Editor’s Note: Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention during the Obama administration, when he oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is President and CEO of Resolve to Save Lives, an initiative of Vital Strategies and Senior Fellow for Global Health at the Council on Foreign Relations. Twitter: @DrTomFrieden.
On Thanksgiving morning, Covid reminded us that neither death nor mutations take a holiday. And while the virus gathers strength, a pandemic of pandemic fatigue undermines our ability to stop the virus. The newly discovered Omicron variant quickly led to border closures, a stock market plunge, and a collective sigh of despair: Will the pandemic ever end?
To stop disease spread, we need to learn quickly, communicate well, and act effectively.
There’s a lot we don’t know yet about Omicron, and definitive answers to the most important questions will likely take weeks or longer. The most valuable resource we need to live well and prosper in the age of Covid is timely, accurate information, accurately interpreted and appropriately acted on.
The most important unknown about Omicron is to what extent it evades protection from vaccines and prior infection. And the most important unknown about our response is whether governments can retain the trust of enough people to implement effective control measures. Our best hope to control the pandemic is to learn together and spread best practices around the world.
Media coverage of Omicron has, understandably, driven a sense of despair. But it’s encouraging to reflect on the enormous progress of the past year. We know more about how the virus is transmitted, risk factors for and treatments to better care for patients with severe disease, and that masks, ventilation, and distancing prevent spread. Most of all, we have remarkably safe and effective vaccines.
Let’s not sugar-coat what’s coming. The United States and Europe are already experiencing a large Covid surge from the Delta variant, the flu season is starting, and Omicron is likely to cause another wave of infections. Even without Omicron, the U.S. would be facing difficult months ahead. It’s shaping up to be a hard winter.
Although there are important roles for better ventilation and effective testing programs, success confronting Covid will, on one hand, take increased vaccination and indoor masking, including through mandates, and on the other hand, individual and societal decisions on balancing individual and collective risks and benefits.
First, vaccinate, vaccinate, vaccinate. That is: Reach those who haven’t yet received their first dose. Even places with high vaccination rates are vulnerable to large outbreaks, primarily among the unvaccinated. A more infectious variant increases the threshold for herd immunity. Get third doses to those who are immunosuppressed, and boost everyone. And vaccinate the world. When it comes to immunity against a potentially deadly virus, more is better.
We set ourselves up for new dangerous variants by failing to address global vaccine equity. Most people in high-income countries are fully vaccinated and tens of millions have gotten boosters while less than 10% of Africa’s population has been fully vaccinated. Manufacturers have consistently missed their production targets, and poorer countries have been at the back of the line for vaccines.
Rapidly expanding production of highly effective mRNA vaccines is our best hope of preventing more dangerous variants from causing another pandemic wave. The persistent failure of Pfizer and Moderna to either expand vaccine production sufficiently themselves or license their technology to consortia of other producers means that billions of people, including virtually everyone in lower-income countries, remain avoidably at risk from infection and death.
The mRNA technology is faster to scale up and more easily tweaked to address variants; both companies announced they could have Omicron-specific vaccines ready within months. But the global need could easily be at least four times the current production capacity of both companies combined.
Second, although we’ve gotten used to going without masks, with increasing cases and a more infectious variant, it’s time to mask up again. If everyone masks indoors where Covid is spreading, everyone is safer.
Just as your right to swing your fist doesn’t extend to someone else’s nose, your right to bare your nose and mouth doesn’t extend to killing someone by spreading a deadly virus. Mask mandates need to be implemented, enforced, and adherence monitored to build a collective sense of responsibility and achievement at high levels of mask wearing.
This can be done by tracking and publishing rates of appropriate indoor mask usage and keeping them above 90%. Fix the market so anyone can buy an effective mask at a reasonable price, and give away masks, including N95s, to those who need them. If you’re older or immunosuppressed or live with someone who is, and especially if others around you aren’t masked, you’ll be safer if you upgrade to an N95.
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Third, balance risks and benefits. Vaccination and indoor mask mandates are required, both ethically and for disease control. But many other decisions need to be based on individual and societal values. Ratcheting protections up and down based on how much Covid is spreading – how hard it’s raining Covid outside – can help, but which gatherings to restrict, whether to go to restaurants and bars, and how to balance economic activity with protecting public health can have different right answers for different people, at different times and in different places.
Pandemics – including pandemics caused by new SARS-CoV-2 variants – are not inevitable. Information is power. Viruses outnumber us trillions to one; our best hope is to outsmart them.