By the end of 2020, there was great hope that high levels of vaccination would eventually lead humanity to gain control over SARS-CoV-2, the virus that causes COVID-19. In an ideal scenario, the virus would be contained at very low levels, without major social disruption or significant number of deaths.
But since then, new “variants of concern” have emerged and spread across the world, putting current pandemic control efforts, including vaccination, at risk of derailment.
Simply put, the game has changed, and a successful global rollout of current vaccines alone is no longer a guarantee of victory.
No one is really sure of the COVID-19 until everyone is safe. We are in a race against time to get global transmission rates low enough to prevent the emergence and spread of new variants. The danger is that variants will emerge that can overcome the immunity conferred by the previous vaccination or infection.
In addition, many countries are unable to track emerging variants through genomic surveillance. This means that the situation may be even more serious than it looks.
As members of the Lancet’s COVID-19 Commission on Public Health Task Force, we urge urgent action in response to the new variants. These new variants mean that we cannot rely solely on vaccines to provide protection, but we must maintain strong public health measures to reduce the risk of these variants. At the same time, we need to accelerate the vaccine program in all countries on an equitable basis.
Together, these strategies will provide “maximum suppression” of the virus.
What are ‘concern variants’?
Genetic mutations of viruses such as SARS-CoV-2 appear frequently, but some variants are labeled as “worrying variants” because they can reinfect people who have previously had an infection or vaccination, or are more transmissible or can lead to more serious illnesses .
Read more: United Kingdom, South Africa, Brazil: a virologist explains each variant of COVID and what they mean for the pandemic
There are currently at least three documented SARS-CoV-2 variants of concern:
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B.1.351, first reported in South Africa in December 2020
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B.1.1.7, first reported in the UK in December 2020
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P.1, first identified in Japan among travelers from Brazil in January 2021.
Similar mutations are emerging in different countries simultaneously, which means that even border controls and high vaccination rates cannot necessarily protect countries from home variants, including worrying variants, where there is significant transmission in the community.
If there are high levels of transmission and therefore 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.
Eraldo Peres / AP
South Africa’s experience suggests that previous SARS-CoV-2 infection offers only partial protection against variant B.1.351 and is about 50% more transmissible than pre-existing variants. Variant B.1.351 was already detected in at least 48 countries in March 2021.
The impact of the new variants on vaccine efficacy is not yet clear. Recent evidence from the UK real world suggests that the Pfizer and AstraZeneca vaccines provide significant protection against serious illness and hospitalizations for variant B.1.1.7.
On the other hand, variant B.1.351 appears to reduce the effectiveness of the AstraZeneca vaccine against mild to moderate illnesses. We still don’t have clear evidence on whether it also reduces effectiveness against serious illnesses.
For these reasons, reducing transmission in the community is vital. No single action is sufficient to prevent the virus from spreading; we must maintain strong public health measures in conjunction with vaccination programs in all countries.
Why do 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 are at risk of eroding the effectiveness of vaccines.
That is why we are calling for a global “maximum suppression” strategy.
Public health leaders must focus on efforts to suppress viral infection rates as much as possible, thereby helping to prevent the emergence of mutations that could become worrying new variants.
The immediate launch of vaccines alone will not be enough to achieve this; Continued public health measures, such as face masks and physical distance, will also be vital. Ventilation of internal spaces is important, some of which are under the control of people, some of which will require adjustments to buildings.
Fair access to vaccines
Global equity in access to vaccines is also vital. High-income countries must support multilateral mechanisms, such as the COVAX facility, donate excess vaccines to low- and middle-income countries, and support increased vaccine production.
However, in order to avoid the emergence of worrying viral variants, it may be necessary to prioritize countries or regions with the highest levels of disease prevalence and transmission, where the risk of the appearance of such variants is greatest.
Read more: 3 ways to vaccinate the world and make sure everyone benefits, rich and poor
Those with control over health resources, services and systems must ensure that support is available for healthcare professionals to manage the increase in hospitalizations in shorter periods during outbreaks, without reducing care for non-COVID-19 patients.
Health systems must be better prepared against future variants. Suppression efforts must be accompanied by:
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genomic surveillance programs to quickly identify and characterize emerging variants in as many countries as possible around the world
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large-scale rapid “second generation” vaccine programs and increased production capacity that can support equity in vaccine distribution
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vaccine efficacy studies on existing and new variants of concern
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adapt public health measures (such as double masking) and commit again to the health system arrangements (such as ensuring personal protective equipment for the health team)
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behavioral, environmental, social and systems interventions, such as allowing ventilation, distance between people and an effective system to locate, test, track, isolate and support.
Read more: Global weekly COVID cases are falling, says WHO – but ‘if we stop fighting on any front, it will come back hard’
Concerning variants of COVID-19 changed the game. We need to recognize and act on this if we want, as a global society, to prevent future waves of infections, even more blockages and restrictions, preventable diseases and death.