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After months of what seemed to be a receding pandemic supported by vaccines and adherence to new COVID appropriate protocols as the new normal, the world is witnessing the ghosts of the past rising once again. Barely months after the Indian strain called the Delta, or B.1.617.2 which was 40-60% more transmissible than Alpha and almost twice as transmissible as the original Wuhan strain of SARS-CoV-2 took over the world as a dominant strain, a new variant dubbed as "Omicron (B.1.1.529)" has emerged. Originally detected in South Africa in mid-November 2021, Omicron is now spreading across the globe with Asia, Europe, and North America reporting infections from this strain.

In addition to acquiring the mutations of the delta variant, the Omicron variant has over 50 mutations with 32 of them seen on its spike protein, two times higher than Delta, indicating that the virus has further adapted to the human species. Even more worrisome and unsettling is the fact that the variant also includes the vaccine-resistant alterations seen in Beta variant. The worst variant the pandemic has thrown up till date and carrying the mutations P681H and N679K, Omicron is feared to reduce vaccine effectiveness by close to 40% to 50%. There are fears that this strain is capable of outsmarting monoclonal antibodies, such as Regeneron`s treatment, since these therapies target parts of the virus that have now mutated. Currently classified as `variant of concern`, fears over the spreading Omicron have once again pushed countries across the globe to re-impose international and domestic travel restrictions. Omicron is now expected to displace the circulation Delta and other variants. It`s only a matter of time before a newer more competitive virus emerges. With Europe already battling fourth and fifth waves of infections, the new Omicron variant is bringing back ghosts of the past year. Fears are again rising over possible increase in infections, mortalities, overburdened hospitals, healthcare systems and lockdowns resulting in yet another economic nightmare. Lockdowns, travel and movement restrictions will be back once again if infection from this new strain fails to be controlled. India which is just recovering from the intense second wave with hopes of the disease reaching an endemic state, the new variant is reigniting fears of a possible third wave.

With several countries facing repeated waves of infections, the world is up against a new challenge in this war against the virus. An uphill challenge confronts governments in rapidly stepping up efforts to accelerate the pace of vaccine administration, despite numerous challenges. It`s a race against time and to successfully end the pandemic, mass vaccination drives must outpace the speed with which the coronavirus is currently mutating. Vaccine inequality is the prime reason behind the emergence of these new series of mutant strains which are more infectious, transmissible and responsible for resurgence of infection outbreaks worldwide. With the rise in vaccination rates especially in developed countries, measures designed to limit the spread of Covid-19 like mask mandates and capacity limits have been relaxed. The subsequent relaxation strengthened consumer confidence and allowed economic activity to return to normalcy. However, with the Covid-19 virus rapidly mutating, new variants have emerged in many parts of the world, posing a threat of potential future waves. Different parts of Europe are currently witnessing fourth and fifth waves of infection spread. These new variants are more deadly than the original virus, more easily transmissible and can impact the effectiveness of vaccines.

Prolonging pandemic and new mutant strains means that immunity among vaccinated population is beginning to slip, throwing the focus on booster doses. The leading vaccine makers, Pfizer-BioNTech, Moderna and AstraZeneca announced plans to pursue development of booster shots to address the emerging threat of new virus variants. The booster shot will be essential to keep the immune system to the optimum level. A number of wealthy countries like the US, Germany and Israel are considering booster shots to increase protection against Covid-19. Germany is expected to roll out booster shots to vulnerable individuals. mRNA-vaccines from Pfizer/BioNTech and Moderna will be offered as booster shots, regardless of the vaccine administered previously. In India, Bharat Biotech, the makers of Covaxin, received regulator`s approval for conducting trials for a third shot that will be administered as a booster dose. While a booster dose is typically an exact replica of the initial vaccine, it can also be tweaked. Moderna, AstraZeneca, Pfizer are working on variant-specific booster shots. Recently, Moderna announced positive initial data from its ongoing phase 2 study.

The data revealed that the booster dose increased neutralizing antibody responses against the original virus as well as B.1.351 and P.1, in previously vaccinated individuals. Studies suggest that a third dose can boost antibodies even in immunocompromised patients. The rapid pace at which new strains capable of evading antibodies are rising is throwing the focus on vaccine tweaking and researchers are already working on updating vaccines with the new spike proteins to prepare for new variants with a new version of the vaccine. This however requires additional clinical trials, more time consuming research work, and regulatory approvals. The time-to-market remains a main challenge with the process taking six to eight months before vaccines can be updated and commercialized. This time-consuming development process is a major setback when compared to the rapid rate of infection spread from new strains.

In this race against virus evolution, swift and rapid vaccinations are the need of the hour to limit the spread of mutant strains, notwithstanding the fact that vaccines themselves are contributing to virus mutations. Rapid mass vaccinations will make the mutation process and threat more manageable. It is an undeniable fact that vaccines will see a slow erosion in efficacy and effectiveness over the long-term. Therefore it is important to slow the spread of the virus by vaccinating as many people as possible at the earliest. To end the pandemic, which currently seems to have received yet another setback will require more dedicated focus on vaccine equality, international cooperation in COVID research, more transparent information transfer and alert systems on new emerging strains, waiver of IP on vaccines, and science-based swift decisions regarding travel bans. All of these are vital to prevent squandering away "hard won gains" achieved against the virus over the last 2 years.