Coronavirus (COVID-19) Press Conference with Sikhulile Moyo, Roger Shapiro and Joseph Makhema, 12/03/21

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Sikhulile Moyo, laboratory director for the Botswana Harvard HIV Reference Laboratory in Gaborone, Botswana, and research fellow in the Department of Immunology and Infectious Diseases. And Roger Shapiro, an associate professor of immunology and infectious diseases and chair of the board of directors of the Botswana Harvard AIDS Institute Partnership. And Joseph Makhema, CEO of the Botswana Harvard AIDS Institute Partnership. This call was recorded at 11:00 a.m. Eastern Time on Friday, December 3rd.


MODERATOR: All right. Dr. Shapiro, would you like to open it up? Do you have any opening comments for us?

ROGER SHAPIRO: Sure. Thank you, Nicole. I have a quick opening statement. So good morning, it’s my pleasure to speak with you today about the Omicron variant and its initial discovery by Dr. Sikhulile Moyo at the Botswana Harvard partnership for BHP. The first point I’d like to make is that this discovery was not accidental. During the course of the epidemic, Dr Moyo has worked to continuously sequence the SARS-CoV-2 viruses that have been identified by our laboratory, and he has worked in close cooperation with the Botswana government and the COVID task force of Botswana in leading these efforts. He tracked the shift to the beta variant in very early 2001 and then the shift to the Delta variant later in the year. And his team at BHP has sequenced over two thousand three hundred viruses and is currently working at to do many more. And Dr. Moyo is poised to quickly identify any new variants that emerged in Botswana. The second way that this wasn’t an accident is that the BHP Lab had the capability to perform virus sequencing through our long-standing work to combat HIV in Botswana, and Dr Moyles team could rapidly pivot to working on the SARS-CoV-2 when it when the pandemic hit. And this demonstrates the value of long-term investments in research, infrastructure and research led by scientists in Africa and throughout the world to fight global infectious diseases. But as we learn, no good deed goes unpunished, and the travel bans that have emerged from this scientific finding are counterproductive. They will not protect us from new variants such as Omicron, which is now spreading in over 38 countries, and they have a large human and scientific cost attached to them. There’s a far better path for minimizing the impact of new variants and for reducing the chance that they will emerge, which is to roll out vaccines everywhere by reducing the amount of total circulating virus worldwide. We will reduce the chance that it can mutate and of course, will save lives. So thanks. Happy to answer any other questions.

MODERATOR: Thank you, Dr. Shapiro. Dr Moyo, do you have anything you’d like to add?

SIKHULILE MOYO: Thank you, Professor Shapiro. Thank you for the opportunity for the work that is being done in Botswana. As you know, the Botswana Harvard partnership established in 1996 between the Harvard School of Public Health and the government of Botswana and the Minister of Health has really laid out a foundation for a number of groundbreaking research, from mother to child transmission studies to antiretroviral therapy studies and into vaccines for HIV and other infections, and also leading efforts in training and capacity building. I’m a product of that capacity building and training. I haven’t been exposed through the ranks at BHP and have been mentored by mentors at the Harvard School of Public Health. We realized that this long-term investment has trained a number of people and others in our group as well. So this opportunity to work with SARS-CoV-2 really was a pivot and to build on to the work that we have been doing in HIV. And it prepared us to systematically be able to sequence the SARS-CoV-2 virus and working with a public health response. And it’s very important that the way we have been doing the sequencing was not just answering scientific questions, but it was at the heart of public health response, monitoring and tracking emergence of this virus. From the onset, we realized that the introductions of the early lineages and we could track them. We could see from the signatures, from the viruses how they have changed is compared to the original one strain viruses. And it was in evidence for us that the mutations are occurring, and we have seen that with our wave one, certain lineages or viruses with circulating there. And we saw that in the beginning of wave two, which was around December, we had one common variant, the beta variant that took over and we had a number of infections and deaths associated with that variant earlier in the year between February and March. We experienced a high number of infections, clearly showing that tracking these mutations in this virus is important. And around April, May, we had this Delta variant, which also entered into the population. And as a result, if you look at our epi curve, you’ll see that we actually entered into the third wave, which peaked around August, September, and that’s where some of the highest deaths and infections occurred and didn’t go down. And for now, we are really like enjoying that our infection rates have gone down. Life is returning to normal. And now in the beginning or in the middle of November, we are seeing another variant. And we are excited that we’re able to partner with the government, with the Minister of Health and other scientists in the region and also at the Harvard School of Public Health to contribute in the public health response. Thank you.

