After weeks at two-year low, COVID cases rising again in a few countries. In the United States, there are 100,000 new infections daily, up from 30,000 in mid-March.
This trend is intensifying an important debate in epidemiological circles. What is the best strategy to prevent mass death from the worst possible? new COVID variant? New restrictions? New vaccines? New therapy? A mix of three?
Whatever consensus is formed could lead us into the fourth year of the pandemic. But of course there is an advantage. Public health costs money. And in the world’s wealthiest country, the United States, some right-wing politicians are doing their best to ensure that no new money is available to speed the development, production and distribution of vaccines, and new therapy.
Vaccine development is stalled. China is still pushing for domestically produced vaccines that don’t work. Leading Western vaccine manufacturers have been focusing on developing special boosters for the Omicron variant recently. But by the time these boosters are ready in the fall, Omicron has likely been replaced by a new and more dangerous variant.
Two years ago, the world worked together to develop a highly effective and rapid messenger RNA vaccine. Less money and less urgency today mean that vaccine development is slowing down precisely at a time when the virus is accelerating.
Experts warn potential disasterlater this year or next, growing.
To be clear, the current COVID increase is mild. In the US alone, there were an average of 800,000 new cases daily by mid-January. And hospitalizations and deaths have not increased at the same rate as cases, due to high levels of vaccination as well as natural antibodies from past infections.
But the rise in cases in some countries — fueled by what appears to be mutate faster than ever in the SARS-CoV-2 virus — is a reminder that the pandemic is not over. Viruses are constantly changing – and finding new ways to overcome our immune walls.
There is a lot of uncertainty here. Eric Bortz, a virologist and public health expert from the University of Alaska-Anchorage, told The Daily Beast: “The virus may or may not evolve, progressing in the short term towards increasing vaccine evasion. big.
Epidemiologists are not taking advantage of the opportunity. They are looking ahead, trying to predict how the new coronavirus might evolve, and what we should do about it. They almost unanimously believe that the pathogen will be with us for many years. But they disagree on what we should do with it.
There are options in the event that SARS-CoV-2 makes an evolutionary leap and negates the protection of our vaccines and antibodies. This is the nightmare scenario and the one that fuels the fiercest debate.
New lockdowns are one of the options, but are least likely to happen due to the profound unpopularity of tough restrictions on schools, businesses and travel. Of China catastrophic experience with the tight lockdown in recent months only underscores the danger of new COVID restrictions.
The most viable options are pharmaceuticals. Vaccine. Antiviral drugs.
The vaccines we currently have are a mixed bag. These include old-fashioned Russian and Chinese fighters that use cold viruses as vectors for coronavirus fragments or contain all destroyed SARS-CoV-2. There is not much good data on these vaccines, and many experts doubt their effectiveness.
But then there are the top Western vaccines, including the latest messenger RNA injections from Moderna and Pfizer and a cold virus vector vax from Johnson and Johnson. Clear data. These vaccines provide strong protection against serious infections — 70-, 80-, or 90%, depending on the subject, how long ago, and whether they were boosted. are not.
James Lawler, an infectious disease specialist at the University of Nebraska Medical Center, told The Daily Beast: “The reality is that we have a vaccine that still works. “Just weakened immunity.” All vaccines and natural antibodies will wear off over time. But a string of new coronavirus variants and sub-variants is increasingly contagious — Omicron last fall, followed by Omicron subvariants BA.1, BA.2, BA.4, BA.5, BA.2.12 and XE — accelerated the decline of immunity.
A second booster of an existing two-dose mRNA vaccine may restore and prolong the effectiveness of the injection. Some of the leading vaccine manufacturers are even working on Omicron-specific boosters.
The inherent versatility of mRNA vaccines makes that possible. The basic mRNA vaccine formulation is the same for any disease or variant of the disease. You just swap out the new genetic material, depending on what you want to prevent. “We can use it to change the vaccine in the short term,” Ali Mokdad, a professor of health metrology at the University of Washington Institute of Health, told The Daily Beast. “But it all depends on how quickly the virus mutates.”
The seemingly accelerated rate of viral evolution in COVID may mean that the disease outstrips mRNA refinement processes. It is possible that by the time the Omicron-specific booster emerges, Omicron and its closest offspring will be gone and some highly mutated new form of SARS-CoV-2 will prevail.
Instead of chasing COVID variants with boosters, we can change course and build entirely new defenses against the virus. There are two main new vaccines in development: the “mucosal” nasal vaccine and the universal “pan-coronavirus” vaccine.
“I think vaccines will continue to play a very important role in public health for the foreseeable future,” Paul McCray, an immunologist at the University of Iowa, told The Daily Beast. “Mucosal vaccines – given intranasally – will be combined.”
The nasal vaccine, which is given by spray, induces immunity in the mucous tissues of the nose and throat, where COVID infections often start. Currently available COVID vaccines are injected into muscle tissue. The antibodies they produce, while effective against viruses, can be less than more effective than intranasal-derived antibodies.
Where the nasal vaccine is highly optimized for a respiratory virus like COVID, the pan-coronavirus does the opposite. It aims to be common rather than specific. “The best solution is a global pan-COVID vaccine,” says Bortz.
The rationale is that there are many coronaviruses besides SARS-CoV-2. Some scientists have even argued that the newest Omicron subspecies are so highly evolved that they qualify as an entirely new coronavirus. “There are sublines of Omicron that are immunologically distinct,” says Bortz.
A vaccine active against all or many coronaviruses can overcome mutations in any particular pathogen. Its advantage is that a single vaccine, periodically boosted, can protect a number of diseases against the current and subsequent COVID pandemic. The downside is that any generic COVID vaccine may be less effective than a vaccine tailored for a specific coronavirus. Jack of all trades, there is no master.
Oh, and a safe and effective pan-coronavirus vaccine, like the nasal vaccine, “could be years away,” Bortz points out.
There are some epidemiologists who argue that therapy, rather than a vaccine, should be the main effort because SARS-CoV-2 continues to mutate. After three years of bumpy development, there are certainly plenty of drugs to choose from: monoclonal antibodies, remdesivir, paxlovid.
The latter, a prescription pill, was a real breakthrough when the US Food and Drug Administration authorized it for emergency use to some patients in December. After testing positive. With COVID, you can take a course of paxlovid at home and halve your chances of becoming seriously ill.
However, the strategy of prioritizing therapy represents a type of surrender. Reactive therapies: you get them after you catch COVID. It is clearly safer for the majority of people to prevent infection than to lose the chance to treat it quickly.
In fact, different countries will pursue different public health strategies — and most want a combination of vaccines and therapies. Jabs to prevent most of the worst infections. Therapies for unvaccinated and breakthrough infections. “Vaccines are important, but treatment should be the priority in case of illness,” Mokdad said.
The problem, of course, is limited resources. Paying for all these new vaccines and therapies, in the quantities the world demands, is a political issue — and a difficult one.
To avoid stalemate and overcome the toughest COVID strategy choices, governments can fund all options. Worryingly, in the country with the most spenders, the right is working to keep federal purse strings closed.
Administration of US President Joe Biden wants $10 billion in new funding to keep fresh supplies today vaccines and therapies, and promote the development of tomorrow vaccines and therapies. But the Republicans in the US Senate, who have the votes needed to approve the amount, Has emphasized about pooling the funding request with an unrelated measure to block asylum seekers at the southern border.
That the battle over immigration could weigh on America’s COVID strategy, at a time when that strategy may need to change.