Last year was supposed to be the year of the vaccine. What will 2022 bring? Marc Daalder reports

Analysis: At the start of 2021, there was a light at the end of the Covid-19 tunnel.

Overseas, brutal winter waves of Covid-19 were sparking record death tolls in Europe and North America. Multiple new variants of the virus were seen as more transmissible and fuelling the surge. But the cavalry had arrived: vaccines.

Already, the richest countries of the Global North had started their vaccination programmes. Soon, everyone hoped, the coronavirus would fade into the same background noise as influenza or common colds.

Obviously, 2021 did not go that way. It soon became clear that the new variants were so transmissible that herd immunity could no longer be achieved through vaccination alone. New Zealand managed to eliminate incursions of some of these variants, but then Delta crashed onto the scene. Deaths spiked overseas and Auckland collapsed into lockdown.

Making any hard and fast predictions about what 2022 might bring is a surefire way to make a fool of one’s self. Instead, Newsroom sets out here the key Covid-19 questions for the new year:

Is Omicron the new Delta?

Just as the global Delta surge faded and winter arrived in the northern hemisphere, Omicron was detected in southern Africa.

The new variant has prompted sharp spikes in cases around the world. On average, the number of daily new Omicron infections was doubling every two to three days in most countries with community transmission of the variant in late December.

While South Africa, originally the epicentre of the Omicron wave, appears to have turned the corner, it remains to be seen whether that will happen elsewhere. Will Omicron cause brief spikes in cases or will it linger like Delta, causing many more cumulative hospitalisations and deaths as a result?

Previous variants have also supplanted one another. Alpha, in the United Kingdom, displaced the original wild-type coronavirus in November and December 2020. By mid-2021, Delta was king in Britain and almost no Alpha cases showed up in sequencing.

Omicron may not play the same role. Because its mutations are so different from those of Delta, it’s possible that infection by one of these variants doesn’t lend immunity against the other. In the United Kingdom in late December, the percentage of likely Omicron cases flattened out at about 75 percent. The remaining quarter of daily cases could have been the variant’s “stealth” version – detectable by the usual genomic sequencing but not a quick and rough PCR method used for early surveillance – or they could have represented a simultaneous surge in Delta cases.

As the new kid on the block, Omicron certainly has the greatest potential to infect the most people. But that doesn’t necessarily mean it will completely outrace Delta. The two could coexist, fuelling alternating or simultaneous waves of hospitalisations and deaths for some time to come.

Should we expect another variant by the end of the year?

Almost certainly yes.

Omicron is just the latest variant. It may be spreading faster than any previous version of the virus, but that doesn’t mean that evolution has run out of tricks. After all, Delta was the nightmare strain just a few months ago.

“We really have to plan for a succession of variants that will emerge around the globe and probably emerge in a similar way that Omicron has,” University of Otago epidemiologist Michael Baker said.

“It does look like we’re going to see successive waves of variants that are getting most of their advantage from immune evasion.”

Baker also cautions against assuming future variants will be less virulent – cause less severe disease – than the ones we have now. The jury is still out on whether Omicron is inherently less severe or whether it is just infecting populations less likely to be hospitalised by the coronavirus (such as young people or vaccinated people). We may not know the answer until mid or late January.

Either way, it’s a common but false conception that viruses inherently evolve to become more transmissible and less damaging. Evolution selects for traits that make it easier for the virus to spread, but that can have little or no impact on virulence – or even amp up the severity of disease.

How will New Zealand respond?

The traffic light system was developed for Delta, but the Government seems confident it can hold up to future variants as well.

Already, the reopening of the borders has been pushed back as we await more data about Omicron. Alongside the borders, the traffic light system was supposed to be our ticket to freedom. Those who were vaccinated could enjoy life as normal in most settings. Even the strictest one, red, would be sort of like Level 2 under the alert level system for the double jabbed.

Baker now expects to see two key changes as the year progresses – and particularly once Omicron makes it into the community.

First, boosters are likely to be added to the definition of “fully vaccinated”. That means that once your vaccine pass expires – currently they’re set to do so every six months – you’ll need to have had your booster in order to renew it.

Second, additional public health measures should be layered on top of the traffic light system, in Baker’s view.

“We’re going to need to keep all our public health and social measures going because they’ll work on all versions of the virus, as we’ve always known,” he said.

“They got us through the first year with no vaccine. It may be the strategy depends much more on public health measures.”

Vaccination will still play a crucial role in slowing the spread of the virus but something extra is likely to be needed in addition.

When will it end?

As rich countries reach high triple dose levels – or even quadruple, with some countries now recommending a second booster shot – the conversation about vaccine equity will heat up.

Those in the developed world will be frustrated as new variants which come into being in poorer countries fuel massive surges even in highly-vaccinated Europe and North America. But this is simply the result of lack of access to vaccines, giving the virus the perfect opportunity to spread more, mutate more, and evolve traits that allow it to move through unvaccinated and vaccinated populations alike.

The World Health Organisation now says that Africa (the entire continent of 1.3 billion people) won’t reach its target of vaccinating 70 percent of its population until late 2024. That’s nearly three years away. And that’s just for two doses – forget about boosters.

Expect even greater focus on the inequities of the global vaccine rollout in this context. A handful of wealthy European countries are blocking a proposal at the World Trade Organisation to loosen patent rules for coronavirus vaccines, which would allow the doses to be manufactured more widely. New Zealand and the United States have ostensibly come out in support of the proposal, but have done little to actually change the minds of their wealthy partners.

This will be the flashpoint of the vaccine equity conversation. It will take place in international fora and in domestic debates over whether we should be using our bully pulpit to chastise holdouts in the United Kingdom and European Union.

One thing is certain: The pandemic won’t end for New Zealand until it ends for everyone. As long as the developing world can’t access vaccines, we’ll always live under the threat of new variants blasting holes in our own vaccine-acquired immunity.

Marc Daalder is a senior political reporter based in Wellington who covers climate change, health, energy and violent extremism. Twitter/Bluesky: @marcdaalder

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