MODERATOR: Thank you, Dr. Moyo. Dr. Makhema, do you have anything you’d like to add at this point?

JOSEPH MAKHEMA: Only to emphasize that it is absolutely crucial that we continue to ensure that any public health response is seen to be global, it’s systematic, it is standardized and it’s not punitive. And that’s from a scientific perspective. Our scientists are very collaborative. We appreciate the efforts, investments in training and capacity building that have occurred from the Harvard School of Public Health, with our institution ensuring that there is regional local capacity to track such epidemics of disease surveillance to ensure that ultimately there is capacity throughout the world for global health and protection against emergent public health diseases. And therefore, I think we as an institution are certainly willing and are collaborative in all the work and are grateful for that investment that the Harvard School of Public Health did eventually undertake with its own a Harvard partnership and the Ministry of Health as a global health outreach we believe should be. Thank you.

MODERATOR: Thank you, Dr. Makhema. First question.

Q: Hey, thank you so much for taking my question. Actually, I have two questions. The first is immunologically, the United States and southern Africa are pretty different, and I believe that there have been a kind of a different suite of variants in southern Africa. So I’m wondering if you have any thoughts on how that might affect what Omicron could look like when it. Well, it is in the United States now. And also if you what you’re seeing in southern Africa at this point on how it behaves as compared to Delta and other variants? Thank you.

ROGER SHAPIRO: Sikhulile, do you want to start or should I?

SIKHULILE MOYO: You can take this.

ROGER SHAPIRO: OK, sure, but I think we don’t know yet where this is headed. In South Africa, cases are exponentially going up and I think that is certainly a concern that this new variant transmits easily. We’re learning more and we don’t know exactly how easily, but there’s no question that this new variant is transmitting very well. How much better it may transmit than Delta, I think, remains to be seen. The key questions about severity and the protection that we get from vaccines are also still to be determined. And I think the next coming weeks will really help us understand whether we see hospitalizations catch up to transmissions. We hope that will not occur. We would love to see a disconnect between transmissions and hospitalizations, and that will help us feel that this, you know, either certainly not more severe and perhaps a more mild disease, but getting to, you know, how this will affect different parts of the world. We just can’t say. We don’t think that there should be a difference in how people in different parts of the world respond. I mean, we’ve all seen Delta. The world has all essentially been infected with Delta over the past year. Prior to that, we’ve had immune exposures to a limited number of variants for those with natural infection and those who have been vaccinated against, you know, a limited repertoire of the vaccines that are available. So I think that the world’s immune systems should respond in a fairly similar manner to this new threat. And it just will have to play out and we’ll see how it goes.

MODERATOR: Are you all set?

Q: Yeah, that’s fine, thank you.

MODERATOR: Thank you. All right, next question.

Q: All right. Thank you so much for doing the call and also pardon the background noise. I have two main questions, and the first is there have been some really great articles talking about how different Omicron is compared to past versions of the virus. And Dr. Moyo, I know because you’ve been sequencing the virus, this must have really stood out to you. And I’m just wondering, you know, if you have any thoughts maybe on where Omicron came from and how it arose? The other thing I was hoping you could do for us is maybe give us a timeline of events, of how you came in, how you found the variant and your interaction with the scientists in South Africa. Can you just tell us how that unfolded and give us some dates?

