By the end of 2020, there was a strong hope that high levels of vaccination would cause humanity to finally gain the upper hand over SARS-CoV-2, the virus that causes COVID-19. In an ideal scenario, the virus would then occur at very low levels without further societal disruption or significant deaths.
But since then, new ‘variants of concern’ have emerged and spread worldwide, jeopardizing current efforts to control pandemics, including vaccination.
Simply put, the game has changed and a successful worldwide introduction of current vaccines in itself is no longer a guarantee of victory.
No one is really safe from COVID-19 until everyone is safe. We are in a race against time to make global transmission figures low enough to prevent the emergence and spread of new variants. The danger is that variants arise that can overcome the immunity that vaccinations or previous infection offer.
What’s more, many countries do not have the ability to detect emerging variants via genomic surveillance. This means that the situation may be even more serious than it appears.
As members of the Lancet COVID-19 Public Health Task Force, we urgently call for action in response to the new variants. These new variants mean that we can not rely on the vaccines alone to provide protection, but that 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 in a fair way.
Together, these strategies will deliver maximum suppression of the virus.
What is ‘variant of concern’?
Genetic mutations of viruses such as SARS-CoV-2 occur frequently, but some variants are referred to as “variants of concern” because they can re-infect people who have had a previous infection or vaccination, or are more transmissible or lead to a worse disease.
Read more: UK, South African, Brazilian: a virologist explains each COVID variant and what it means for the pandemic.
There are currently at least three documented SARS-CoV-2 variants that are of concern:
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B.1.351, first reported in December 2020 in South Africa
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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 January 2021 in Japan among travelers from Brazil.
Similar mutations occur simultaneously in different countries, which means that not even border controls and high vaccination rates can necessarily protect countries from home-grown varieties, including varieties that are of concern where there is large community transmission.
If there are high transmission levels, and thus extensive replication of SARS-CoV-2, anywhere in the world, more variants of concern will inevitably arise and the more infectious variants will prevail. With international mobility, these variants will spread.
Eraldo Peres / AP
South Africa’s experience indicates that infection with SARS-CoV-2 in the past offers only partial protection against the B.1.351 variant, and that it is approximately 50% more transmissible than existing variants. The B.1.351 variant has already been detected in at least 48 countries as of March 2021.
The impact of the new variants on the efficacy of vaccines is still not clear. Recent actual evidence from the UK suggests that both the Pfizer and AstraZeneca vaccines offer significant protection against serious diseases and hospitalizations against the B.1.1.7 variant.
On the other hand, the B.1.351 variant appears to reduce the efficacy of the AstraZeneca vaccine against mild to moderate diseases. We do not yet have clear evidence as to whether it also reduces efficacy against serious diseases.
For these reasons, it is essential to reduce the spread of communities. No single action is sufficient to prevent the spread of the virus; we must maintain strong public health measures along with vaccination programs in every country.
Why we need maximum suppression
Every time the virus repeats, there is an opportunity for a mutation. And as we have already seen around the world, the resulting variants run the risk of eroding the effectiveness of vaccines.
That is why we have called for a global strategy of ‘maximum repression’.
Public health leaders need to focus on efforts to maximize the infection rates of viruses, thus preventing the occurrence of mutations that could become new variants of concern.
Rapid vaccination of vaccines alone will not be enough to achieve this; continued measures for public health, such as face masks and physical distance, will also be of utmost importance. Ventilation of indoor spaces is important, some of which are under human control, some of which buildings have to adapt.
Fair access to vaccines
Global equity in access to vaccines is also essential. High-income countries should support multilateral mechanisms such as the COVAX facility, donate excess vaccines to low- and middle-income countries, and support increased vaccine production.
However, to prevent the occurrence of concerned virus variants, it may be necessary to prioritize countries or regions with the highest incidence and transmission levels of diseases, where the risk of such variants emerging is greatest.
Read more: 3 ways to vaccinate the world and make sure everyone benefits, rich and poor
Those in charge of healthcare resources, services and systems should ensure that support is available for healthcare professionals to manage increased hospitalizations for shorter periods without reducing the care of non-COVID-19 patients.
Health systems need to be better prepared for future variants. Suppression efforts must be accompanied by:
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genomic monitoring programs to quickly identify and characterize emerging variants in as many countries around the world as possible
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rapid large-scale “second generation” vaccine programs and increased production capacity that can support the fairness of vaccine distribution
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studies of the efficacy of the vaccine on existing and new variants of concern
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adapting public health measures (such as dual masking) and re-applying them to health care system arrangements (such as providing personal protective equipment for health personnel)
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behavioral, environmental, social, and system interventions, such as enabling ventilation, distancing between people, and an effective system for finding, testing, locating, isolating, and supporting.
Read more: Global weekly COVID cases fall, says WHO – but ‘if we do not fight against it on any front, it will come back’
COVID-19 variants of concern changed the game. We must realize and respond to this if we as a global society want to avoid future waves of infections, and even more locks and restrictions, and avoidable diseases and death.