What’s the Mu variant? And will we keep seeing more concerning variants?


Paul Griffin, The University of QueenslandThis week the World Health Organization named a new “variant of interest” of the coronavirus, called the Mu variant. It was first found in Colombia in January 2021, and has been found in about 39 countries so far.

Mu has changes, called mutations, which mean it might be able to evade some of the protection we get from COVID vaccines.

But one reassuring element is that, despite being around since January 2021, it doesn’t seem to be outcompeting Delta, the dominant variant across most of the world.

If Mu was truly a really bad variant, we would have expected to have started to see indications of this, and we haven’t yet.




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What’s a variant of interest?

An impressive element of our COVID response has been frequent genomic sequencing, which we haven’t done before on this scale. This tracks and maps the evolution of the virus in real time, as it adapts and mutates.

Some mutations will be detrimental to the virus, but some will be beneficial, allowing it to spread better, escape the protection offered by vaccines or even evade COVID tests.

If there are changes to the virus that mean it looks like it has the potential to do more harm, then we might designate it a “variant of interest”.

Mu has mutations that might confer some of these properties, but evidence is still emerging.

The four other variants of interest are Eta, Iota, Kappa and Lambda.

If there’s good evidence Mu is more serious and beginning to overtake other variants such as Delta, it might be upgraded to a “variant of concern”. The four variants of concern are Alpha, Beta, Gamma and Delta.

Can it escape vaccines?

Most COVID vaccines target the “spike protein” of the virus, which it uses to enter our cells. Our vaccines expose our bodies to a part of the virus, commonly the spike protein, so our immune system can learn to fight the virus off if it encounters it.

If a variant has significant changes in the spike protein, this may decrease the effectiveness of our vaccines.




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The WHO said preliminary evidence suggests the Mu variant could partially evade the antibodies we get from vaccination.

But because this data is from lab studies, we can’t be sure how the variant will actually play out in the population.

We need more research to be certain about how it behaves in humans, and work on this is ongoing.

The good news is our vaccines currently protect well against symptomatic infection and severe disease from all variants of the virus so far.

Vaccines may not protect forever

There’s a high probability a new variant will arise one day that can significantly escape the protection offered by our vaccines, which are based on the original strain of the virus. We would call this an “escape variant”.

It’s hard to know if and when this would happen, but rampant community transmission of the virus increases the chances of such a variant emerging.




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However, the leading COVID vaccine manufacturers are well prepared if this eventuates. Some are already developing vaccines for new variants, such as Delta.

If we did discover an escape variant, some vaccine manufacturers could alter their existing vaccines to match the new variant, possibly within 6-8 weeks. Medical regulators around the world would likely accelerate the approval process to make this possible. Certain studies would be required but these could be done quickly, so long as the new vaccine had basically the same properties as the existing vaccine.

It’s possible we could see a variant overtake Delta in terms of infectiousness eventually. Scientists think it’s at least 50% more infectious than the Alpha variant, which was about 50% more infectious than the original strain.

Evolutionary theory predicts the virus may become more transmissible over time, but less severe, as a virus wants to spread as much as possible and doesn’t want to kill its host before it can do so. But this may not necessarily be how SARS-CoV-2 plays out, and realistically we’re still in the early days of this virus.

The best way of combating variants is to get as many people vaccinated as possible, so there are fewer susceptible hosts for the virus to reproduce and mutate.




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There is a risk that once we have the majority of the world vaccinated, vaccines may place “selective pressure” on the virus to evolve to escape vaccines. But the benefits of having more people vaccinated outweighs this risk.

I don’t think it’s time to be concerned about Mu yet. If it became a “variant of concern”, then we might be more worried. But we have some amazing tools to fight this virus, including many successful vaccines — the majority of which can be adapted quickly to new variants.

It’s likely we’ll have regular booster shots to protect us against variants in the future.The Conversation

Paul Griffin, Associate Professor, Infectious Diseases and Microbiology, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Could Britain be sued for reopening and putting the world at risk from new COVID variants?


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Kris Gledhill, Auckland University of TechnologyWith most COVID-19 restrictions now lifted in England, the world is watching to see what this so-called “freedom day” will bring.

Some scepticism is warranted, given Britain’s approach throughout the pandemic has hardly been a success. By July 19, there had been 128,985 deaths from COVID-19, and the death rate per million of population was just under 1,900.

True, there are countries with worse rates, including Hungary, Italy and the Czech Republic in Europe. But countries that have taken a different approach have vastly better figures: for example, 35.8 deaths per million of population in Australia, and 5.39 in New Zealand.

No doubt Boris Johnson’s government took its emphatic 2019 election victory and relatively successful vaccination program as a mandate for opening up.

But the current situation doesn’t support such optimism. Infection rates are now the worst in Europe and the death rate is climbing. By contrast, Australia has much lower death and infection rates but state authorities have responded with lockdowns.