SIKHULILE MOYO: Thank you for that question. Still, a lot is unknown, but as you know that mutations develop spontaneously as the virus mutates and replicates. And these ones, they can accumulate and spread. But we are still trying to understand how so many mutations arose for Omicron in this short space of time. If you look at the previous lineages, if you look at all five, if you look at beta, you can see that the mutations accumulated over time. So it’s still really a mystery why a virus has so many mutations. You would scientifically think it would make it like a wimpy virus, but it does look like it has advantages. And we hypothesize that because of the mutations that are concentrated in the spike protein in the receptor binding domain, which really is an area hotspot for the interaction between the virus and the human cell, we think that the mutations that are giving Omicron an advantage are increasing the affinity of the virus to the cell, increasing replication capacity and also allowing the virus to evade the immune fury of the immune system. So there is quite some hypotheses on how this could have evolved. Is it very clear that it’s not clear how the virus could have accumulated such mutations? It could have been a zoonotic transmission that’s still to be established if more sequencing occurred. It could have occurred in in an environment of immune compromised individuals that has not been proven. And I saw some reports that the initial sequences were from individuals that were immunosuppressed. And I want to categorically state clear that that kind of information was not available. There was no evidence of that kind of immune suppression, at least from the cases that we identified in Botswana. So there’s still a lot in that area. But I think because most of the mutations are concentrated in the spike, that might be giving the virus a lot of advantage in terms of infecting the host cells in terms of our timelines, as you know, is described by Professor Shapiro, we are doing routine genomic surveillance in our genomic surveillance. We are randomly selecting samples on a weekly basis in a systematic way throughout the country. So it was not a surprise that we are taking this violence. And in the week of 15 to the 19, we had three pages of sequencing. You know, it takes about 24 to 36 hours to get sequences done. So the second bits that we had, which was finishing like on a Thursday or so, we noticed that there were four sequences that had unusual lineage that had not been seen in in Africa. It had not been seen in many parts of the world, and that really gave us some questions. And also, it’s as scientists you want to make sure that you’ve done everything right. So we went back to the lab. We checked all our processes QC and we did reanalysis and we observed that these sequences are still different lineage. And with the genome coverage of more than 95 percent, 98 percent of the could be genome. That really was a solid finding, and we thought we should let it go. But because there are processes you need to inform when you have a strange finding according to our policies, you need to inform our Minister of health. So we did that. So on the 19th, we analyzed this data and there was that was a Friday. On a weekend, we prepared some summary for the Ministry of Health, which on Monday morning, early morning of Monday 23rd, we released the reports to the Minister of Health. And at that time we didn’t know a new virus, but we certainly knew that there is something different about this virus. We didn’t know that it has not been seen anywhere else. The closest lineage that the database was giving it was B.1.1.263. But if you look at that lineage, it has less mutations and definitely it couldn’t be that lineage. But the database had called it 263. So we notified the minister of Health and say we had an unusual lineage currently classified as B.1.1.263. We require more information, they provided us more information, and we could see that these individuals were traveling together. They were coming from outside for some work arrived on the 7th of November. The specimen that we sequenced is the 11th of November. So at the time of depositing the sequence on the 23rd of November and early morning, about nine o’clock our time. That was the first earliest sample to be sequenced from Botswana.

When we released it into the database later on, in a few hours later, in the afternoon or so, South Africa also released six of the sequences. So when they released six of their sequences, of course, the genome database is an open source, so individuals evolutionary biologists began to pick that. There’s a Botswana sequence that is looking like as many insertions and that Twitter from that evolutionary biologist actually confirm that, yeah, we were in the right place in identifying an unusual, we call it, an unusual pattern of mutations. And the South African scientists, we collaborate. Professor Tulio as my Ph.D. supervisor. So we had a chat and and noticed that there’s something new in some evolutionary biologists in the UK, we’re now calling it puts on a class that session class, though it puts on a highly mutated virus, as you might have seen that in the press. So that prompted the database to the administrators of the database and the taxonomy of viruses to look at those sequences, the first nine and one from Hong Kong, which was a partial genome at the time to kind of like look at it and see and of course, they realized it’s a different image. So that particular night of the 23rd to the 24th, especially 24th it received a new lineage could be thought one two one two eight five two nine and at that time, it had not been received a Greek naming as, you know, we try not to stigmatize countries by naming viruses by the country where it was first detected. And on the 26th, as you know, the WHO Virus Working Group met, and by then South Africa sounded the alarm. As scientists, we tried to be transparent as possible. So South Africa, being with scientists, also being a member of the working group, managed to alert the WHO and on the 26th, realizing the way in which the virus was and the potential impact it was upgraded to a variant of concern. And we are excited to be working together and we know that we are contributing in that space. And those are the events that we know about. And so correctly, WHO is assigned the first detected in Botswana. And of course, because the hours between is also classified as first detected in Botswana, South Africa and Hong Kong, just to acknowledge the scientists. But the first sequence to be deposited was from Botswana. And by all intents and purposes, as scientists were working together, we are in the same network of Africa Pathogen Genomics Initiative. So really, we discussed some of these findings and thus enriching. And I’m also part of the Massachusetts General Club are driven of from the Harvard associated universities every Friday. We also look at data from around the world. So it’s an enriching experience and scientists do collaborate and we are not competing about who is first. But it’s important to realize that we are poised to do this work because of the training and exposure and the collaboration that exists among ourselves. Thank you.

