe
The SARS-CoV-2 omicron variant is spreading rapidly in Europe, even in countries with high levels of vaccination, including those that have moved quickly with booster vaccinations.12 We write as health professionals and researchers from across Europe to call for concerted European action to address the immediate threat and to move rapidly to develop joint plans to tackle future variants of concern effectively. EU Member States have accepted the principle of a European Health Union and have put in place measures to create a Health Emergency Preparedness and Response Authority.3 They now need to show that they can work together in ways that they have not always done before.
The need for urgent action stems from knowledge gained from laboratory and epidemiological studies that antibodies resulting from vaccination or prior infection with earlier variants have reduced ability to neutralise omicron, leading to frequent reinfections.45 While infections with omicron appear to be inducing less severe disease and to result in fewer deaths in these highly vaccinated populations, it is still causing high levels of hospitalisations in many countries, with pressure on health services exacerbated by infections among health and other essential workers.1678 There are also worrying reports of its impact on children, who in most countries have been at most only partially vaccinated, as well as concerns about its longer term consequences, including long covid. While early reports from South Africa, amplified by media organisations, suggested that omicron is causing “mild” disease, the Director General of World Health Organisation (WHO) has argued that it should not be categorised in this way.9
Two years into the pandemic, the dangers of delayed, ineffective, or uncoordinated mitigation measures should be clear. We also know which strategies are most effective.10 These are a combination of minimising mixing with others in indoor spaces, and where this cannot be avoided, making these settings safer with good ventilation, air filtration, and mask wearing, supported by appropriate use of testing. There is no excuse for delay or inaction.
Why the urgency? Sera of vaccinated individuals exhibit a substantial reduction in ability to neutralize omicron, with most currently available monoclonal antibodies incapable of neutralising it.11121314 Vaccination with only two doses offers little protection against infection but protection does increase markedly following a third dose.413 There is also reassuring evidence that vaccination induces a T cell response against omicron, although the duration of protection conferred by a third dose remains to be determined.15 However, despite the success of vaccination programmes in many countries, the majority have yet to receive booster doses and there are still many people with little or no immunity, including those with reduced immune function, for example due to age or comorbidity, and children who, in most countries, have yet to be vaccinated, who have no history of prior infection.
For now, here are at least two critical questions (i) how well vaccination protects against infections and severe disease over time, noting that, so far, omicron has not yet spread extensively into older age groups in many countries and (ii) how much pressure the increased transmissibility and/or immune evasion of omicron puts on health systems, both through increased numbers of patients and staff absences. Even under the most optimistic assumptions, letting omicron run unfettered risks potentially devastating consequences. Our call for an immediate, united, coordinated response across Europe is threefold:
First, we urgently need to reduce infections to avoid overwhelming health systems and protect public life and the economy. Our concern is not only with the burden of severe disease; it is also with absences, through illness, even if mild, or quarantining of essential workers in all sectors, including education, transport, and infrastructure.1617 Implementing effective measures such as working from home, mask mandates, and reducing indoor gatherings would bring rapid benefits, relieving pressure on these systems, and thus decreasing the likelihood of needing far-reaching stringent measures, such as closures, curfews, or lockdowns. These policies can certainly be adopted at national or regional levels but, from a European perspective, more can be done by coordinated action. Specifically, we need a coordinated communication strategy to support them, saying loudly and clearly that “covid is airborne,” with everything that follows from that. In particular, this points to a focus on measures that seek to ensure that the settings for common gatherings, for example in schools, factories, and entertainment venues, provide as safe environments as possible. This must be supported by coordinated guidance and, in due course, European legislation on how to make them safe, including ventilation standards.
Second, we need to protect children in ways that allow them to benefit from education safely. There are clear signals from South Africa and the United States of a steep rise in hospital admissions among children associated with high community transmission even if it is still unclear how this translates to Europe.1819 However, if we wait for more evidence, the sheer number of hospitalised cases, even if not severely ill, could soon overwhelm limited paediatric care capacity. In this context we must note there are few anti-covid treatments currently approved for children and those approved for adults are also in short supply. European countries have, so far, varied greatly in how they have responded to covid in schools. For now, we call on all relevant actors, including European professional bodies (in health and education), the European Commission, and the European Region of WHO to engage in urgent discussions on how to share experience of good practice in both safe classrooms and remote learning.
Third, we need to buy time so that more individuals, including children, can be vaccinated, including scale up of supplies of paediatric doses. Rapid scale-up of vaccinations and boosters is essential, but will not be fast enough to defeat the omicron wave. However, we can prepare for further variants. This requires concerted European (and indeed global) action to develop new polyvalent and new variant vaccines, coupled with a concerted campaign to reach those who have yet to be vaccinated. Again, we call for sharing of best practice, including measures that overcome the remaining barriers that people face, as well as concerted Europe-wide measures for infodemic management, and especially targeting sources of disinformation. This will necessitate engaging with social media platforms in ways that individual countries may find difficult. However, Europe also needs to do more to make the world safe. This includes additional support for Access to COVID-19 Tools (ACT) and the COVID-19 Vaccine Access Facility (COVAX), as well as withdrawal of opposition to measures that would facilitate manufacturing in low and middle income countries.