Furthermore, many scientists have condemned the opening-up policy. The authors of the John Snow Memorandum stress the risks to the 17 million people in the UK who have not been vaccinated, and state:

[This approach] provides fertile ground for the emergence of vaccine-resistant variants. This would place all at risk, including those already vaccinated, within the UK and globally.

Taking the UK to court

Is it enough to hope Boris de Pfeffel Johnson will not just dismiss these concerns as piffle? Perhaps there is an alternative — taking the UK to court. Specifically, to the international courts that deal with matters of human rights.

For countries in the Council of Europe, this would be the European Court of Human Rights. Globally, there is the option of the Human Rights Committee of the United Nations.

How would this work? A court claim requires what lawyers call a “cause of action” — in this case, a breach of human rights, including the right to life and the right not to be subject to inhuman and degrading treatment.




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In the main international human rights treaty, the International Covenant on Civil and Political Rights (ICCPR), article 6 requires that the right to life, which belongs to everyone, must be protected. Article 2 of the European Convention on Human Rights (ECHR) says the same.

In 2019, the UN Human Rights Committee noted this right to life amounts to an “entitlement […] to be free from acts and omissions that are intended or may be expected to cause their unnatural or premature death”.

It also noted the obligation on states to take steps to counter life-threatening diseases.

A duty to protect

European Court of Human Rights case law establishes that the duty to protect life includes a requirement on states to take reasonable steps if they know (or ought to know) there is a real and immediate risk to life.

This has usually involved the criminal actions of dangerous people, but there is no reason it should not cover government policy that rests on an acceptance that people will die.

After all, the entire human rights framework was put in place to limit states from breaching rights.




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This duty to protect applies not just to deaths. Both the ICCPR and the ECHR have absolute prohibitions on inhuman and degrading treatment. For many people, the severity of COVID-19, including the consequences of long COVID, meet this standard.

If government policy can mitigate such consequences, human rights standards mandate that it should.

In short, this is not just a matter of the right to health. Because the UK will likely allow the virus to spread from its shores, the rest of the world is at risk and therefore has an interest here. So can other countries take action?

A political calculation

Human rights conventions are treaties — promises by states to each other as to how they will act. Article 33 of the ECHR is very clear: states can ask the European Court of Human Rights to adjudicate whether another state is breaching rights. There are many instances of this happening.

Importantly, the court can issue “interim measures” under its procedural rules to preserve the status quo while it hears a case.




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The UN Human Rights Committee may also consider state-to-state complaints under article 41 of the ICCPR if a state has agreed to this — and the UK has made the relevant declaration.

Of course, any decision by a state to take another to court is political. But this pandemic is not just a health issue, it is also a matter of life and death. Protecting life should be a political priority precisely because it is such a fundamental right.

Politicians willing to stand up for human rights should use the tools that exist to achieve that aim.The Conversation

Kris Gledhill, Professor of Law, Auckland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How worried should you be about coronavirus variants? A virologist explains his concerns


A COVID-19 patient in an ICU unit in a hospital in Capetown, South Africa, in December 2020. A variant emerged in South Africa that has since spread to other parts of the world. Other new variants could emerge elsewhere.
Rodger Bosch/AFP via Getty Images

Paulo Verardi, University of ConnecticutSpring has sprung, and there is a sense of relief in the air. After one year of lockdowns and social distancing, more than 171 million COVID-19 vaccine doses have been administered in the U.S. and about 19.4% of the population is fully vaccinated. But there is something else in the air: ominous SARS-CoV-2 variants.

I am a virologist and vaccinologist, which means that I spend my days studying viruses and designing and testing vaccine strategies against viral diseases. In the case of SARS-CoV-2, this work has taken on greater urgency. We humans are in a race to become immune against this cagey virus, whose ability to mutate and adapt seems to be a step ahead of our capacity to gain herd immunity. Because of the variants that are emerging, it could be a race to the wire.

A variant in Brazil is overwhelming the country’s health care system.

Five variants to watch

RNA viruses like SARS-CoV-2 constantly mutate as they make more copies of themselves. Most of these mutations end up being disadvantageous to the virus and therefore disappear through natural selection.

Occasionally, though, they offer a benefit to the mutated or so-called genetic-variant virus. An example would be a mutation that improves the ability of the virus to attach more tightly to human cells, thus enhancing viral replication. Another would be a mutation that allows the virus to spread more easily from person to person, thus increasing transmissibility.

None of this is surprising for a virus that is a fresh arrival in the human population and still adapting to humans as hosts. While viruses don’t think, they are governed by the same evolutionary drive that all organisms are – their first order of business is to perpetuate themselves.