Q: Can I ask one follow up? So these four individuals, the four initial sequences came from the same group of people that were traveling together. I think I’ve read that that was a foreign diplomat. Is that correct?

SIKHULILE MOYO: Yeah, that’s correct. As you heard from there, the president of Botswana also confirmed that these were foreign diplomats that were visiting the country for a diplomatic mission.

Q: Thank you so much.

MODERATOR: Next question.

Q: Hi, I was just wondering if you could speak at all about how do you reconcile the genotype with the illness that’s been described so far? I appreciate it’s early days, but if you could speak about that at all. And then I also was hoping that you would be able to chat a little bit about what this says about Botswana and Africa’s expertize in genomic surveillance.

SIKHULILE MOYO: Thank you so much. Like you say, data is still coming in, and preliminary data is really suggesting that in terms of transmission, we are seeing an explosion in southern Africa, especially in the region of South Africa, where the virus is been growing exponentially. And I think that might have released a preprint just highlighting that quite a large proportion of the individuals that were infected with the Omicron were apparently vaccinated. So look out on that preprint and confirm the actual numbers. So there is a suggestion that is possible that because of the nature of the hypo mutations in this virus, that there’s a chance that it may reduce some of the vaccine efficacy but is still very, very early. And you must take that with a grain of salt. It’s only been a week and a half in two. So really, we need more data to support some of these hypotheses in some of the incidental findings that are coming out in different places. And of course, as you saw in the some of the media reports and verified by a peer review publication that it seems like some of the cases are really mild, but it’s still early to tell. Like Professor Shapiro said, it’s still early. It apparently takes between 5 to 10 to 15 days to really start seeing increases in hospitalizations or or increases in severity of disease. And so I would be very cautious, too, to make a conclusion maybe in the coming two or three weeks. There’s quite a lot of data that is going to come out about some people are growing this virus in the lab to see how it is being neutralized by some of the the neutralizing antibodies and also implications for vaccines. And I believe that some of the vaccine manufacturers as well are looking at the early sequences, which is something that of course, we would like to discuss some more because with the transparency of what we have done, allowing the world to now look at that data and generate knowledge to impact development of vaccines, which is very important. So it really means that scientists should not be punished in the response that we see. I was enjoying the contribution that we have made in terms of this discovery and how it might have averted a number of deaths that we may see with this virus. So that is very important contribution we think we have made.

But when you open the news, we also said to see the number of countries closing their borders, shutting flights, a number of people, you know, tweeting and say, you scientists, what have you done? You have closed our Christmas. And I believe that that’s not how scientists should be rewarded. And that’s very important. And I think because we realize onset of the threat of changing viruses from the original one strain, getting mutations like 614G, increasing replication capacity and the development of beta variants, we realized that genomic surveillance was going to be a cornerstone of our response. So with the Minister of Health and the Presidential Task Force, we established a systematic genomic surveillance system, which is part of our vaccine rollout plan. So it’s intentional. We have decided to really track this virus as a public health response and must have capacity that was really built around HIV work thanks to all the vendors and the donors that have supported the work around HIV that is allowed us to really grow. And also the capacity building through the mentorship that we’ve received to be able to have this kind of sequencing capacity, there’s still more to be done. Reagents run out because the flights are not going. So how do we continue with our work when there’s a threat that reagents may run out because there’s not much traffic coming this way? So South Africa has well established a network of genomic surveillance across all the provinces and established more than 9 to 10 centers that are sequencing the virus. So with the Africa CDC Africa Center for Disease Control, equivalent of US CDC, they have been able to bring. African countries together to have sequencing hubs, a sequencing hub in Kenya, in Nigeria, in South Africa, to be able to support other countries. They send their samples to these countries to be able to to sequence. So that capacity has really developed so much that Africa has generated more than 52,000 world genome SARS-CoV-2 sequences that have been deposited in the international databases, transparently allowing scientists, even outside Africa, to be able to interrogate them for discovery, for drug development and for vaccines. So we believe in open science, and the funders also believe in open science, and that’s what we should promote. There’s more to be done. There are countries in the region that have no sequencing capacity and even ourselves, we need to expand sequencing capacity. Right now, infections seem to be going up. It means that we need to more than triple or quadruple our sequencing capacity. So thank you so much. I think where we need to monitor, especially when vaccination rollout increases, we need to be watching out for any vaccine escape mutations because they will be growing in and in an environment of vaccines and actually areas where there is very little coverage of vaccines. Those are the areas that we should be targeting to provide more sequencing capacity and to increase the coverage because if we are allowing one part of the world to have, there is still mutations accumulating. Because we are allowing variants, we are allowing viruses to be transmitted because there is low coverage. We are a global village. Look at how many continents, how many countries right now are reporting Omicron just indicating that we are a global economy, a global village, and we should be responding in this similar way in a global response. Thank you.

