COVID-19 vaccination effort in race against the mutants
The U.S. approval of the first vaccines less than a year after identification of the new coronavirus was a remarkable feat. But the discovery of new mutant strains of the virus might seriously compromise vaccine efficacy and any promise of a quick return to normalcy.
We find ourselves in a race against these mutants, one that can only be won by vaccinating billions to achieve worldwide herd immunity. This goal has been hampered by the logistical challenges of large-scale vaccination, manufacturing and storage limitations.
We are behind our original vaccination targets in the United States — although President Joe Biden has been pushing hard to accelerate the pace — and most countries have not even started vaccinating yet. In the meantime, the pandemic continues to rage, and the virus adapts and mutates.
We should not be fooled. COVID-19 is not going to go away overnight. If we quickly achieve universal vaccination, we can live with the disease much like we live today with the common cold or a mild flu, with virtually no deaths or hospitalizations. Only then will our lives return to normal.
But to do that, to avoid constantly playing catch-up with the virus, we must limit its replication and ability to mutate by accelerating our vaccination plans. The more a virus spreads and replicates, the more it makes mistakes when making copies and creates new versions. Mutants with evolutionary advantages, such as increased replication efficiency or ability to escape the immune response, become dominant.
Some mutants, such as the South African variant, are more worrisome because they carry multiple changes, each having possible biological implications. While each mutant appears to increase the infectivity of the virus, it’s still unclear whether that leads to more severe disease or death.
But all known mutations affect the spike protein. And, since today’s vaccines are based on the original virus spike protein, that means the inoculations could be less efficient against mutants. Indeed, while vaccines are highly effective against the original virus, preventing up to 95% of all infections and virtually 100% of severe disease and death, emerging data show that they are less effective against mutants.
The good news is that the vaccines seem to remain effective at preventing severe disease or death — more than 85% in trials of the Johnson & Johnson vaccine and 100% for Novavax’s — even in the face of mutations. That gives us an incredible window of opportunity to rapidly vaccinate a large proportion of the world population before more dangerous mutants arise.
But producing more than 10 billion doses is not an easy task and cannot be achieved overnight. Moderna, Pfizer/BioNtech and Novavax started from scratch with new technology. Setting up a new complex multi-step manufacturing process is taking time. Others have been delayed as they retool their manufacturing lines to make their process more efficient.
To address the need for increased production and access, companies have come together, such as Sanofi partnering with Pfizer to make their vaccine, Merck with J&J and Novartis with CureVac. Those collaborations should be facilitated and encouraged. But we also need to continue to build the pipeline and approve new vaccines — hopefully, Novavax by May, Sanofi, CureVac or Inovio before the end of the year.
The approval process for updated versions addressing the mutations could be simplified so that we have resistant-ready vaccines this year. Rich countries must financially support organizations such as Covax, which was set up to ensure rapid, equitable access to vaccines to all corners of the globe.
Accelerating our vaccination plan, while maintaining commonsense masking and distancing precautions, remains the best defense against the virus.