These mutations have resulted in several new SARS-CoV-2 variants, leading to outbreak clusters, and in some cases, global spread. They are broadly classified as variants of interest, concern or high consequence.

Currently there are five variants of concern circulating in the U.S.: the B.1.1.7, which originated in the U.K.; the B.1.351., of South African origin; the P.1., first seen in Brazil; and the B.1.427 and B.1.429, both originating in California.

Each of these variants has a number of mutations, and some of these are key mutations in critical regions of the viral genome. Because the spike protein is required for the virus to attach to human cells, it carries a number of these key mutations. In addition, antibodies that neutralize the virus typically bind to the spike protein, thus making the spike sequence or protein a key component of COVID-19 vaccines.

India and California have recently detected “double mutant” variants that, although not yet classified, have gained international interest. They have one key mutation in the spike protein similar to one found in the Brazilian and South African variants, and another already found in the B.1.427 and B.1.429 California variants. As of today, no variant has been classified as of high consequence, although the concern is that this could change as new variants emerge and we learn more about the variants already circulating.

More transmission and worse disease

These variants are worrisome for several reasons. First, the SARS-CoV-2 variants of concern generally spread from person to person at least 20% to 50% more easily. This allows them to infect more people and to spread more quickly and widely, eventually becoming the predominant strain.

For example, the B.1.1.7 U.K. variant that was first detected in the U.S. in December 2020 is now the prevalent circulating strain in the U.S., accounting for an estimated 27.2% of all cases by mid-March. Likewise, the P.1 variant first detected in travelers from Brazil in January is now wreaking havoc in Brazil, where it is causing a collapse of the health care system and led to at least 60,000 deaths in the month of March.

Second, SARS-CoV-2 variants of concern can also lead to more severe disease and increased hospitalizations and deaths. In other words, they may have enhanced virulence. Indeed, a recent study in England suggests that the B.1.1.7 variant causes more severe illness and mortality.

Another concern is that these new variants can escape the immunity elicited by natural infection or our current vaccination efforts. For example, antibodies from people who recovered after infection or who have received a vaccine may not be able to bind as efficiently to a new variant virus, resulting in reduced neutralization of that variant virus. This could lead to reinfections and lower the effectiveness of current monoclonal antibody treatments and vaccines.

Researchers are intensely investigating whether there will be reduced vaccine efficacy against these variants. While most vaccines seem to remain effective against the U.K. variant, one recent study showed that the AstraZeneca vaccine lacks efficacy in preventing mild to moderate COVID-19 due to the B.1.351 South African variant.

On the other hand, Pfizer recently announced data from a subset of volunteers in South Africa that supports high efficacy of its mRNA vaccine against the B.1.351 variant. Other encouraging news is that T-cell immune responses elicited by natural SARS-CoV-2 infection or mRNA vaccination recognize all three U.K., South Africa, and Brazil variants. This suggests that even with reduced neutralizing antibody activity, T-cell responses stimulated by vaccination or natural infection will provide a degree of protection against such variants.

Stay vigilant, and get vaccinated

What does this all mean? While current vaccines may not prevent mild symptomatic COVID-19 caused by these variants, they will likely prevent moderate and severe disease, and in particular hospitalizations and deaths. That is the good news.

However, it is imperative to assume that current SARS-CoV-2 variants will likely continue to evolve and adapt. In a recent survey of 77 epidemiologists from 28 countries, the majority believed that within a year current vaccines could need to be updated to better handle new variants, and that low vaccine coverage will likely facilitate the emergence of such variants.

What do we need to do? We need to keep doing what we have been doing: using masks, avoiding poorly ventilated areas, and practicing social distancing techniques to slow transmission and avert further waves driven by these new variants. We also need to vaccinate as many people in as many places and as soon as possible to reduce the number of cases and the likelihood for the virus to generate new variants and escape mutants. And for that, it is vital that public health officials, governments and nongovernmental organizations address vaccine hesitancy and equity both locally and globally.

[Insight, in your inbox each day. You can get it with The Conversation’s email newsletter.]The Conversation

Paulo Verardi, Associate Professor of Virology and Vaccinology, University of Connecticut

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why variants are most likely to blame for India’s COVID surge


Rajib Dasgupta, Jawaharlal Nehru University With more than 300,000 new COVID cases a day and hospitals and crematoria facing collapse, Director-General of the World Health Organization Tedros Adhanom Ghebreyesus has called the situation in India “beyond heartbreaking”.

India’s government has blamed the people for not following COVID-safe public health directives, but recent data shows mask use has only fallen by 10 percentage points, from a high of 71% in August 2020 to a low of 61% by the end of February.

And the mobility index increased by about 20 percentage points, although most sectors of the economy and activity had opened up. These are modest changes and do not adequately explain the huge increase in cases.




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A more likely explanation is the impact of variants that are more transmissible than the original SARS-CoV-2 virus.

