Perverse incentives

Genomic surveillance vital for global public health

The newly discovered variant of Covid-19, named Omicron by the World Health Organization, has now been identified in multiple countries around the world. There is no clear scientific evidence yet as to whether it exhibits immunity escape, which would put those who are vaccinated or have recovered from a previous case of Covid-19 at risk. Nor is it clear if it is more or less severe in terms of hospitalisation or fatalities than the now dominant Delta variant. Yet stringent travel bans targeting southern African countries have already come into force. South African President Cyril Ramaphosa said in a speech on Sunday there was no scientific basis for travel bans and that they were unfair.

It is certainly the case that when such bans are imposed countries should consider the incentives they are setting up for national health authorities if future variants are discovered. The South Africans did everything right: They ensured that a large proportion of their Covid-19 test samples were sent for genomic sequencing to identify variants, and when a new variant was found they shared the data fully and swiftly with the global public health community. For the country and its neighbours to now be targeted for action sets up problematic and perverse incentives that may significantly delay the announcement of future variants. In the long run, that would be more dangerous for public health than any benefits accruing from hasty travel bans.
 

This is not to say that countries, including India, should not respond to the emergence of Omicron. Certainly, surveillance and testing at airports as well as the requirements on international travellers will need to be stepped up. The Indian authorities have already done so —except these do not come into force immediately, but with a lead-in time from December 1, a delay which does not make a great deal of sense. As with lockdowns, travel bans have been shown to have a limited level of effectiveness over time, and other forms of public health response are probably more efficient responses to a new variant.

Among these responses must surely be a return to higher levels of testing of the public. But in India that will not be sufficient because too few samples from Covid-19 positive tests are being collected and sent for genomic sequencing. As reported by this newspaper, less than 0.5 per cent of samples have been subjected to genomic analysis to identify variants. Further, rather than showing an increase over time as more capacity has been added, the pace is in fact slowing on average. Concern has been raised for months that genomic sequencing is not enough of a priority for the government. Earlier this year, the head of the relevant government committee resigned, stating that barriers were being placed in the way of evidence-based policy making to counter the pandemic, and there were reports that the government had been informed weeks ahead of the devastating second wave that the Delta variant was being observed in a large proportion of sequenced samples. These errors must be learned from and not brushed under the carpet. India must test more, and sequence more — and, finally, the data from genomic surveillance must inform policy decisions. This is the right way to respond to Omicron, not knee-jerk travel restrictions.