COVID-19 could be headed to a scary place

As COVID-19 vaccine coverage expands in the U.S. and we get back to some semblance of normalcy, there is a high risk of sleepwalking into a catastrophic next phase of the pandemic and a return to lockdowns.

It is likely that variants will emerge that evade all existing vaccines.

The job of a virus, like all living organisms, is to survive and reproduce. Every time any virus reproduces, mutations occur. If the virus encounters an immune response that hinders it, variants that have mutated in a way that allows them to escape from that immunity are more likely to survive and spread.

The known variants that have emerged thus far have occurred in the absence of significant vaccine coverage — perhaps because of immune pressure from relatively high infection rates. Thus far, the variants seem to be susceptible to available vaccines. 

However, the rapid spread of variants even with relatively high vaccine coverage is deeply concerning. For example, the Delta variant in the UK is now dominant, leading to surge in new infections and a delay in lifting lockdown measures.

Overcoming variants requires full vaccination. With the exception of the Johnson and Johnson vaccine, one jab will not do it. While the UK has one of the highest vaccine coverage rates in the world, less than half the population has been fully vaccinated. The U.S. is slightly behind.

Approximately 10 percent of the world’s population has been fully vaccinated. In the poorest countries, less than 1 percent have received a first dose. Many of these countries are delaying the second jab to try to provide some protection to as many people as possible.

Partial vaccination, of a person, a country or the world, is a recipe for disaster. The way to stay ahead of the virus is to fully vaccinate to reach the illusive “herd immunity.” However, experts believe that the presence of variants could require up to 90 percent coverage.

Of course, a new vaccine to beat variants down can be generated in a matter of weeks. But that requires recalling all stocks, producing and distributing new vaccines and many painful arms and other side effects, potentially increasing hesitancy — and a lot of time. If we do not act now, we could be locked in persistent cycles of partial vaccination, new escape variants, producing and distributing new vaccines.

The Independent Panel on Pandemic Preparedness and Response (IPPPR) made concrete recommendations on how to avert the ongoing crisis. First, basic public health measures like social distancing and masks for unvaccinated persons must remain in force. 

Wealthy countries have secured nearly 5 billion doses of vaccine for a population of approximately 1.16 billion. Even with two doses for every person, that is a surplus of nearly 3 billion doses. Because not all of the doses have been delivered, IPPPR recommended that at least 1 billion doses be provided to lower-income countries by September and at least 2 billion by the first half of 2022.

President Biden’s commitment of 500 million doses is a good start. However, the limp performance of the rest of the G7 at their recent meeting is worrisome. The G20 should take strong action before it meets in October.

But vaccines are not enough. The yawning gap between full vaccination and herd immunity combined with the current and likely future surges in infections due to variants — and the possibility of variants that escape vaccine protection — requires widespread availability of diagnostics and effective pan-coronavirus therapies that are easy to distribute and use. The recent announcement by NIH of $1.2 billion for innovative approaches is commendable.

In addition, novel approaches to prevent all SARS-CoV-2 with pan-coronavirus vaccines or prophylaxis are needed. 

Finally, local manufacture is necessary to increase supply of vaccines, diagnostics and treatment. The commitment by European countries and the Biden administration to invest in manufacture of vaccines in Africa is a good beginning, but much more is required.

Unfortunately, there is far more focus on where the virus began than where it is going. It is important eventually to know if the SARS-CoV-2 virus that causes COVID-19 leaked out of a laboratory or was a unusual but not unprecedented genetic leap from bats to humans. However, focusing on the origin now could divide the world into U.S. and China camps at a time when we need global unity to end this pandemic and prepare for the next one. 

We get it. No one wants to think about variants that escape all vaccines right now. We want some return to our pre-pandemic lives. And it is easier to look for scapegoats and focus on the past than the future. But if was act now, we can potentially get ahead of the virus before it gets there.

Because where COVID-19 is going could be a very scary place.

Mark Dybul and Deus Bazira are Co-Directors of the Center for Global Health Practice and Impact, Georgetown University Medical Center. Dybul was a member of the Independent Panel on Pandemic Preparedness and Response and has led the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.