Q: Just one clarification on that first answer. In terms of the illness that’s been described so far again, I appreciate it’s very early days and I realize that we might not have a wide group of people that we re looking at like, for example, it may be mostly in younger people that we getting data for for the tap or information on how severe the the disease is. But do you think that there’s any chance with this number of mutations that even with those number of mutations, this might be a signal that we in the states have an end in sight to the pandemic. From the perspective that, you know, viruses effectively don’t ultimately want to kill their hosts, they want to be able to stick around. And so it may become a milder form of of what we’ve been seeing in the previous waves.

SIKHULILE MOYO: Yeah, I hope I got your question clearly. You think that the onset of Omicron suggests that definitely viruses do not accumulate mutations in a single step, as you know, so it could be they’ve accumulated before we even detected them. We know that possible they’ve been circulating and accumulating mutations. What is worrying and concerning is the speed in which they’ve been accumulating mutations. There are many regions of the world which are not sequencing enough. So in terms of how this virus developed is still a question out there. And we hope that as data is coming in, people are going back to their freezers and they are pulling out old samples. And as you know, some people have been able to see as early as sometime in October that this lineage was already circulating. So it has really accumulated mutations. But what is surprising is the speed in which it accumulated mutations, probably in areas where there is very low coverage of sequencing. There was no chance that it could be detected early. So definitely it means that we need to strengthen the surveillance system, especially for this virus. I hope I got your question clearly.

Q: Good, thank you.

MODERATOR: Next question.

Q: Thank you, guys for taking my question. I have two, and I’ll actually start with you, Dr. Shapiro. Knowing that we’re still two or three weeks away from really knowing more about the Omicron variant, how transmissible it is and how will the vaccines work, what should states be doing to prepare for this? Because two or three weeks from now, we’re in full swing for the holiday season. You know, do we need to see mask mandates come back? What steps should states be taking now?

ROGER SHAPIRO: Thanks for the question. It’s not an easy one to answer. And I think there’s going to be a lot of input into that that’s going to balance overreaction versus what makes sense as we head into the holidays. I think it certainly makes sense to step up our vaccination efforts. The one thing we know we can do is we can vaccinate and we’ve heard a lot about this vaccine. This particular variant may or may not respond well to the vaccines. But one thing I want to make clear is that most scientists believe that the vaccines, because they stimulate a broad immune response, not just antibody, but also our T-cells, that the broader immune response from the cellular immune system will protect us even from the Omicron variant. So it remains to be seen, but we do hope that vaccines will still keep people out of the hospital and certainly reduce the number of deaths from this variant. And so vaccinating still remains the first, second and third thing we should be doing to prepare for this. I think the faster that we can bring oral antiviral agents to the market, the better. I really look forward to the FDA’s approval of the new oral COVID treatments that are coming out from Pfizer and Merck that will allow us to get it, you know, get outpatient management and hopefully again, keep people out of the hospital. I think that when we get into more prevention, such as mask mandates, you know, we’ve seen this start to step up already. We’ve seen that the administration is moving some of those measures forward. And I think that it makes sense to be ready to do all this, to be poised for further restrictions, but maybe not to do it just yet. You know, we’ve certainly not seen this variant take off in the United States. We’re all watching closely. But I believe that it’s too soon to take really drastic measures.

On a broader level, as we learn more about this variant, and if we do begin to get that comfort with OK, variants are going to happen. Are vaccines still protect us against the most severe disease? And let’s just move on. I think that each time we have a new variant and we make it through and this is a really important test is Omicron variant, I think starts to get us to the point where we can say, let’s do this, this is manageable and we’ve been dealing with flu seasons in our country forever. And we’re going to deal with COVID season too and we’re going to manage it, we’re going to minimize, you know, we’re going to minimize hospitalizations and deaths because that’s the goal. But we’re probably going to have COVID season in the United States and throughout the world for a long time to come.