Variants in India

Viruses keep changing and adapting through mutations, and new variants of a virus are expected and tracked in a pandemic situation such as this.

The Indian SARS-CoV-2 Genomics Consortium (INSACOG), a group of ten national laboratories, was set up in December 2020 to monitor genetic variations in the coronavirus. The labs are required to sequence 5% of COVID-positive samples from states and 100% of positive samples from international travellers.

The United Kingdom is currently testing about 8% of its positive samples and the United States about 4%. India has been testing about 1% altogether. INSACOG has so far tested 15,133 SARS-CoV-2 genomes. This means of every 1,000 cases, the UK has sequenced 79.5, the US 8.59, and India only 0.0552.

In the final week of December, India detected six cases of the UK variant (B.1.1.7) among international travellers.




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The current second wave started in the northwestern state of Punjab in the first half of February and has not yet plateaued. One of the advisers to the Punjab government confirmed that more than 80% of the cases were attributed to the UK variant.

Significantly, the most affected districts are from Punjab’s Doaba region, known as the NRI (non-resident Indian) belt. An estimated 60-70% of the families in these districts have relatives abroad, mostly in the UK or Canada, and a high volume of travel to and from these countries.




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B.1.617, or what has been called the “Indian double mutation”, has drawn attention because it contains two mutations (known as E484Q and L452R) that have been linked to increased transmissibility and an ability to evade our immune system.

Many experts in India now think this is driving the surge.

Even as India’s health ministry announced the detection of the mutants on March 24, it went on to add:

[…] these have not been detected in numbers sufficient to either establish or direct relationship or explain the rapid increase in cases in some states.

The head of the Indian Council of Medical Research said there was no reason for panic because mutations are sporadic, and not significant. That day, the states of Maharashtra and Punjab accounted for 62.5% and 4.5% of 40,715 new cases, respectively.




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Across the world, several key mutant strains have emerged thanks to ongoing virus replication in humans. Both ability to replicate and transmit, and a better ability to escape our immune systems, led to the variants establishing themselves as dominant strains across geographies and populations.

The UK variant (B.1.1.7) is at least 30% more transmissible. At a recent webinar, Indian experts observed the “Indian strain” (B.1.617) is similarly transmissible to the UK variant, but there is little evidence so far of it being more lethal than the original virus.

Why higher transmissibility is so concerning

According to epidemiologist Adam Kucharski at the London School of Hygiene and Tropical Medicine, the conundrum is this:

[…] suppose 10,000 people are infected in a city and each infects 1.1 other people on average, the low end for the estimated rate of infection in England. After a month, 16,000 people would have been infected. If the infection fatality rate is 0.8%, as it was in England at the end of the first wave of infections, it would mean 128 deaths. With a variant that is 50% more deadly, those 16,000 cases would result in 192 deaths. But with a variant that is 50% more transmissible, though no more deadly, there would be 122,000 cases after a month, leading to 976 deaths.

In all likelihood, this is the current Indian scenario: a higher overall death count despite the variants being no more fatal in relative terms.

Setting up a genomic surveillance system and consistently testing 5% of the positive samples is an expensive but important tool in the journey ahead. This can help us identify emerging hotspots, track transmission and enable nimble-footed decision-making and tailored interventions.The Conversation

Rajib Dasgupta, Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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


Daniel Cole/AP

Susan Michie, UCL; Chris Bullen, University of Auckland; Jeffrey V Lazarus, Barcelona Institute for Global Health (ISGlobal); John N. Lavis, McMaster University; John Thwaites, Monash University; Liam Smith, Monash University; Salim Abdool Karim, Centre for the AIDS Program of Research in South Africa (CAPRISA), and Yanis Ben Amor, Columbia UniversityAt the end of 2020, there was a strong hope that high levels of vaccination would see humanity finally gain 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 significant numbers of deaths.

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

Put simply, the game has changed, and a successful global rollout of current vaccines by itself is no longer a guarantee of victory.

No one is truly safe from COVID-19 until everyone is safe. We are in a race against time to get global transmission rates low enough to prevent the emergence and spread of new variants. The danger is that variants will arise that can overcome the immunity conferred by vaccinations or prior infection.

What’s more, many countries lack the capacity to track emerging variants via genomic surveillance. This means the situation may be even more serious than it appears.

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

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

What are ‘variants of concern’?

Genetic mutations of viruses like SARS-CoV-2 emerge frequently, but some variants are labelled “variants of concern”, because they can reinfect people who have had a previous infection or vaccination, or are more transmissible or can lead to more severe disease.




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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 United Kingdom in December 2020
  • P.1, first identified in Japan among travellers from Brazil in January 2021.

Similar mutations are arising in different countries simultaneously, meaning not even border controls and high vaccination rates can necessarily protect countries from home-grown variants, including variants of concern, where there is substantial community transmission.

