After weeks at a two-year low, COVID cases are picking up again in some countries. In the United States, there were an average of 100,000 new infections every day – up from 30,000 in mid-March.
The trend intensifies an important debate in epidemiological circles. What is the best strategy to prevent catastrophic mass deaths from the worst possible new COVID variants? New restrictions? New vaccines? New therapies? A mix of the three?
Whatever consensus emerges could take us into the fourth year of the pandemic. But of course there is a catch. Public health costs money. And in the world’s wealthiest country, the United States, some right-wing politicians are doing their best to ensure that no new money is available to rush the development, production and distribution of new vaccines and therapies.
Vaccine development has stalled. China is still pushing locally made vaccines that don’t work very well. The leading Western vaccine manufacturers are focused on developing boosters specifically for the latest Omicron variant. But by the time those boosters are ready this fall, Omicron should have been replaced by a new and more dangerous variant.
Two years ago, the world worked together to develop highly effective messenger RNA vaccines, and fast. Today there is less money and less urgency, meaning vaccine development is slowing down just as the virus is accelerating.
Experts warn that the potential for disaster will increase later this year or next.
To be clear, the COVID surge is small for now. In the US alone, there were an average of 800,000 new cases per day in mid-January. And hospitalizations and deaths are not increasing at the same rate as cases, due to high vaccination rates as well as natural antibodies from previous infections.
But the rise in cases in some countries – fueled by what appear to be accelerating mutations in the SARS-CoV-2 virus – is a reminder that the pandemic is not over yet. The virus is constantly changing – and finding new ways to bypass our immunity wall.
There is a lot of uncertainty here. “The virus may or may not evolve into ever greater vaccine evasion in the short term,” Eric Bortz, a virologist and public health expert at the University of Alaska-Anchorage, told The Daily Beast.
Epidemiologists take no chances. They look ahead and try to project how the novel coronavirus might develop and what we should do about it. They almost agree that the pathogen will be with us for years to come. But they disagree on what we should do about it.
There are options if SARS-CoV-2 takes a major evolutionary leap and evades the protective effects of our vaccines and antibodies. This is the nightmare scenario that fuels the most intense debate.
New lockdowns are an option but the least likely due to the deep unpopularity of severe restrictions on schools, businesses and travel. China’s disastrous experience with strict lockdowns in recent months has only underscored the dangers of major new COVID restrictions.
The most viable options are pharmaceutical. vaccinations. Antiviral drugs.
The vaccines we currently have are mixed. These include old-fashioned Russian and Chinese vaccinations that use cold viruses as vectors for fragments of the coronavirus or contain whole killed SARS-CoV-2. There isn’t much good data on these vaccines, and many experts are skeptical about their effectiveness.
But then there are the best of Western vaccines, including the latest messenger RNA syringes from Moderna and Pfizer and a common cold virus vector vaccine from Johnson and Johnson. The data is clear. These vaccines offer strong protection against serious infections — 70, 80, or 90 percent, depending on who was vaccinated, how long ago it was, and whether they were also boosted.
“The reality is we have vaccines that are still working very well,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast. “It’s just that immunity goes down.” All vaccines and natural antibodies fade over time. But a string of increasingly contagious variants and subvariants of the novel coronavirus — Omicron last fall, followed by Omicron subvariants BA.1, BA.2, BA.4, BA.5, BA.2.12, and XE — have accelerated the decline Immunity.
A second booster dose of an existing two-dose mRNA vaccine could restore and prolong the efficacy of the vaccine. Some of the leading vaccine manufacturers are even working on Omicron-specific boosters.
The inherent flexibility of mRNA vaccines makes this possible. The basic formula of the mRNA vaccine is the same for every disease or variant of a disease. You simply trade in new genetic material depending on what you want to prevent. “We could use it to change the vaccine in a short period of time,” Ali Mokdad, a professor of health metrics at the University of Washington Institute of Health, told The Daily Beast. “But it all depends on how fast the virus mutates.”
The seemingly accelerated rate of viral evolution in COVID could mean that the disease is outpacing mRNA optimization processes. It is possible that by the time the Omicron-specific boosters arrive, Omicron and its closest descendants will be gone and a highly mutated new form of SARS-CoV-2 will be dominant.
Instead of chasing COVID variants with boosters, we could change course and build entirely new defenses against the virus. Two major new vaccine types are under development: “mucosal” nasal vaccines and universal “pan-coronavirus” vaccines.
“I think vaccines will continue to play a very important public health role for the foreseeable future,” Paul McCray, an immunologist at the University of Iowa, told The Daily Beast. “Mucosa vaccines — intranasally — will be in the mix.”
The nasal vaccines, administered through a spray, induce immunity in the mucous tissues of the nose and throat — where COVID infection generally begins. Existing COVID vaccines are all injected into muscle tissue. While the antibodies they produce are effective against the virus, they could be fewer more effective than antibodies derived from the nasal passage.
Where a nasal vaccine is highly optimized for a respiratory virus like COVID, a pan-coronavirus goes the opposite way. It is meant to be universal rather than specific. “The best solution is a universal pan-COVID vaccine,” Bortz said.
The reason is that there are many other corona viruses in addition to SARS-CoV-2. There are even scientists arguing that the latest Omicron subvariants are so sophisticated that they should be considered a brand new coronavirus. “There are sublineages of Omicron that are already immunologically distinct,” Bortz said.
A vaccine that works against all or many coronaviruses could be ahead of mutations in a particular pathogen. The upside is that a single vaccine, regularly boosted, could provide some protection against the current and next COVID pandemic. The downside is that any universal COVID vaccine may be less effective than a vaccine tailored for a specific coronavirus. Can do a lot, but nothing good.
Oh, and a safe and effective pan-coronavirus vaccine, like a nasal vaccine, “may be years away,” Bortz pointed out.
There are some epidemiologists who think that therapies, not vaccines, should be the main effort as SARS-CoV-2 continues to mutate. After three years of crash development, there are certainly many drugs to choose from: monoclonal antibodies, remdesivir, paxlovid.
The latter, a prescription pill, was a real breakthrough when the US Food and Drug Administration approved it for emergency use in certain patients in December. After testing positive for COVID, you can take a Paxlovid regimen at home and cut your chances of serious illness in half.
However, a therapy-first strategy represents a kind of surrender. Therapies are reactive: you receive them after contracting COVID. It’s obviously safer for a larger majority of people to prevent an infection rather than take the risk of treating it quickly.
Realistically, different countries will have different public health strategies – and most will want a mix of vaccines and therapies. Vaccinations to prevent most of the worst infections. Therapies for unvaccinated and breakthrough infections. “Vaccines are critical, but treatment should be a priority just in case,” Mokdad said.
The problem, of course, is that resources are limited. Paying for all of these new vaccines and therapies in the quantities the world needs is a political issue — and a difficult one.
To keep lockdowns off the table and sidestep the toughest COVID strategy decisions, governments could fund all options. Worryingly, in the top-spending country, a right-wing fringe is working hard to keep the federal wallet shut.
The administration of US President Joe Biden wants 10 billion dollars in new funds to ensure supplies today Vaccines and therapies are flowing while accelerating the development of tomorrow is vaccines and therapies. But Republicans in the US Senate, whose votes are needed to approve the money, have insisted on lumping the funding request with an independent measure to block asylum-seekers on the southern border.
That an immigration fight could strain America’s COVID strategy at the very moment that strategy needs to change.
https://www.thedailybeast.com/the-massive-screwup-that-could-let-covid-bypass-our-vaccines?source=articles&via=rss The massive mistake that could lead to COVID bypassing our vaccines