There is fear in the air. Fear that the COVID pandemic may not get under control because the virus is mutating so fast. Fear that the vaccines may not be effective against these new variants. But fear should not be the driving force behind public health policy decisions. A measured analysis of facts and data is what is important.
With the WHO’s approval, the South African government has let fear halt the AstraZeneca vaccine rollout program. While current studies demonstrate that some of these vaccines are less effective in generating protective antibodies against these variants, especially the South African variant, this is not the whole picture. The vaccine still provides protection against severe outcomes. Careful analysis of the current vaccine data and the scientific community’s understanding of immunity supports the strategic advisory group’s view that challenged this governmental decision. South Africa made a poor ethical and medical decision that other nations should not follow.
Yes, the South African variant, B.1.351, is more aggressive and more contagious. This variant is spreading quickly in South Africa and has been detected in many U.S. states, including Virginia, California, South Carolina, and Texas. While new vaccines, (e.g., Moderna, Pfizer, Novavax, AstraZeneca, and Johnson & Johnson) might be less effective in generating effective antibodies against this variant, it does not mean that the vaccines will be ineffective.
The government should encourage the public to understand and focus on the real question of vaccine efficacy — Do vaccinated individuals contract severe COVID disease? In looking at the facts, the latest studies indicate that Moderna and Pfizer vaccines are over 95 percent effective. The AstraZeneca, NoVac, and J&J vaccines dramatically reduce these clinical outcomes for people infected with the original and variant forms of SARS-CoV-2, even in South Africa. AstraZeneca reported that none of the recipients were hospitalized after 22 days — the time it took for an immune response to build up.
Even though the J&J vaccine is about 60 percent effective in generating effective antibodies, the U.S. government has approved this vaccine as well. The capacity of a vaccine to generate antibodies is not an endpoint to measure whether a vaccine is effective. Reporting a reduced level of neutralizing anti-COVID antibodies in and of itself is an incomplete assessment of a vaccine because even reduced neutralizing antibodies in vaccinated people might still confer COVID protection. In addition, vaccine efficacy also requires the immune system to turn on specific cytotoxic cells, such as natural killer cells, cytotoxic T-cells, and memory cells that attack and kill the COVID virus and virally infected cells. In fact, many of the vaccine studies (i.e., such as Pfizer and Moderna) show that the vaccines generate the appropriate cytotoxic killer cells to destroy the COVID variants.
To date, there are over 50 vaccine candidates that have, or will, enter clinical trials. Some may even turn out to be much less effective against the SARS-CoV-2 mutants. Suppose by some chance, we discover that all these vaccines are dramatically less efficacious in preventing COVID disease. In that case, the vaccine technologies that are successful against the common SARS-CoV-2 virus can be quickly redesigned to create booster shots to protect society against the South African SARS-Cov-2 variant and probably against any new variant that will arise in the future.
Moderna and Pfizer announced that they would begin clinical testing of a candidate booster vaccine intended to address the COVID variants of concern. Our experience with the flu vaccine has taught Americans the unfearful concept that we may need to adjust our vaccine platforms as new variants emerge.
Many scientists believe that SARS-CoV-2 variants may pose vaccine challenges, but these variants are not game-changers to achieve the end game to terminate this pandemic. The public should understand the need to vaccinate as many people as possible to achieve herd immunity and stop this pandemic. The more vaccines we have, the quicker we will achieve herd immunity. Society should be less fearful and more supportive of future research focusing on these SARS-CoV-2 variants and new vaccine platforms.
We must let science, not emotions, lead when making decisions that can change the trajectory of the pandemic and, ultimately, our lives.
John D. Loike is a bioethicist.
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