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

South Africa’s experience suggests that past infection with SARS-CoV-2 offers only partial protection against the B.1.351 variant, and it is about 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 impact of the new variants on the effectiveness of vaccines is still not clear. Recent real-world evidence from the UK suggests both the Pfizer and AstraZeneca vaccines provide significant protection against severe disease and hospitalisations from the B.1.1.7 variant.

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

For these reasons, reducing community transmission is vital. No single action is sufficient to prevent the virus’s spread; we must maintain strong public health measures in tandem with vaccination programs in every country.

Why we need maximum suppression

Each time the virus replicates, there is an opportunity for a mutation to occur. And as we are already seeing around the world, some of the resulting variants risk eroding the effectiveness of vaccines.

That’s why we have called for a global strategy of “maximum suppression”.

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

Prompt vaccine rollouts alone will not be enough to achieve this; continued public health measures, such as face masks and physical distancing, will be vital too. Ventilation of indoor spaces is important, some of which is under people’s control, some of which will require adjustments to buildings.

Fair access to vaccines

Global equity in vaccine access is vital too. High-income countries should support multilateral mechanisms such as the COVAX facility, donate excess vaccines to low- and middle- income countries, and support increased vaccine production.

However, to prevent the emergence of viral variants of concern, it may be necessary to prioritise countries or regions with the highest disease prevalence and transmission levels, where the risk of such variants emerging is greatest.




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Those with control over health-care resources, services and systems should ensure support is available for health professionals to manage increased hospitalisations over shorter periods during surges without reducing care for non-COVID-19 patients.

Health systems must be better prepared against future variants. Suppression efforts should be accompanied by:

  • genomic surveillance programs to identify and quickly characterise emerging variants in as many countries as possible around the world
  • rapid large-scale “second-generation” vaccine programs and increased production capacity that can support equity in vaccine distribution
  • studies of vaccine effectiveness on existing and new variants of concern
  • adapting public health measures (such as double masking) and re-committing to health system arrangements (such as ensuring personal protective equipment for health staff)
  • behavioural, environmental, social and systems interventions, such as enabling ventilation, distancing between people, and an effective find, test, trace, isolate and support system.



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COVID-19 variants of concern have changed the game. We need to recognise and act on this if we as a global society are to avoid future waves of infections, yet more lockdowns and restrictions, and avoidable illness and death.The Conversation

Susan Michie, Professor of Health Psychology and Director of the UCL Centre for Behaviour Change, UCL; Chris Bullen, Professor of Public Health, University of Auckland; Jeffrey V Lazarus, Associate Research Professor, Barcelona Institute for Global Health (ISGlobal); John N. Lavis, Professor and Canada Research Chair in Evidence-Informed Health Systems, McMaster University; John Thwaites, Chair, Monash Sustainable Development Institute & ClimateWorks Australia, Monash University; Liam Smith, Director, BehaviourWorks, Monash Sustainable Development Institute, Monash University; Salim Abdool Karim, Director, Centre for the AIDS Program of Research in South Africa (CAPRISA), and Yanis Ben Amor, Assistant Professor of Global Health and Microbiological Sciences, Executive Director – Center for Sustainable Development (Earth Institute), Columbia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Flu vaccines are updated every year. We can learn from this process as we respond to COVID variants


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Sheena G. Sullivan, WHO Collaborating Centre for Reference and Research on Influenza and Kanta Subbarao, The Peter Doherty Institute for Infection and ImmunityWhile the future of the pandemic remains uncertain, we’ll probably have to live with COVID-19 for some time.

We face a range of possible scenarios. At the most optimistic end of the spectrum, new vaccines will protect against all current and future variants of concern. At the other extreme, we’ll see the frequent emergence and spread of new variants, against which existing vaccines will have limited effect.

It’s likely we’ll land somewhere in the middle.

Notably, although new variants do threaten the effectiveness of COVID-19 vaccines, decades of experience updating influenza vaccines can inform our global response.

Evolving variants

We’re still learning about how new viral variants affect vaccine effectiveness.

The B.1.1.7 variant, which emerged in the United Kingdom in late 2020, is more infectious and deadlier than the original strain of SARS-CoV-2 (the virus that causes COVID-19). Fortunately, though, preliminary data indicates COVID vaccines still work well against it (although this research hasn’t yet been peer-reviewed).

Meanwhile, a study published yesterday found the Oxford/AstraZeneca vaccine is ineffective against mild or moderate COVID-19 caused by the B.1.351 variant. This study was done in South Africa, where this variant emerged and is currently dominant.

Results of clinical trials of the Novavax and Johnson & Johnson vaccines indicated about 60% overall effectiveness in South Africa, according to the vaccine manufacturers. This is lower than the 70-90% reported in the United States and the UK.




