Count 2020 as a lucky year. This may sound odd given that the world grappled with a pandemic that has killed close to 1.8 million people and crippled many countries’ economies. The “luck” relates to the more than 90% efficacy of the two vaccines–Pfizer Inc.-BioNTech SE’s shot and Moderna Inc.’s candidate–that gained emergency approval after thorough clinical analysis. Enormous leaps in science and technology helped make this happen and could well speed the end of the pandemic. And more vaccines are on the way. Unfortunately, there is a risk that this early success leads to complacency.
The virus responsible for Covid-19 disease–SARS-CoV-2–is mutating, as viruses do all the time. This happens randomly. Sometimes the changes give one variant a slight advantage over its peers, but often they make no difference from an immunological standpoint. Over time, though, it is likely that mutations may develop that are less sensitive to the protection provided by vaccines. It is for this reason that a global, coordinated surveillance effort is required to make sure that we are on top of the way the virus is changing. Sadly, this does not seem to be happening.
The U.K. is far ahead in this surveillance effort, led by the Covid-19 Genomics U.K. Consortium, a group of scientists who have analyzed the full genome of more than 150,000 SARS-CoV-2 viruses isolated from infected individuals. This gargantuan undertaking helped them identify 1,777 changes in the virus’s proteins, including the so-called B.1.1.7 variant, whose seeming ability to transmit more effectively has worried experts and forced stay-at-home measures and travel restrictions in the U.K.
The variant is impressive in that it harbors more mutations, 23 in total, than has ever been seen before in a single virus, with eight of them in the spike protein — the protruding rod-like structure that decorates the outside of the virus and is targeted by the majority of vaccines, including Pfizer’s and Moderna’s. While there is no hard evidence yet that this variant is more resistant to existing vaccines, it raises concerns.
I was worried about the possibility of “escape” mutations occurring once vaccinations had been rolled out broadly, but it appears these changes are happening even in the absence of widespread inoculations. The problem is, while we have a handle on the types of changes happening in the U.K., we don’t know how many other variants are circulating in the European Union, U.S. and Asia because the data isn’t being tracked adequately. This needs to change if we are to effectively manage the virus.
What needs to be done? Three things. First, governments around the world need to cooperate and increase their surveillance of the virus to match that of the U.K. so we can better assess any changes in response to vaccination. We will soon know if the B.1.1.7 variant is as equally sensitive to vaccines as the most common strain, with the likelihood being that it is. But we need any new variant found across the globe to be assessed for its responsiveness to vaccine-induced immunity so that we don’t get surprised. The playbook for this already exists: This is done for the flu virus, and we develop a new vaccine every year. The same should apply here if needed. In addition, a set of rules needs to be developed and agreed upon globally as to what constitutes a variant of concern. For example, do we develop vaccine candidates for each new variant found with mutations — which would have meant around 4,000 candidates by now — or only those that have been shown to have lower sensitivity to our vaccines in laboratory tests?
The next step is to make sure vaccine companies work closely with governments and develop versions of their vaccines incorporating any new variants of concern. While there is a cost and effort in doing this, it will be relatively low for those using new technology, such as Pfizer-BioNTech and Moderna with their mRNA shots, and AstraZeneca Plc and Johnson & Johnson with their “viral-vector” vaccines. These technologies lend themselves to the rapid development of new candidates in less than two months. Companies should conduct preclinical and non-human primate tests to compare these new vaccine candidates with those that have already been approved. In this way, they will be ready to deploy them in trials if the need arises.
The last piece of the puzzle is the regulatory framework around getting new vaccines to market. Again, we have an existing playbook from the flu vaccine. Companies, regulators and governments need to work out a set of simple rules so that we don’t have to wait for massive late-stage trials to be conducted before deploying a new vaccine formula. It should be possible to get a modified vaccine to the masses within a few months if the preclinical work is already done.
I am optimistic that all these things can be done. We already have the U.K. doing widespread genomic analysis. A rejuvenated U.S. Centers for Disease Control and Prevention would be a significant addition. With a couple more regions, such as China and the EU, joining in, a global consortium could systematically track the virus. And our pharmaceutical and biotechnology industry has shown its ability and willingness to move fast.
After such good initial vaccine news, it would be a pity to lose ground in the virus fight, especially if it can be avoided. We just need to act on these things as soon as possible.
Once again, the Covid-19 health message is getting muddled. Even as officials and scientists urge the public to get vaccinated, they warn that after vaccination, we’ll still have to go on isolating and wearing masks.
It’s a mistake to oversimplify this way. We should be talking about using the vaccines to end the pandemic — not filling people with dread that they will be stuck with isolation and masks forever. The evidence is compelling that a strong, rapid vaccination campaign could render SARS-CoV-2 less of a threat than seasonal flu through building herd immunity.
Without herd immunity as a shared goal, some might skip the vaccine, influenced by scare stories about side effects and rare allergic reactions, especially if they are young and face only a small chance of dying from the virus.
It’s simple enough to tell people that if we all work hard to avoid getting or spreading the disease during the vaccination campaign, and everybody steps up to get the shots, aspects of normal life could resume this year. And even before we reach herd immunity, people who live alone and are vaccinated might be able to visit other vaccinated people without undue fear of disease, guilt or social stigma.
There is some encouraging data on herd immunity from the clinical trials of two leading vaccines, says infectious disease doctor Monica Gandhi of the University of California, San Francisco. While the three leading vaccines have proven extremely effective at preventing symptomatic illness, two showed some hints that they limited transmission of the virus as well.
In the trial for the Moderna vaccine, researchers tested all the participants for SARS-CoV-2 when they returned to get a second dose and found that the first dose alone was about 60% effective at stopping so-called asymptomatic cases.
The trial for the vaccine made by Astra Zeneca included some weekly swabbing of participants who reported no symptoms, and concluded about 60% effectiveness at stopping so-called asymptomatic cases.
Gandhi says she’s not surprised — there’s a biological reason to think vaccines will cut transmission rates. The immune response would presumably help the body fend off or quickly clear infection whether with or without symptoms.
Art Krieg, a doctor specializing in autoimmune disease and biotech founder, agrees. “Once people are getting vaccinated, it’s almost inconceivable that this is not going to slow transmission,” he says.
Some encouraging news also comes from research newly published in the journal Nature suggesting that protective immunity likely lasts many months, if not years, in those who have been infected. The same might apply to the vaccinated.
Herd immunity won’t eradicate the disease, but will significantly slow it down. Earlier estimates have suggested that will kick in when about 70% of the population has been infected or vaccinated, but that percentage may be higher or lower depending on how well the vaccines work against transmission and the rise of new variants that are more easily transmitted.
The race against mutations should only serve as another motivating factor for a quick and persuasive vaccination campaign, since the odds of new variants go way down if people get vaccinated quickly. “The more people are infected by this virus, the faster new forms and new mutations are going to evolve,” Krieg says.
UCSF’s Gandhi says there’s enough evidence to justify a hopeful message. “You have this ongoing debate from scientists about what to do after vaccination — do we mask and distance,” she says. She worries that the current messages have led people to think they will have to avoid other people forever, “and that’s not a way people can live.” She’s been vaccinated but is still taking precautions, such as wearing a mask at work. But the point of the vaccines, she says, is to end the isolation.
And yes, it is bad for people to live cut off from each other. “I have never seen my patients more miserable — I have never seen them more depressed, lonely, upset, more mentally ill, relapsing into substance abuse,” she says.
With people suffering emotionally, socially and financially, we don’t need more doom and gloom. We need a shared goal and a science-based message of hope for a livable future.
As published by Bloomberg