As Alabama moves forward with its vaccine launch, the state this week saw its first confirmed case of the UK’s highly contagious coronavirus strain.
And the constant global spread of other variants from Brazil and South Africa, the latter found in South Carolina this week, is increasing the stakes to immunize Americans as quickly as possible.
However, new uncertainties are emerging about the effectiveness of existing vaccines against mutations and whether it will be necessary to launch a modified version of the vaccines.
“This is COVID’s newest wrinkle,” said Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center. “Just when we thought we were at the top and we are developing and now implanting the vaccine, here are some new mutations that are emerging.”
Experts like Schaffner are hopeful that existing vaccines will still be effective against new strains, but say more research is needed.
On Friday, Dr. Antony Fauci called the arrival of new variants to the United States “an alert” to vaccinate as many Americans as possible as quickly as possible to prevent the virus from spreading and mutating.
“It’s an incentive to do what we’ve been saying all along: vaccinate as many people as we can, as soon as possible,” he said.
The current Moderna and Pfizer vaccines appear to be effective against the highly contagious variant in the UK, which was identified in Montgomery and Jefferson counties this week and is fast becoming the dominant COVID-19 strain in the United States. New research this week shows that the strain can also cause more serious cases.
Johnson and Johnson announced on Friday that their vaccine, which is awaiting FDA approval, is slightly less effective, with 57% effectiveness against the South African variant, compared with 72% of the original strain. The South African variant was identified in South Carolina this week in two individuals with no apparent connection and no travel history.
Moderna is modifying its vaccine for use against the South African strain, should this prove necessary as more information becomes known.
A Brazilian variant is causing special concern among scientists because of the speed with which it has spread so far. This week, the variant was identified in Minnesota on a person who had traveled to Brazil.
“The problem with a new virus is that it has a lot of room to grow, change and change to optimize itself,” said Dr. Michael Mina, from Harvard School of Public Health. “The question is how quickly will it keep updating?”
Experts say more research should be done on the effectiveness of vaccines against the South African strain, which is currently the most deviant from the original virus.
“Whatever the mutation that happens, vaccine manufacturers can keep up with it, but given the multiplicity of strains circulating at the same time, that can be a challenge,” said Dr. Schaffner.
Dr. Mina of Harvard said he is less confident that existing vaccines can be updated for any and all future variants. Assuming that it is possible to successfully modify existing vaccines, it may make sense to first wait and see where the virus is going,
“If we make a change to the vaccine, when it is released, we may have a new virus on our hands again or a new version of that virus,” he said.
But Dr. David Kimberlin, a pediatric infectious disease specialist at the University of Alabama at Birmingham, is hopeful that a modified vaccine will not be needed.
“What we know now is very comforting. It seems that the people who receive the current vaccines have protection, ”he said. “What we know today may not be what we know in a week or a month.”
The launch of an updated vaccine would come with a series of complications, such as the need for new trials.
And then there would be new questions about which priority vaccine groups to give vaccines first, especially if some of the most vulnerable people have already been immunized and the youngest have yet to receive any doses, said Mina.
“It will be a real challenge to do it well and (fairly),” he said.
“We are already seeing enormous difficulties in achieving fairness in the distribution of vaccine launches.”
And it is unclear how some people will be willing to line up for a hypothetical third injection, be it a booster or a new vaccination. Recent research shows that only three-quarters of Americans say they would definitely or likely receive a vaccine.
“People already have COVID fatigue,” said Dr. Schaffner. “They’re going to come back to us and say ‘what do you mean, why didn’t you take care of this virus the first time? Now are you saying that there are new strains? Give me some time'”
For now, the expansion of rapid testing, wearing masks and social detachment are the most powerful tools for preventing future mutations of the virus, said Dr. Mina.
“The best thing we can do to help vaccines, to ensure that vaccines are maintaining their protective nature, is to reduce cases to the maximum by other means,” he said.
Dr. Kimberlin, from UAB, urged Alabamians to get a vaccine when it was their turn.
“Come in now and then and after that, wear masks” and stand two meters away, he said. “These will be the kinds of things that will guide us through this period as we learn more about the variants.”