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Notwithstanding differences in each country’s health systems and health status of their populations, which may explain some of the differences, this is a concerning trend.

Reassuringly, Johnson & Johnson reported 85% effectiveness against severe disease, regardless of country or variant. This suggests while some existing vaccines may not entirely prevent infection and mild illness caused by certain variants, they may still protect from severe illness and reduce the load on hospitals.

But if new variants continue to emerge, COVID vaccines may need to be reformulated regularly.

Several manufacturers have announced they’re already working on boosters designed to be more effective against the B.1.351 variant, which has now been detected in 48 countries.

An illustration of SARS-CoV-2, the virus that causes COVID-19.
New variants of SARS-CoV-2 pose a threat to vaccine effectiveness.
Shutterstock

Understanding the global spread of new variants

To develop updated vaccines that best respond to new variants, we need to understand the spread of the variants around the world. This is a big challenge.

To know which variant a person is infected with we need to sequence the viral genome (the genetic material of the virus), which can be expensive and time-consuming. While global access to diagnostic tests is improving, huge disparities in access to sequencing technology remain.

These disparities are reflected in information we have about currently circulating variants. Another variant of concern, P.1, shares some of the key mutations present in the B.1.351 variant. So it may present similar problems with vaccine effectiveness, although clinical trial data are lacking.

The P.1 variant was first identified in Tokyo in travellers from Brazil in January 2021. However, we now understand it’s been circulating in Brazil since early December 2020.

Around the world there have only been about 700 shared P.1 sequences, compared with more than 150,000 sequences of the B.1.1.7 variant. There are certainly far more than 700 cases of P.1, but resource constraints mean we’re not getting the full picture of how different variants are spreading.




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What’s the difference between mutations, variants and strains? A guide to COVID terminology


Further, while sequencing capacity has been massively scaled up during the pandemic, it cannot determine whether a mutation will change how the SARS-CoV-2 virus interacts with our immune system. This requires more lab work, called “antigenic characterisation”, with limited global capacity to undertake this specialised testing.

Patchy understanding of the nature and spread of new variants may lead manufacturers to focus on modifying their vaccines towards better-known variants, which at the moment are those found in more developed countries. These vaccines may be less effective in developing countries where less well-understood variants may predominate.

So we need ongoing, coordinated and global sharing of sequencing information and virus samples to track virus evolution and vaccine effectiveness.

Lessons from influenza surveillance

We’ve encountered similar challenges in the development of influenza vaccines, which are updated annually to ensure they remain effective against new strains.

Existing ‘flu surveillance has already been adapted to some degree for COVID. The Global Initiative on Sharing All Influenza Data, an online platform set up in 2008, has become the main tool used to share SARS-CoV-2 sequences.

In the case of influenza, we’ve seen a coordinated global response. The Global Influenza Surveillance and Response System, established in 1952, includes more than 140 laboratories across 114 countries. These labs share information on influenza viruses with five WHO Collaborating Centres, including genomic sequences, antigenic characterisation, and epidemiological data.

The WHO collaborating centres are then responsible for conducting further analysis to guide vaccine composition, inform regular global updates on circulating strains, and provide training and support to national laboratories.

Twice a year, WHO makes recommendations on vaccine composition for the following influenza season. These recommendations are not binding, but national regulatory agencies and manufacturers have consistently used them to develop ‘flu vaccines for more than 40 years.

A health-care worker dressed in PPE draws up a vaccine.
COVID vaccines are now rolling out around the world.
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A similar approach may prove useful for COVID-19. So far, manufacturers have made decisions about COVID-19 vaccine composition in consultation with national regulatory agencies. Developing a global framework to identify variants that warrant a vaccine update will allow manufacturers to focus on the technical aspects of vaccine development.

In turn, this will facilitate more rapid rollout of vaccines — and importantly, vaccines that are effective against variants circulating around the world, rather than only those affecting developed countries.

Some positives

Despite these challenges, current COVID-19 vaccines appear to provide strong protection against moderate to severe illness caused by most variants, and are likely to provide at least reasonable protection against others.

Also, SARS-CoV-2 mutates more slowly than influenza, meaning vaccines may need to be updated less frequently.

And finally, it will be easier and faster to modify new mRNA and vectored SARS-CoV-2 vaccines than traditional influenza vaccines.




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Australia’s COVID vaccine rollout is well behind schedule — but don’t panic


The Conversation


Sheena G. Sullivan, Epidemiologist, WHO Collaborating Centre for Reference and Research on Influenza and Kanta Subbarao, Professor, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the difference between mutations, variants and strains? A guide to COVID terminology



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Lara Herrero, Griffith University and Eugene Madzokere, Griffith University

Living through a global pandemic over the past year has seen all of us expanding our vocabularies. We now understand terms like PPE, social distancing and contact tracing.

