New coronavirus variants have changed the game, and vaccines won’t be enough
- At least three documented Covid-19 variants of concern are spreading fast around the world, putting vaccination efforts at risk of being derailed
- A global strategy of ‘maximum suppression’, including continued public health measures, such as face masks, will be vital to prevent the emergence of mutations
Put simply, the game has changed, and a successful global roll-out of current vaccines by itself is no longer a guarantee of victory.
What’s more, many countries lack the capacity to track emerging variants via genomic surveillance. This means the situation may be even more serious than it appears.
As members of The Lancet Covid-19 Commission Task Force on Public Health, we call for urgent action in response to the new variants. These new variants mean we cannot rely on the vaccines alone to provide protection but must maintain strong public health measures to reduce the risk from these variants. At the same time, we need to accelerate the vaccine programme in all countries in an equitable way.
Together, these strategies will deliver “maximum suppression” of the virus.
WHAT ARE ‘VARIANTS OF CONCERN’?
Genetic mutations of viruses like Sars-CoV-2 emerge frequently, but some variants are labelled “variants of concern”, because they can reinfect people who have had a previous infection or vaccination, or are more transmissible or can lead to more severe disease.
There are currently at least three documented Sars-CoV-2 variants of concern:
B. 1.351, first reported in South Africa in December 2020
B.1.1.7, first reported in the United Kingdom in December 2020
P. 1, first identified in Japan among travellers from Brazil in January 2021.
Similar mutations are arising in different countries simultaneously, meaning not even border controls and high vaccination rates can necessarily protect countries from home-grown variants, including variants of concern, where there is substantial community transmission.
If there are high transmission levels, and hence extensive replication of Sars-CoV-2, anywhere in the world, more variants of concern will inevitably arise and the more infectious variants will dominate. With international mobility, these variants will spread.
South Africa’s experience suggests that past infection with Sars-CoV-2 offers only partial protection against the B. 1.351 variant, and it is about 50 per cent more transmissible than pre-existing variants. The B. 1.351 variant has already been detected in at least 48 countries as of March 2021.
On the other hand, the B. 1.351 variant seems to reduce the efficacy of the AstraZeneca vaccine against mild to moderate illness. We do not yet have clear evidence on whether it also reduces effectiveness against severe disease.
For these reasons, reducing community transmission is vital. No single action is sufficient to prevent the virus’s spread; we must maintain strong public health measures in tandem with vaccination programmes in every country.
WHY WE NEED MAXIMUM SUPPRESSION
Each time the virus replicates, there is an opportunity for a mutation to occur. And as we are already seeing around the world, some of the resulting variants risk eroding the effectiveness of vaccines.
That’s why we have called for a global strategy of “maximum suppression”.
Public health leaders should focus on efforts that maximally suppress viral infection rates, thus helping to prevent the emergence of mutations that can become new variants of concern.
Prompt vaccine roll-outs alone will not be enough to achieve this; continued public health measures, such as face masks and physical distancing, will be vital too. Ventilation of indoor spaces is important, some of which is under people’s control, some of which will require adjustments to buildings.
FAIR ACCESS TO VACCINES
However, to prevent the emergence of viral variants of concern, it may be necessary to prioritise countries or regions with the highest disease prevalence and transmission levels, where the risk of such variants emerging is greatest.
Those with control over health care resources, services and systems should ensure support is available for health professionals to manage increased hospitalisation over shorter periods during surges without reducing care for non-Covid-19 patients.
Health systems must be better prepared against future variants. Suppression efforts should be accompanied by:
genomic surveillance programmes to identify and quickly characterise emerging variants in as many countries as possible around the world
rapid large-scale “second-generation” vaccine programmes and increased production capacity that can support equity in vaccine distribution
studies of vaccine effectiveness on existing and new variants of concern
adapting public health measures (such as double masking) and recommitting to health system arrangements (such as ensuring personal protective equipment for health staff)
behavioural, environmental, social and systems interventions, such as enabling ventilation, distancing between people, and an effective find, test, trace, isolate and support system.
Covid-19 variants of concern have changed the game. We need to recognise and act on this if we as a global society are to avoid future waves of infections, yet more lockdowns and restrictions, and avoidable illness and death.
This article originally appeared in The Conversation and was authored by Susan Michie (Professor of Health Psychology and Director of the UCL Centre for Behaviour Change, UCL); Chris Bullen (Professor of Public Health, University of Auckland); Jeffrey V Lazarus (Associate Research Professor, Barcelona Institute for Global Health); 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, BehaviourWorks, Monash Sustainable Development Institute, Monash University); Salim Abdool Karim (Director, Centre for the AIDS Program of Research in South Africa); Yanis Ben Amor (Assistant Professor of Global Health and Microbiological Sciences, Executive Director - Center for Sustainable Development (Earth Institute), Columbia University)