Dr. Rochelle Walensky, Director, U.S. Centers for Disease Control and Prevention (CDC)
While the world surpasses 100 million reported COVID-19 infections, vaccine distribution is ramping up across the globe. In Europe, health authorities are attempting to overturn a slow start and increasing vaccination of high-risk groups: healthcare workers and those over 65. In the U.S., over 10 percent of the population has received at least one dose of a vaccine, with the country averaging administration of about 1.5 million vaccinations a day. Efforts are underway to distribute vaccines to low- and middle-income countries through the COVAX Facility, a global mechanism for pooled procurement and equitable distribution of COVID-19 vaccines.
Accelerating the pace of vaccination is critical in light of health officials’ increasing concern about SARS-CoV-2 variants emerging from the U.K. (B.1.1.7), South Africa (B.1.351), and Brazil (B.1.1.28). All three variants are proving to be more transmissible – and mixed evidence suggests B.1.1.7 may be deadlier. As global policymakers attempt to curtail their spread, new research and new questions are surfacing around current vaccines’ efficacy against the new strains. Initial research indicates that the Moderna, Pfizer-BioNTech, and AstraZeneca-Oxford University vaccines continue to work well against B.1.1.7, but how vaccines respond to other variants is not yet clear.
This week’s edition of Rabin Martin’s COVID-19 Briefing explores the identified variants and their potential impact on global pandemic recovery. Will vaccine distribution be able to keep up with demand before hyper-resistant strains emerge? Will these new strains set the world back in the collective fight to end the pandemic? Our earlier COVID-19 Briefings are available here.
The U.S. accounts a quarter of global cases, reporting 27,356,234 cases and 474,198 deaths.
Global pandemic spread (Johns Hopkins University)
Variants on the Rise
The beginning of the pandemic in 2020 was marked by limited understanding of SARS-CoV-2. Faced with a novel coronavirus, scientists immediately began intensive research to unwind its mysteries. Now, more than one year later, there is strong baseline knowledge of how the virus operates. However, the rise of new viral variants is pushing the scientific community hard to get a clear picture of how the coronavirus is evolving and the impact on human life.
Below are summaries of what the world currently knows about the three variants of concern: where they have spread, how they are different from the original SARS CoV-2, and the implications on vaccine distribution. Rabin Martin refers to variants not by their purported place of origin, but by their genotypic names in support of efforts to dispel misinformation and avoid stigma from geographic associations.
B.1.351 was the first variant of the original SARS-CoV-2 strain detected globally. First confirmed in South Africa in early August 2020, the variant is now in 44 countries, and experts worry about its potential to spread further. B.1.351 is now the dominant strain in South Africa – making a vaccine effective against B.1.351 essential for epidemic control.
Currently, there is no evidence to suggest B.1.351 leads to increased mortality or an increased risk of reinfection. However, the variant is 1.5 times more transmissible than the original virus, making containment more difficult. The variant spiked “a monster second wave” of infections in South Africa in December and January, leading the country to reinstitute lockdowns and mobility restrictions. In the months since first detection, B.1.351 has been responsible for more than 90 percent of new cases and tens of thousands of excess deaths in the country.
Containing the spread of the variant has proven challenging, leading public health officials to search for the best options for vaccine rollout. Studies have shown that both Moderna’s and Pfizer-BioNTech’s mRNA vaccines produce a reduced immune response against B.1.351, but the impact on disease protection is currently unknown. Novavax’ protein-based vaccine candidate and Johnson & Johnson’s adenovirus-based vaccine candidate were both found to have slightly lower efficacy against B.1.351 but continue to convey protection.
In contrast, a small study of AstraZeneca-Oxford University’s vaccine, ChAdOx1, found the vaccine was not effective in protecting patients against the strain. However, on Wednesday, February 10, WHO recommended the continued use of ChAdOx1 in all countries, including those where new variants are present.
First detected in the United Kingdom in September of last year, the B.1.1.7 variant has proven far more transmissible (potentially up to 75 percent) than the original virus. In the U.K., the proportion of cases arising from B.1.1.7 rose from 63 percent in mid-December to 90 percent by mid-January. While case and death counts are falling across the country, the proportion of cases caused by the variant remains high.
B.1.1.7 has been reported in 86 countries. In the U.S., cases are doubling every ten days – at this current rate, new models generated by the CDC predict that the variant will dominate new cases by March.