But just when perhaps we thought we had a handle on most of the terminology, we’re faced with another set of new words: mutation, variant and strain.

So, what do they mean?

The genetic material of SARS-CoV-2, the coronavirus that causes COVID-19, is called ribonucleic acid (RNA). To replicate, and therefore establish infection, SARS-CoV-2 RNA must hijack a host cell and use the cell’s machinery to duplicate itself.

Errors often occur during the process of duplicating the viral RNA. This results in viruses that are similar but not exact copies of the original virus. These errors in the viral RNA are called mutations, and viruses with these mutations are called variants. Variants could differ by a single or many mutations.

Not all mutations have the same effect. To understand this better, we need to understand the basics of our genetic code (DNA for humans; RNA for SARS-CoV-2). This code is like a blueprint on which all organisms are built. When a mutation occurs at a single point, it won’t necessarily change any of the building blocks (called amino acids). In this case, it won’t change how the organism (human or virus) is built.

On occasion though, these single mutations occur in a part of the virus RNA that causes a change in a particular building block. In some cases, there could be many mutations that together alter the building block.




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


A variant is a referred to as a strain when it shows distinct physical properties. Put simply, a strain is a variant that is built differently, and so behaves differently, to its parent virus. These behavioural differences can be subtle or obvious.

For example, these differences could involve a variant binding to a different cell receptor, or binding more strongly to a receptor, or replicating more quickly, or transmitting more efficiently, and so on.

Essentially, all strains are variants, but not all variants are strains.

A diagram depicting the evolution from mutation to variant to strain.
Viruses with mutations become variants. If the variant displays different physical properties to the original virus, we call it a new strain.
Lara Herrero, created using BioRender, Author provided

Common variants (which are also strains)

Three of the most common SARS-CoV-2 variants are what we’ve come to know as the UK variant (B.1.1.7), the South African variant (B.1.351) and the Brazilian variant (P.1). Each contains several different mutations.

Let’s look at the UK variant as an example. This variant has a large number of mutations in the spike protein, which aids the virus in its effort to invade human cells.

The increased transmission of the UK variant is believed to be associated with a mutation called N501Y, which allows SARS-CoV-2 to bind more readily to the human receptor ACE2, the entry point for SARS-CoV-2 to a wide range of human cells.

This variant is now widespread in more than 70 countries, and has recently been detected in Australia.

While we commonly call it the “UK variant” (which it is), it’s also a strain because it displays different behaviours to the parental strain.

We’ve got lots more to learn

There is some confusion around how best to use these terms. Given all strains are variants (but not all variants are strains), it makes sense the term variant is more common. But when the science shows these variants behave differently, it would be more accurate to call them strains.

Pleasingly, the World Health Organisation and health departments in Australia appear to be using the terms correctly in the context of SARS-CoV-2.




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The big question everyone is asking at the moment is how the new variants and strains will affect the efficacy of our COVID vaccines.

The scientific community is uncovering more information about emerging mutations, variants and strains all the time, and leading vaccine developers are testing and evaluating the efficacy of their vaccines in this light.

Some recently licensed vaccines appear to protect well against the UK variant but recent data from Novavax, Johnson & Johnson and Oxford/AstraZeneca indicates possible reduced protection against the South African variant.

Health authorities in South Africa recently paused their rollout of the Oxford/AstraZeneca vaccine for this reason. However, its too early to tell what impact, if any, this will have on Australia’s vaccine plans.

The vaccine rollout in Australia will assess all information as it comes to light and ensure optimal available protection for the population.




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Concerning coronavirus mutation now found in UK variant – here’s what you need to know


The Conversation


Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith University and Eugene Madzokere, PhD Candidate in Virology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Are vaccines already helping contain COVID? Early signs say yes, but mutations will be challenging


Maximilian de Courten, Victoria University; Maja Husaric, Victoria University, and Vasso Apostolopoulos, Victoria University

More than 130 million COVID vaccine doses have been administered worldwide already, according to the University of Oxford’s “Our World in Data” vaccination tracker.

Israel, the United Kingdom, the United States, the United Arab Emirates and China are leading this huge global effort.

COVID vaccines were initially tested and approved on their ability to reduce the severity of the disease.

However, the long-term goal of vaccination is to decrease infection rates and eliminate the virus.

Excitingly, early signs suggest vaccines are already helping drive down infection rates in some countries, including Israel and the UK.

In saying that, it’s early days, and some preliminary data suggest countries might have to update their vaccine strategies to deal with emerging variants of the virus.

Israel is leading the way

The US (43 million doses), China (40 million) and the UK (13 million) have administered the most doses in total.

However, these numbers don’t take into account population size, so looking at the number of doses injected per 100 people is more meaningful.

Here, the league table is currently topped by Israel, with around 67 vaccination doses administered per 100 people.

