As of March 12, more than 341 million doses of COVID-19 vaccines have been administered globally at a remarkable pace of 8.5 million doses a day, according to Bloomberg. Nearly a third of those vaccinations have occurred in the United States, where we have already administered more than 101 million doses and are giving another 2.3 million doses a day. Against this flood of promising developments, there is an undercurrent of concern regarding new variants that could undermine this progress.
To understand the challenge we face related to variants, it is first important to ground ourselves in the scale of this pandemic. At the end of February, there were approximately 114 million global confirmed cases of COVID-19, and the actual number of infections is actually much higher given underreporting and asymptomatic cases.
As few as 1 in 2.5 COVID-19-related hospitalizations and 1 in 7.1 nonhospitalized cases have been reported, according to an Oxford study in partnership with the Infectious Disease Society of America and supported by the U.S. Centers for Disease Control and Prevention. That level of underreporting of cases would be shocking anywhere in the world but is especially so in a country like the U.S. with its high frequency and well-established reporting processes. The data from many other parts of the world is likely to be even less consistent.
This study would suggest a significantly higher percentage of the population has some level of natural immunity to the virus. Unfortunately, it also implies that with such widespread infection there is an enormous opportunity for the virus to replicate, mutate and create variants. Several variants have emerged in recent months, each originating from different regions across the globe. Many of these variants are more transmissible, and some are showing resistance to antibodies from previous infections and vaccines created from the original 2019 strain.
The figure below, obtained from Nextstrain, an open-source project for tracking genomic data of pathogen evolution across the globe, illustrates how the SARS-CoV-2 virus has changed globally over the last year. The original 2019 strain is in dark blue (labeled 19A) and each band represents a different variant. Over time, this shows how the prevalence of existing variants tends to fall as it is replaced by a new one.
This ability for diseases to mutate and adapt is what makes them so successful from an epidemiological perspective and so frustrating to combat. The flu, chickenpox and HIV are all endemic diseases that scientists have been working to eradicate for decades. Many in the scientific community believe that COVID-19 is also destined to become endemic, and we tend to agree.
On March 8 the journal Nature released a study of the effectiveness of the Pfizer and Moderna vaccines against the U.K. and South Africa variants. The good news is that there was no major deterioration of antibody response against the U.K. variant (B.1.1.7); however, there was substantial loss of effectiveness against the South African strain (B.1.351) which also shares similar mutations as the Brazilian variant (P.1 or 501Y.V3).
According to the authors, “Mutationally, this virus is traveling in a direction that could ultimately lead to escape from our current therapeutic and prophylactic interventions directed to the viral spike. If the rampant spread of the virus continues and more critical mutations accumulate, then we may be condemned to chasing after the evolving SARS-CoV-2 continually, as we have long done for influenza virus. Such considerations require that we stop virus transmission as quickly as is feasible, by redoubling our mitigation measures and by expediting vaccine rollout.”
Now is the time to double down on our efforts so that so much hard-fought ground is not lost. This is not just a matter of action for states and counties in the U.S., but for all nations as we collectively fight the pandemic. The emergence of these variants is why the efficient and equitable distribution of vaccines across all nations is critical. As long as there are reservoirs of the virus anywhere in the world, there will be outbreaks of COVID-19, and that will only add to the mounting human and economic toll. In the end, as impressive as the achievements of the medical community have been, the science of the ever-changing virus shows that this is no time to relax.
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