The increased transmissibility is troubling given that the variant may be more deadly than the original SARS CoV-2 virus. However, initial research has shown no significant impact on the efficacy of Moderna’s, Pfizer-BioNTech’s, or AstraZeneca-Oxford University’s vaccines. Additionally, preliminary data from Phase 3 trials of Novavax’ vaccine candidate, which is not currently approved in any country, showed the vaccine was 85.6 percent effective against B.1.1.7.
Researchers know the least about the newest variant, B.1.1.28, first identified in Brazil in December 2020. The variant has now been found in 15 countries. Scientists are currently investigating the variant’s impact on mortality as well as vaccine efficacy. At present, it is suggested that the variant is both more transmissible and poses a higher risk of reinfection, based on the experience in Manaus, Brazil in December and January. After being particularly hard hit in the Spring, with 75 percent of the city’s two million people infected, experts expected the population to be nearing herd immunity. However, the appearance of B.1.1.28 caused an explosion of cases in Manaus.
Dr. Zeynep Tufekci, Professor, University of North Carolina
From the Experts
“[COVID-19 vaccines are a] stunning scientific achievement for the world…unprecedented in the history of vaccinology.”
Dr. Dan Barouch, Harvard Medical School
Monday, February 8
“We all have a role to play. Every time you decide to stay at home, to avoid crowds, to wear a mask or to clean your hands, you are denying the virus the opportunity to spread.”
Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO
Monday, February 8
“It’s becoming increasingly apparent that we’re going to be stuck in this whack-a-mole reality, where we have variants that don’t respond to vaccines. We’ll try to tweak those vaccines to target new variants, but because the virus will still be able to spread in some populations in some parts of the world, other variants will pop up.”
Dr. Andrea Taylor, Assistant Director, Duke Global Health Innovation Center
Monday, February 8
“[With the new administration] we’ve seen compassion from leadership. For the first time, we’ve seen genuine understanding of grief.”
Laurie Garrett, Pulitzer Prize-winning author
Monday, February 8
“If people think that we can exchange vaccines for personal behavior, and that getting the vaccine is the passport to spin class, I think they’re going to be sorely shocked when we sleepwalk our way back into the next surge, into the next wave, and then into the next lockdowns.”
Dr. Michael Ryan, Director, World Health Organization Health Emergencies Program
Tuesday, February 9
“There is no reason for alarm, but for attention…Based on the evidence we have now on the variants of concern, we are confident that our growing portfolio of COVID-19 vaccines remains useful and will guide us through the end of this pandemic.”
Dr. Carissa Etienne, Director, Pan American Health Organization
Wednesday, February 10
What We’re Reading
- Li Wenliang: ‘Wuhan Whistleblower’ Remembered One Year On – BBC News
- Do the Math: Vaccines Alone Won’t Get Us Out of This Pandemic – Iain MacLeod, STAT News
- At This Early Stage of the COVID-19 Vaccine Roll-Out, Most Older Adults Have Not Yet Been Vaccinated As Supply Remains Limited – Meredith Freed, Juliette Cubanski, Nancy Ochieng, and Tricia Neuman, Kaiser Family Foundation
- Why Opening Restaurants Is Exactly What the Coronavirus Wants Us to Do – Caroline Chen, ProPublica
- The Coronavirus Crossroads: The Vaccinated, the Stymied and the Waiting – Jennifer Steinhauer, The New York Times
- America Has Hit the Pandemic Wall – Maura Judkis, The Washington Post
- End the Pandemic Faster by Listening to Developing Countries – Ethan Guillén, Foreign Policy
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Weekly Epidemiological Update: February 9
- WHO Weekly Operational Update: February 8
- CDC Coronavirus Resource Page
- COVID-19 Health Systems Response Monitor
- NCD Alliance COVID resources relevant to NCDs
Funding and Policy Trackers
- International Monetary Fund Policy Tracker
- Kaiser Family Foundation Coronavirus Policy Tracker
- U.S. Chamber of Commerce Foundation Corporate Aid Tracker
- Devex Interactive Funding Tracker
Resource Pages and Market Research Literature
- JAMA Resource Center
- The Lancet COVID-19 Resource Centre
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT News COVID-19 Tracker
- Global Health NOW’s COVID-19 Expert Reality Check
- International Association of National Public Health Institutes COVID-19 Resources
- Center for Strategic and International Studies The Reopening and Take as Directed Coronavirus Crisis Update Podcast
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
- COVID-19 Watch Weekly Updates
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About Rabin Martin
Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.
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