Almost 25% of the population are fully vaccinated with both doses. And all this in just five weeks.

Israel aims to vaccinate everyone over the age of 16 and reach at least 80% of its nine million people by May this year.

Reaching at least 70% of the population via vaccination (and/or natural infection) is needed for herd immunity for COVID, according to initial modelling by University of Chicago researchers in May last year.

However, given more infectious variants of the virus have emerged, we may need to vaccinate an even higher proportion of the population to reach herd immunity.

Infection rates are falling

So far, Israel is solely using the Pfizer/BioNTech vaccine. Interim reports from the country suggest the vaccine rollout is linked to a fall in infections in people over 60 years old.

It can be tricky to separate the effects of public health measures such as lockdowns versus the effects of vaccination.

But because the fall is most pronounced in older people who were first in line to receive the vaccine, data suggest this is also partly due to the vaccine, and not just the country’s current restrictions. A team of Israeli researchers found larger falls in infections and hospitalisations after the vaccinations than occurred during previous lockdowns.

Only 0.07% of the 750,000 over-60s vaccinated tested positive for COVID, according to Israeli Ministry of Health data released last week. And only 38 people, or 0.005%, fell ill and required hospitalisation. The chance of testing positive for COVID two weeks after receiving the first dose was 33% lower than in those not vaccinated.

The UK is also showing positive signs

The UK has administered 19.4 doses per 100 people. Around 13.2 million people (or one in five adults) have received the first dose, and 0.5 million have received the second dose.

It’s currently using both the Pfizer/BioNTech and Oxford University/AstraZeneca vaccines in its rollout.

The infection rate appears to be decreasing substantially. The current daily infection growth rate is falling by between 2-5%, and the R number is estimated to be between 0.7 and 1 (an R number of less than 1 means daily new cases will decrease over time).

However, it’s difficult to determine whether these numbers are due to the lockdown or vaccinations. It’s too early to tell whether vaccines are slowing transmission, but the signs are encouraging.

According to data from the Oxford/AstraZeneca vaccine group, released as a preprint with The Lancet last week and yet to be peer reviewed, its vaccine is showing signs of reducing transmission. The shot was associated with a 67% reduction in transmission among vaccinated volunteers in clinical trials in the UK.

It’s early days, but authors of the study suggest the vaccine may have a “substantial” effect on reducing rates of transmission in the future.

In saying that, preliminary data suggest it offers minimal protection against mild or moderate illness caused by the South African variant.




Read more:
South Africa has paused AstraZeneca COVID vaccine rollout but it’s too early to say Australia should follow suit


What threatens the successful rollout of vaccines?

There are three main problems that might hinder the success of this global vaccination drive.

1. Vaccine development, manufacturing, distribution and delivery

The world’s population over the age of five is currently estimated at seven billion people. If we need to vaccinate at least 70% of them to achieve herd immunity, we need to reach around five billion people.

This is an enormous undertaking, so vaccine production and availability are crucial. Many countries face the massive challenge of producing or securing enough vaccines to immunise all their citizens.

Generally, wealthier countries that could afford to make advanced purchase agreements with vaccine producers — or who could manufacture a vaccine domestically — have been the first to start COVID vaccinations.

Unfortunately, partial vaccination of the world’s population won’t achieve herd immunity. One modelling study suggests if high-income countries exclusively acquire the first two billion doses without regard for vaccine equity, the number of COVID deaths could double worldwide.

2. Administering, monitoring, and reporting adverse effects

Vaccinating a large number of citizens quickly can’t be done with existing health institutions alone.

It’s urgent we enable alternative sites such as halls and sporting venues to be used as mass vaccination sites. We also need to allow a range of health professions such as medical students, public health officials and pharmacists to administer doses to help speed up the process.

And once vaccines have been administered, it’s crucial we monitor efficacy and report on any adverse effects, which will require additional resources.




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3. Vaccine effectiveness and virus mutation

The effectiveness of vaccines can be hindered by mutations of the virus. COVID variants originating in Brazil, South Africa, and the UK have triggered huge concern worldwide.

There’s early evidence some of our current crop of COVID vaccines respond less effectively to certain variants, though most of these data are preliminary and are still emerging.




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


If vaccines become less effective, new vaccines will need to be developed either including a booster dose incorporating the region of the mutated virus, or reformulating existing vaccines to include the mutated strains.

This, however, isn’t uncommon — flu vaccines are required to be updated regularly in order to increase protective capacity against new mutated strains.The Conversation

Maximilian de Courten, Professor in Global Public Health and Director of the Mitchell Institute, Victoria University; Maja Husaric, Senior Lecturer; MD, Victoria University, and Vasso Apostolopoulos, Professor of Immunology and Pro Vice-Chancellor, Research Partnerships, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.