'Covid Zero' to 'Living with Covid'

The vaccination rate and vaccines' effectiveness against whichever is the dominant variant must determine policy makers' response from now on

Few of us will sympathise with Novak Djokovic. On Sunday, the unvaccinated Serbian tennis player lost his second appeal against the Australian federal government’s decision to deport him from the island commonwealth; he will now lose his chance to win his tenth Australian Open, which would take him up to a world record 20 Grand Slam men’s singles titles. He may be banned from returning for three years, which is no less than he deserves for thinking himself above the rules.

Yet Australia’s strict implementation of its rules limiting travel seems odd to some outsiders, given that Omicron is running through the country at an astonishing rate. Last Thursday, Australia recorded more than 100,000 new Covid cases.

Various extraordinary measures meant to control the spread of the pandemic are not unlike extraordinary monetary policies: They may be easy for governments to impose in the face of a crisis, but they are not so easy to withdraw. Australia was once a “Covid Zero” country, with draconian lockdowns and hermetically sealed borders. Melbourne, home of the Australian Open, was over the past two years the most locked-down urban agglomeration in the world: Full lockdowns were declared in the city six times, for a total of 262 days. Yet, in August 2021, the federal government abandoned its Covid Zero strategy. (The state of Western Australia, run by the opposition Labor Party, has lower vaccination rates and is still committed to minimising cases even in the face of the Omicron variant.) Singapore, another high-profile Covid Zero location, abandoned the quest a little later, and so did some other Asian countries. Singapore’s reopening was notably difficult; the city-state that had long been at the top of Bloomberg’s “Covid resilience ranking” fell to 39th position in October 2021. Moving from a Covid Zero strategy to one based around living with Covid, clearly tested even Singapore’s famously competent state.

Illustration: Ajay Mohanty

The reversal of Australia’ Covid Zero policies coincided with the arrival of Omicron. The sudden pressure on state capacity meant that the country swiftly began to see a shortage of tests, individual Australians started ignoring positive test results, and political divisions between states and the central government sharpened.

As Australia demonstrates, reversing policies meant to control Covid is far from straightforward. It requires uncommon policy flexibility. If anything, you need to be even more dependent upon scientific and epidemiological advice when you decide to lift restrictions than when you impose restrictions. Australia cost itself by shifting later than most countries from restrictive policies to trust in vaccines — partly because its leadership made the mistake of refusing to trust the Oxford-AstraZeneca shot. Now that it has accepted scientific reality, almost 93 per cent of Australian adults have two shots, and boosters are being rolled out even faster.

Aside from Western Australia and New Zealand, the only remaining Covid Zero holdout is the People’s Republic of China (and its colony, Hong Kong). It is in general even harder to sympathise with the old men who rule from the Forbidden City than it is with anti-vaxxer Serbian tennis players — but at least the Communist elite’s fears may be rational. The country is supposedly vaccinated, but it has depended on the homegrown inactivated virus vaccines made by Sinovac and Sinopharm, which use technology similar to that in Bharat Biotech’s Covaxin and Iran’s COVIran Barekat. Multiple real-world studies have shown that Sinovac and Sinopharm lose some of their effectiveness against the Delta variant, and even more against Omicron.

The largest such study, which followed over 60 million Brazilians vaccinated with both the Oxford-AstraZeneca vaccine and by Sinovac, showed that the latter was considerably less effective, reducing the risk of death in those over 80 by only 35 per cent. Real-world studies of this sort against Omicron are rare, but Hong Kong scientists studied the blood of 25 residents that had received a full course of Sinovac and found that none of them had detectable neutralising antibodies against Omicron.

We should have no doubt that mainland China’s leaders have access to similar data, and this is playing a major role in their unwillingness to risk lifting strict restrictions. The biotech company Suzhou Abogen Biosciences is testing an indigenously developed messenger RNA booster, and it seems more than likely that China’s borders will remain closed until that shot has been rolled out and proved to be efficacious. There’s a lot to criticise Beijing for in its Covid policy, but its continued unwillingness to open its borders is not one. If anything, it looks like it may be solidly grounded in scientific evidence.

Policies designed for the original variant in a world without vaccines are obviously not necessarily the right ones for a world with vaccines; nor are they the right ones for a world in which Delta replaced the original variant, or Omicron has replaced Delta. Each of these combinations should throw up a different set of optimal policies. Opening up — “unlocking”, as we call it in India — may not operate only in one direction. New variants, the fading of vaccine protection, new superspreader events may all require some restrictions to be reimposed. But these should be well informed, based on scientific evidence, and reversed when necessary.

In other words, the combination of vaccine prevalence and their effectiveness against the dominant variant must be, in the coming months, central to decisions about social distancing rules, border requirements, and so on. It may be hard for politicians and policy makers to accept that there is no easy deterministic prediction for what rules might be valid, say six months from now. But they have no option but to ensure that scientists have access to the data that would reveal these two crucial pieces of information: Which variant is dominant, and vaccine effectiveness against that variant. And policy makers, recognising that more and better vaccines are always helpful, must keep on expanding and deepening their national vaccine rollouts.

The writer is head of the Economy and Growth Programme at the Observer Research Foundation, New Delhi