When does a COVID-19 variant become a concern (for you)?

Executive Summary

  • The UK, South African and Brazilian variants are of concern because of increased prevalence and they carry mutation(s) such that vaccine and antibody therapies have shown less neutralizing activity in the lab
    • Early Novavax clinical trial findings showed lower vaccine efficacy against the South African variant compared to the UK variant
  • The New York variant is of concern because of increased prevalence and it carries a mutation (like the South African variant) where vaccine and antibody therapies have shown less neutralizing activity in the lab

My first blog post was about whether the vaccines would address variants and I noted that scientists needed to do more research. Some of that research is now suggesting how current vaccines could be less effective against variants if they carry specific mutations.

I started out trying to understand how variants are defined and there are three nomenclatures. I will use the PANGO lineage here since it is the most detailed and can help track emerging variants (the other two are GISAID and Nextstrain).

In the media, you may have heard about the UK (B.1.1.7), South African (B.1.351) or Brazilian (P.1) variants of concern, but these are not technical terms (I’ve put the PANGO lineage in parentheses). These are variants of concern because of increased prevalence and they carry mutations where vaccine and antibody therapies have shown less neutralizing activity in the lab. Furthermore, the South African variant (versus the UK variant) showed lower efficacy in preliminary findings of the Novavax vaccine study. In America, the New York variant (B.1.526) is currently a variant of concern because it showed increased prevalence and was reported as the carrying the mutation (E484K) where vaccine and antibody therapies showed less neutralizing activity in the lab.

Does the COVID-19 vaccine protect against all variants?

Executive Summary:

  • There is evidence that the vaccine is effective against some variants
  • It is uncertain whether the vaccine will be effective against future variants, in which case they will need to be updated

Whether you’re considering the COVID-19 vaccine or not, you may be wondering whether the vaccine protects against new variants being discovered. Although I’m public health professional, I didn’t stay up-to-date with the latest scientific research, because I knew that there is nothing safer than preventive measures: self-quarantining first and foremost; and physical distancing and wearing a mask when outside and in public spaces. As we launched cshell health, we realized that we needed to fundamentally address health literacy in the context of the present: COVID-19 vaccine and variants. So the first thing I did was go to the global authority source, the World Health Organization (WHO) to see what they had to say on variants (published December 31th 2020 and visited on January 21st 2021).

I discovered that in June 2020, the variant that was spreading globally was not the original strain identified in Wuhan, China. Furthermore, additional strains were found in Denmark and the United Kingdom in August/September and end of the year in 2020, respectively. In December 2020, a new variant in South Africa was spreading that was different from an earlier variant. This new variant showed that it was more likely to spread but there was no evidence at the time of worse outcomes.

WHO mentioned four factors in characterizing new variants:

  • is it more contagious?
  • is there a higher likelihood of mortality and morbidity?
  • how likely is reinfection?
  • how do antibodies respond to new variants?

The WHO risk assessment is that, all else equal, if new variants are more contagious, then that could lead to more deaths and hospitalizations.

I also checked what the Center for Disease Control and Prevention had to say on new variants (visited on January 21st 2021 and page last updated January 15th 2021). They have a section on what they do not know, including how new variants spread, the nature of the disease, and what this means for vaccines and therapies.

From what I can tell now, there is no robust evidence on how new variants would respond to the current vaccine. I found an article from CNN on a study suggesting how the vaccine protects against new variants (published January 20th 2021 and visited on January 21st 2021). I read the pre-published study cited, which was published January 19th 2021 by researchers from The Rockefeller University, California Institute of Technology, National Institutes of Health (and its Clinical Center) and Howard Hughes Medical Center. These institutions are reputable in medical science, technology and clinical practice. I noticed that the sample size was small of only 20 volunteers (of which 16 were Caucasian, 8 were females, 14 received the Moderna vaccine) in the report and that activity against some variants have been reduced by “a small but significant margin”. In the Discussion section, they suggest on-going vaccines update and immune monitoring to address viral evolution.

As I was writing this, Dr. Fauci returned to the media spotlight. What the New York Times summarized was aligned with what I found: vaccine may be effective for new variants for now but may need to be updated for mutations. I would say that he is good with not causing any unnecessary public alarm and focusing on when a positive outcome would be due if we followed the necessary public health steps, specifically vaccination rates to reduce the spread, mutation and pressure on health systems.