Q: And one quick follow up. I know again, it’s still early. Do we anticipate that Omicron could lead to another deadly winter surge like we saw last year where we did see increased hospitalizations? Any concerns for what winter could bring?

ROGER SHAPIRO: Well, the timing of this certainly suggests that winter could be a surge. And even without the fact that this variant emerged just now, right as we’re heading into winter, we know that coronaviruses is generally surge in winter and we’ve seen it with prior waves. And so it’s certainly reasonable to expect that cases are going to continue to go up.

Q: Thank you, and then Dr Moyo, can you just say your first name for us, we want to make sure I’m pronouncing you correctly on TV.

SIKHULILE MOYO: My name is Sikhulile. Thank you.

Q: Thank you.

MODERATOR: Next question.

Q: Thank you. I have a couple of concerns. The first one is that it is said that Omicron has a very close relationship with HIV. So, could you explain more? And the second is that where, when and how will the next variant appear in the future? And also, I’m wondering that the appearance of Omicron is a good thing, or it means that we will all come over again. And so do you have any comments? And if in the future the Iman Crown will spread around the world? Will the situation in South Africa and Botswana be different from that in Asia? Thank you.

ROGER SHAPIRO: I could take a stab at it at the beginning of these answers. So, as Dr Moyo mentioned, there has been speculation that because there is an endemic HIV in southern Africa and a very large number of persons living with HIV that some scientists have speculated this, and the press has speculated that this new variant, Omicron, may have emerged in the setting of uncontrolled HIV, and it’s a reasonable consideration, but we just had absolutely no proof of this at this point. And I think more research needs to be performed. The reason it’s a reasonable consideration is that we’ve seen that people with severe immunocompromised, and that includes cancer patients and immunosuppressive agents and also people who have uncontrolled HIV and advanced disease have had longer periods of COVID, where the virus does continue to replicate longer in their bodies. And we’ve seen evidence that during the course of that replication, the mutations can emerge. And so there is certainly scientific plausibility for this hypothesis, but we just don’t have proof at this time. To just briefly answer about how this will impact the rest of the world, we just don’t know yet. And just to speculate whether we will see the same thing in Asia as is occurring in Africa or in North America or in Europe. We just don’t know yet. We are concerned that Omicron is exponentially spreading in southern Africa and South Africa particularly, and we are watching it closely and we just have to wait and see what happens in other countries.


MODERATOR: Are you all set?

Q: Yes. And Dr. Moyo, my question about if it’s a good thing or whether it means that we should all come over again about the appearance of Omicron? And could you also comment on the relationship with HIV and Omicron and also, do you think it means we should come over again after the Omicron spreads around the world?

SIKHULILE MOYO: Yeah, I’m hoping I get your question. The association with HIV, definitely there’s a preprint article that you should read. I think there are two cases now that show how the Delta variant could have developed some mutations written in an individual with uncontrolled HIV. But those are just two cases. And I think I think as Professor Shapiro tried to answer, that hypothesis really stands to be seen. And I think it’s too early to associate it with HIV. And I think that association, just because of any Zuko’s due to, I don’t think is just robust enough evidence to suggest that we have seen as SARS-CoV-2 COVID growing in countries in large increases in areas even with low HIV. So that causal relationship really should be treated with a lot of caution.

Q: OK, so what will the researchers do in the next two weeks? Can you tell in specific?

SIKHULILE MOYO: What I know in the next two weeks, as Fauci also announced, there’s quite a number of studies looking at the behavior of this virus, characterizing individuals that have had this virus, seeing whether some of the current vaccines are working on this virus. So that’s very, very important. So we are going to see as well, where there’s going to be an increase in hospitalizations because of Omicron. So that’s very important in a number of studies I expected. Some people are isolating the virus and growing it and challenging it with agents to see whether there will be effective. So we expect to see quite a lot of data.

Q: OK, thank you. Thank you so much.

MODERATOR: Next question.

Q: Thank you so much for taking my question. Appreciate it. Basically, for like Dr. Moyo, I was wondering sort of if you were surprised sort of by the global response to the finding and sort of the travel bans given sort of all we’ve learned during COVID about how effective or how ineffective those can be? And then what sort of instead of travel bans and restrictions would you like to see from European and in the US?

