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New COVID variants have changed the game and vaccines will not be enough. We need global ‘maximum repression’

By the end of 2020, there was a strong hope that high levels of vaccination would eventually give humanity the upper hand over SARS-CoV-2, the virus that causes COVID-19. In an ideal scenario, the virus would then be contained at very low levels without further societal disruption or a significant number of deaths.

But since then, new “variants of concern” have emerged and spread around the world, putting current pandemic control efforts, including vaccination, at risk of being derailed.

Simply put, the game has changed, and a successful global rollout of current vaccines in itself is no longer a guarantee of victory.

No one is really safe from COVID-1

9 until everyone is safe. We are in a race against time to keep global transmission speeds low enough to prevent the emergence and spread of new varieties. The danger is that variants will arise that can overcome immunity by vaccinations or prior infection.

In addition, many countries lack the capacity to track new varieties through genomic monitoring. This means that the situation may be even more serious than it seems.

As members of the Lancet COVID-19 Commission Taskforce on Public Health, we call for swift action in response to the new variants. These new variants mean that we cannot rely on the vaccines alone to provide protection, but we must maintain strong public health measures to reduce the risk from these variants. At the same time, we need to speed up the vaccine program in all countries in a fair way.

Together, these strategies will provide “maximum suppression” of the virus.

What are ‘variants of concern’?

Genetic mutations of viruses such as SARS-CoV-2 often occur, but some variants are labeled “variants of concern” because they can reinfect people who have had a previous infection or vaccination, or are more transmissible, or can lead to a more serious disease.

Read more: UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic

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 UK in December 2020

  • P.1, first identified in Japan among travelers from Brazil in January 2021.

Similar mutations occur in different countries simultaneously, meaning that not even border controls and high vaccination rates can necessarily protect countries from home-grown varieties, including varieties of concern where there is significant transmission from society.

If there are high transmission levels and thus extensive replication of SARS-CoV-2, anywhere in the world, inevitably more variants of concern will arise and the more infectious variants will dominate. With international mobility, these variants will spread.

Man in Brazil's flag cape walks past the billboard showing a running total of Brazil's rollout of the vaccine.
Brazil has vaccinated millions of people, but is also the birthplace of one of the most important current variants of concern.
Eraldo Peres / AP

South Africa’s experience suggests that previous infection with SARS-CoV-2 provides only partial protection against the B.1.351 variant and that it is approximately 50% more transmissible than pre-existing variants. The B.1.351 variant has already been detected in at least 48 countries as of March 2021.

The effect of the new variants on the effectiveness of the vaccines is still not clear. Recent genuine evidence from the United Kingdom suggests that both the Pfizer and AstraZeneca vaccines provide significant protection against severe disease and admissions of the B.1.1.7 variant.

On the other hand, the B.1.351 variant appears to reduce the effect of the AstraZeneca vaccine against mild to moderate disease. We do not yet have clear evidence as to whether it also reduces the effectiveness against severe disease.

For these reasons, it is crucial to reduce the transmission of society. No single action is sufficient to prevent the spread of the virus; we must maintain strong public health measures along with vaccination programs in all countries.

Why we need maximum oppression

Each time the virus replicates, a mutation is possible. And as we already see around the world, some of the resulting variants risk ruining the effectiveness of vaccines.

That is why we have called for a global strategy for “maximum repression”.

Public health leaders should focus on efforts that maximally suppress viral infection rates, thus helping to prevent the emergence of mutations that could become new variants of concern.

Rapid vaccine rollout alone will not be enough to achieve this; continued public health measures, such as face masks and physical distance, will also be crucial. Ventilation of indoor spaces is important, some of which are under people’s control, some of which will require adaptation of buildings.

Fair access to vaccines

Global justice in vaccine access is also crucial. High-income countries should support multilateral mechanisms such as the COVAX facility, donate surplus vaccines to low- and middle-income countries, and support increased vaccine production.

In order to prevent the emergence of worrying viral variants, it may be necessary to prioritize countries or regions with the highest disease prevalence and transmission levels where the risk of such variants occurring is greatest.

Read more: 3 ways to vaccinate the world and ensure that everyone benefits, rich and poor

Individuals in control of health resources, services, and systems should ensure that there is support for healthcare professionals to handle increased admissions over shorter periods during increases without reducing care for non-COVID-19 patients.

Health systems need to be better prepared for future variants. Suppression efforts should be accompanied by:

  • genomic monitoring programs to identify and rapidly characterize new variants in as many countries as possible around the world

  • rapid large-scale “second-generation” vaccine programs and increased production capacity that can support vaccine equilibrium

  • vaccine efficacy studies on existing and new variants of concern

  • adaptation of public health measures (such as double masking) and re-commitment to health system arrangements (such as providing personal protective equipment for health professionals);

  • behavioral, environmental, social, and system interventions, such as enabling ventilation, distance between people, and an effective system for finding, testing, tracking, isolating, and supporting.

Read more: Global weekly COVID cases fall, says WHO – but ‘if we stop fighting it on any front, it will come back roaring’

COVID-19 variants of concern have changed the game. We need to recognize and act on this if we, as a global society, are to avoid future waves of infections, even more lockdowns and constraints, and avoidable disease and death.

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