New COVID Variants Have Changed the Game, and Vaccines Will Not Be Enough

We need global ‘maximum oppression’

At the end of 2020, there was strong hope that high vaccination levels would finally give humanity the upper hand over SARS-CoV-2, the virus that causes COVID-19. In an ideal scenario, the virus would then be contained at very low levels without further social disruption or significant deaths.

But since then, new “worrisome variants” have emerged and spread worldwide, threatening to derail current pandemic control efforts, including vaccination.

Simply put, the game has changed and a successful global rollout of current vaccines is no longer a guarantee of victory in itself.

No one is really safe from COVID-19 until everyone is safe. We are in a race against time to get global transmission speeds low enough to prevent the emergence and spread of new variants. The danger is that variants will emerge that can overcome the immunity of vaccinations or previous infection.

In addition, many countries lack the capacity to track emerging variants through genomic surveillance. This means that the situation could be even more serious than it appears.

As members of the Lancet COVID-19 Commission Taskforce on Public Health, we advocate urgent action in response to the new variants. These new variants mean that not only can we rely on the vaccines to provide protection, but we must take strict public health measures to reduce the risk of these variants. At the same time, we must equitably accelerate the vaccine program in all countries.

Together, these strategies provide “maximum suppression” of the virus.

What are ‘worrying variants’?

Genetic mutations of viruses such as SARS-CoV-2 are common, but some variants are labeled as “variants of concern” because they can reinfect people who have previously had an infection or vaccination, or who are more transmissible or can lead to more serious disease. lead.

There are currently at least three documented SARS-CoV-2 variants of care:

B.1.351, first reported in South Africa in December 2020 B.1.1.7, first reported in the UK in December 2020 P.1, first identified in Japan among travelers from Brazil in January 2021.

Similar mutations occur simultaneously in several countries, meaning that even border controls and high vaccination coverage cannot necessarily protect countries from homegrown variants, including variants of concern, where there is substantial community transmission.

If there are high levels of transmission, and thus extensive replication of SARS-CoV-2 anywhere in the world, more troubling variants will inevitably emerge and the more infectious variants will dominate. With international mobility, these variants will spread.

South Africa’s experience suggests that previous infection with SARS-CoV-2 provides only partial protection against the B.1.351 variant, and it is approximately 50% more transmissible than pre-existing variants. The B.1.351 variant has already been detected in at least 48 countries as of March 2021.

The impact of the new variants on the effectiveness of vaccines is not yet clear. Recent real-world evidence from the UK suggests that both the Pfizer and AstraZeneca vaccines provide significant protection against serious illness and hospitalization due to the B.1.1.7 variant.

On the other hand, the B.1.351 variant appears to reduce the efficacy of the AstraZeneca vaccine against mild to moderate disease. We do not yet have clear evidence whether it also decreases efficacy against serious diseases.

For these reasons, reducing community transmission is vital. No action is enough to prevent the virus from spreading; we must maintain strong public health measures in every country in conjunction with vaccination programs.

Why we need maximum oppression

Every time the virus replicates, there is a chance that a mutation will occur. And as we are already seeing around the world, some of the resulting variants run the risk of undermining the effectiveness of vaccines.

That is why we have called for a global strategy of ‘maximum oppression’.

Public health leaders should focus on efforts to maximally suppress viral infection rates, helping prevent the emergence of mutations that could become new worrisome variants.

Rapid roll-out of vaccines alone is not enough to achieve this; continued public health measures, such as face masks and physical distance, will also be vital. Ventilation of indoor spaces is important, some of which are under human control, some of which require modifications to buildings.

Fair access to vaccines

Global equality in access to vaccines is also vital. High-income countries should support multilateral mechanisms such as the COVAX facility, donate surplus vaccines to low- and middle-income countries, and support increased vaccine production.

However, in order to avoid the emergence of worrying viral variants, it may be necessary to prioritize countries or regions with the highest disease prevalence and transmission levels, where the risk of emergence of such variants is greatest.

Those in control of healthcare resources, services, and systems should ensure that support is available for health professionals to manage increased hospital admissions for shorter periods of time during peaks without diminishing care for non-COVID-19 patients.

Health systems must be better prepared for future variants. Suppression efforts must involve:

genomic surveillance programs to identify and rapidly characterize emerging variants in as many countries around the world as possible; rapid large-scale ‘second generation’ vaccine programs and increased manufacturing capacity that could support equality in vaccine distribution studies of vaccine effectiveness on existing and new variants alarmingly adapt public health measures (such as double masking) and reassign them to health system schemes (such as ensuring personal protective equipment for health personnel) behavioral, environmental, social and system interventions, such as enabling ventilation, distance between people, and an effective find, test, trace, isolate and support system.

The worrying variants of COVID-19 have changed the game. We must recognize and act on this if we, as a global society, are to avoid future waves of infections, further lockdowns and limitations, and preventable disease and death.

Written by:

Susan Michie – Professor of Health Psychology and Director of the UCL Center for Behavior Change, UCL Chris Bullen – Professor of Public Health, University of Auckland Jeffrey V Lazarus – Associate Professor of Research, Barcelona Institute for Global Health (ISGlobal) John N. Lavis – Professor and Canada Research Chair in Evidence-Informed Health Systems, McMaster University John Thwaites – Chair, Monash Sustainable Development Institute & ClimateWorks Australia, Monash University Liam Smith – Director, BehaviorWorks, Monash Sustainable Development Institute, Monash University Salim Abdool Karim – Director, Center for AIDS Research Program in South Africa (CAPRISA) Yanis Ben Amor – Assistant Professor of Global Health and Microbiological Sciences, Executive Director – Center for Sustainable Development (Earth Institute), Columbia University

Originally published on The Conversation.