MODERATOR: It looks like Dr. Moyo may have lost connection again. Could you hold on a moment and we’ll see if we can get him back on and then hopefully we can get a good clear connection with him?

Q: Yeah.

MODERATOR: OK. Next question.

Q: So my question and again, you know, I appreciate the preliminary, you know, we’re in a place where we don’t have all the data that we want to have, but I know scientists are closely looking at if this new variant may affect people who are already caught COVID and recovered as there are higher reinfection rate things along those lines. So with the preliminary data that we have so far, can you kind of speak to that, speak about what we’ve seen so far and what we’re going to look for moving forward?

ROGER SHAPIRO: Sure, I can I can start to answer that one, wrote Dr. Moyo is reconnecting. There does look to be evidence emerging that people who have either had prior COVID or been vaccinated can get this new variant, the Omicron variant, easily. In South Africa, there is a approximately 30 percent of people who have been fully vaccinated. And I think up to 40 percent who have had clinical COVID. So it’s really taking off despite the high amount of immune pressure that that you would expect from those and prior variants had not shown that as much as this current variant. And I think that is one of the most worrisome features of this current variant, which is that it really seems to be transmitting even though some of the people who are getting it. I had evidence of prior COVID or prior vaccination. So that’s the most concerning feature that we’re seeing right now. And it again, it does not mean they have severe disease. So that remains to be seen. But certainly we believe some of the patterns of mutations that this highly mutated variant has is serving to escape prior immune. You know what we had hoped would be immune control of a new variant.

MODERATOR: Does that answer your question?

Q: Yeah, that was great, thank you. I appreciate it.

MODERATOR: Sure. Dr. Moyo, you have a better connection, correct?

SIKHULILE MOYO: Yes, actually, I apologize about my connection. I was just saying that we were really shocked about the travel bans. And I think you have seen the in the history of infectious diseases that travel bans are the only probably delay the onset of infection. They are not effective in the long term. They actually do more harm than good and it means to be admitted. And so that countries that are really trying to slow down movement, they work together. So there has to be real coordination. How do we get ready to impart some vaccines have to right? How do we reduce impact in the economy? And that’s very, very important.

MODERATOR: Do you have any follow ups?

Q: No, that’s great. Thank you very much.

MODERATOR: Great. And we’re just about out of time, but it looks like we’re going out with a go ahead.

Q: I really appreciate your guys doing this, so thank you very much. Have a couple of questions about what this looks like on the ground in southern Africa right now. You know, are you seeing this being transmitted in Botswana as much as it is in South Africa? And also, what about kids? We understand that about I think it’s 10 percent of those who are infected are children and wondering if you know anything more about that. I’m guessing they were not vaccinated. They may have been infected before, but I don’t know. Thanks.

SIKHULILE MOYO: Yeah, thank you. Thank you so much for your question. What we will see with the data that some of the guys released, they are releasing data on a daily basis. You can see it in their Twitter handle NICD. We see that the infections are really, really going up from every day and exponential growth from a thousand to you go to three or four thousand to six thousand in yesterday, 11000 infections being reported in a single day. So definitely there’s evidence that there’s a number of infections, and they’ve also reported that demographic that is been mostly as well as younger people, not mostly, but a fraction of young people. And of course, vaccination is only starting to pick up in young people in South Africa. In Botswana as well, like I mentioned earlier, we are beginning to see an increasing positivity rate in the past few days. So in the next few days, we are going to see quite probably more infections coming through, and that’s important data. It will be cleaner as the day goes by, especially in Botswana. Thank you.

MODERATOR: Are you all set?

Q: Yeah, unless, Roger, you have any more data on young children?

ROGER SHAPIRO: I saw that report, but I’d be cautious about it. I think in previous variants, similar reports came out and then ultimately when more and more cases came in, it was it didn’t really pan out. So I think I’d be very cautious about making any assumptions about children at this moment. Certainly, something to keep an eye on.

ROGER SHAPIRO: Great. Thank you. Last question.

Q: Hello, professors. My question is that for the latest research from South Africa have indicated that the reinfection risk of Omicron is like three times as much as that of the other variants. But from the current reports, we have known that some of the Omicron cases only showed very mild symptoms. So, is there a possibility that I’m wrong or the future mutations of the variants will be inclined to be with higher ability of dodging the vaccine, but causing less severe diseases? Thank you.