The European response in the early stages of the pandemic was often fragmented and delayed.20 We cannot make the same mistakes again.
André Calero Valdez, RWTH Aachen University, Aachen, Germany; Emil N. Iftekhar, Max Planck Institute for Dynamics and Self-Organisation, Göttingen, Germany; Miquel Oliu-Barton, Paris-Dauphine University, Paris, France, and Bruegel, Brussels, Belgium; Robert Böhm, University of Vienna, Vienna, Austria, and University of Copenhagen, Copenhagen, Denmark; Sarah Cuschieri, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Thomas Czypionka, Institute for Advanced Studies Vienna, Vienna, Austria, and London School of Economics and Political Science, London, UK; Uga Dumpis, Pauls Stradins University Hospital, University of Latvia, Riga, Latvia; Giulia Giordano, University of Trento, Trento, Italy; Claudia Hanson, Karolinska Institute, Solna, Sweden; Zdenek Hel, University of Alabama at Birmingham, Birmingham, USA; Anna Helova, Sparkman Center for Global Health and Department of Health Policy and Organisation, School of Public Health, University of Alabama at Birmingham, Birmingham, USA; Ilona Kickbusch, Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland; Peter Klimek, Medical University of Vienna, Vienna, Austria, and Complexity Science Hub Vienna, Vienna, Austria; Lilian Kojan, RWTH Aachen University, Aachen, Germany; Mirjam Kretzschmar, University Medical Center Utrecht, Utrecht, The Netherlands; Tyll Krueger, Wroclaw University of Science and Technology, Wroclaw, Poland; Jenny Krutzinna, University of Bergen, Bergen, Norway; Berit Lange, Helmholtz Center for Infection Research, Braunschweig, Germany; Jeffrey V Lazarus, Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Helena Machado, Institute for Social Sciences, University of Minho, Braga, Portugal; Martin McKee, London School of Hygiene and Tropical Medicine, London, UK; Kai Nagel, TU Berlin, Berlin, Germany; Matjaž Perc, University of Maribor, Maribor, Slovenia, Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Elena Petelos, University of Crete, Heraklion, Greece, Maastricht University, Maastricht, The Netherlands; Nedyu Popivanov, Bulgarian Academy of Sciences and Sofia University, Sofia, Bulgaria; Bary Pradelski, CNRS, Grenoble, France, and Oxford-Man Institute, Oxford, UK; Barbara Prainsack, University of Vienna, Vienna, Austria; Kay Schroeder, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Sotirios Tsiodras, National and Kapodistrian University of Athens Medical School, Athens, Greece; Paul Wilmes, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Guntram Wolff, Bruegel, Brussels, Belgium, and Université libre de Bruxelles, Brussels, Belgium.
Funding: Digital Society research program funded by the Ministry of Culture and Science of the German State of North Rhine-Westphalia (ACV). The Max Planck Society (ENI). German Research Foundation (DFG) grant BO 4466/2-1 (RB). University of Malta (SC). European Union’s Horizon 2020 research and innovation programme under grant agreement No 101016233 (PERISCOPE) (TC). National Research Programme project VPP-COVID-2020/1-0008 (UD). Strategic Grant MOSES at the University of Trento (GG). National Institutes of Health, USA (ZH). European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme, grant agreement no. 724460 (JK). European Union’s Horizon 2020 research and innovation program under grant agreement No 101003480 Project CORESMA (BL). Initiative and Networking Fund of the Helmholtz Association (BL). German Federal Ministry of Education and Research, NaFOUniMedCovid19 FKZ: 01KX2021 (BL). Netherlands Organisation for Health Research and Development (ZonMw), 91216062 (MK). European Union’s Horizon 2020 research and innovation program under grant agreement No 101003480 (Project CORESMA) (MK). University Paris-Dauphine and Bruegel (MOB). Slovenian Research Agency, Grant Nos. P1-0403 and J1-2457 (MP). University of Crete and from Maastricht University (EP). Bulgarian NSF under Grant Nº КП-06-ПН52/4 (NP). Luxembourg National Research Fund (FNR) as part of the COVID-19 Fast-Track research project CO-INFECTOMICS, COVID-19/2020-1/14729513 (PW). European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme, grant agreement no. 863664 (PW).
Competing interests: ZH received grants from the National Institutes of Health. JVL has received funding from AbbVie, Gilead Sciences, MSD, Intercept, Janssen, NovoVax, has participated in a board for the study ‘Same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (The QuickStart Study): a cluster randomised control trial - Australia’, and he is Vice-Chair of the EASL International Liver Foundation, all of which is unrelated to this work. MMK has received funding from the EU Horizon Europe, Wellcome Trust, and UKRI, and is part of Independent SAGE (UK) which is non-remunerated. KN has received funding from the TU Berlin and the BMBF (German Federal Ministry of Education and Research). BPrainsack is a member of the Austrian National Bioethics Committee advising the Federal Government, and in other COVID-19 related advisory positions, all of which are not remunerated. PW has received funding from the Luxembourg National Research Fund and the University of Luxembourg, is co-speaker of the Research Luxembourg COVID-19 Task Force and president of the Luxembourg Society for Microbiology. All other authors have no competing interests.