ROGER SHAPIRO: I could start an answer to that. I think it’s possible for viruses to mutate in a way that makes them either more severe or less severe, and it’s very often the case that viruses adapt to become less severe over time. But it’s not always the case. And over this short term, it’s really hard to predict what direction will be most beneficial to the virus’s survival, which is really all the virus cares about is surviving and replicating. So it’s, you know, it’s certainly interesting to think that a more transmissible but less severe virus would be advantageous. But there are other ways it can go as well. And we can’t hang too much on that optimism. I think over the short term, what’s even more important in terms of clinical outcomes is, is this the first time you have ever seen COVID? Or is this your second or third or fourth time because you’ve been vaccinated or you’ve had natural disease? Now we know, as we said that the Omicron variant seems to disregard our prior exposure, and that is of concern, but remember, it’s not going to be totally disregard it. And there are other aspects of our immune system, such as our cellular immune response that should keep us protected and should keep us out of the hospital, even though it looks like it’s blowing right through that prior exposure and re infecting people. So I think it’s really important that we consider both the number of times someone’s been exposed in our own immune response, as well as where the virus is heading from an evolutionary standpoint, as we figure out where this is all going to play out in terms of clinical outcomes and overall number of cases. Sikhulile, do you want to add to that?

SIKHULILE MOYO: Yeah, I just want to add that I think that the study from South Africa does really also emphasize that they did not find any evidence of reinfection risk increase during the emergence of Beta or Delta variant. And really, suggesting that maybe there was some selection advantage that allowed these variants to spread primarily probably because of increased transmissibility other than immune escape, suggesting that other arms of the immune system get kicked in and help. And and it’s still early. Of course, any evidence of immune escape from prime fixing or vaccination for Omicron is very important for implications for public health. And I’ll caution that while the study found that these 25 to 30 percent probably are lower reinfection in the previous three waves than in Omicron, it may be too early. I think we need to see more data. I’m still interested to see other different vaccination products and see how this will pan out. But preliminary, there is a suggestion from this pre-print that there might be a almost a quarter to a third increase in the reinfection with Omicron. But we do not know whether it would translate to severe disease or increase more or more deaths.

Q: Thank you, that’s all for my question.

MODERATOR: Thank you. Last question.

Q: Hi, thanks. Sorry, I’m late, so I hope no one already asked this, but I wanted to ask about breakthrough infections, you know, say somebody’s got two shots of Pfizer or Moderna six months ago, and then they got a breakthrough infection, say, one month ago. I mean, does that sort of act as a booster, especially, you know, protecting against Omicron too? Or do you think, you know, even people with recent breakthroughs should also be getting boosters? Thanks.

ROGER SHAPIRO: I would say that all exposures to the virus or to a booster, prime our immune system and keep us safer by getting both arms of our immune system, our humoral and our cellular responses maximized so that even if this new Omicron variant can escape through the humoral response or the antibody response, that the cellular response can kick in and keep disease to limited to something only mild or moderate. So any time we’re boosted, we should be priming those aspects of our immune system. The issue always comes up, how targeted that needs to be and whether we need new boosters that are specifically for the Omicron variant. And I think certainly work is going to begin in that area because of the large number of mutations with this variant with Omicron, that it hasn’t been seen before with prior variants. And it’s certainly going to raise the question should we tailor our immune responses more specifically to Omicron? And I think I’d like to end since we’re at the last question by saying that the scientists from Botswana and South Africa who have provided us with the sequencing data have done the world a huge service because they have gotten that information to the vaccine manufacturers in a really timely and efficient early manner to get that process rolling. And I can only hope that the favor will be returned when the vaccines are created so that southern Africa is offered those same vaccines.

MODERATOR: Are you all set?

Q: Yes, thanks.

MODERATOR: OK, great. All right, Dr. Shapiro, Dr. Moyo, do you have any final thoughts you like to share with us before we go?

SIKHULILE MOYO: Just to echo what Professor Shapiro said. We need to systematically increase genomic surveillance, especially in low resource settings, and support our scientists in those regions to continue to do our great work and great science. And also, we need to review strategically how to respond to such findings as a global community. How do we make sure that we are coordinated in our response so that we encourage scientists to be transparent with their data so that next time you’re not cautious because you realize that quite the kind of damage that this finding and transparency has produced. And I think scientists who should be encouraged to be transparent with their data regardless of the repercussions. Thank you.

MODERATOR: Great. Thank you very much, Dr. Moyo.

This concludes the December 3rd press conference.

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