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How Covid-19 Vaccines Can Stay Efficient in the Long Run, Despite New Variants

The nightmare scenario is that the coronavirus pandemic never truly ends. Making sure that never comes to pass has become the central focus of a global scientific effort to track the myriad evolutions of the SARS-CoV-2 virus.

For many in the developed world, the arrival in late 2020 of effective vaccines represented the beginning of the end of the pandemic. To be sure, manufacturing and distributing the billions of doses needed to protect the world’s population is an ongoing, difficult and expensive challenge. But a common assumption was that the vaccines would always work, and life for the vaccinated could soon return to some semblance of normalcy.

That happy scenario remains the likely outcome. But risks loom, the most important of which is that SARS-CoV-2 continues to evolve into more infectious and deadly variants. Poor uptake of vaccines in the developing world ensures that this evolutionary process will continue and perhaps even accelerate in the coming months. And if given enough time and human hosts, the virus may mutate to the point where the original vaccines are no longer effective.

When that happens, Covid-19 could boomerang back on the developed world and create an entirely new pandemic. And then this process could happen all over again in a series of never-ending pandemics akin to the arrival of seasonal flu.

At this point, there is little evidence that SARS-CoV-2 is nearly as changeable or virally elusive as the flu. But the first step in ensuring that this boomerang effect never begins is the creation of a global pandemic surveillance system to track the virus’s evolution.

The Rockefeller Foundation has joined a broad and global movement to create this system, and the foundation’s effort is led by  Dr. Jonathan Quick, managing director of the foundation’s pandemic response, preparedness and prevention and author of “The End of Epidemics: The Looming Threat to Humanity and How to Stop It.”

The first step in the creation of this system is ensuring that there is adequate laboratory-based testing around the world for Covid-19 infections using the latest in polymerase chain reaction technology, or PCR.

Every region of the world should not only have a robust testing network but should be able to send viral material from between 1 percent and 5 percent of positive tests to a lab that is capable of sequencing its genome.

“All those genomes then have to be entered into a database along with basic information about the patients who provided the viral material,” Dr. Quick said. “Because it’s the clinical and epidemiological data of those patients that allows researchers to answer questions about whether small changes in the genetic sequence of the virus are significant. Do those changed make the virus more infectious, deadly or vaccine resistance?”

“So we’re focusing on increasing the representativeness and quality of basic sequencing through networks in India, Africa and Latin America,” Dr. Quick said.

The foundation is working with the global repositories of sequencing information to improve the speed of the upload and availability of the sequencing information as well as improve its linkages with the kind of clinical data that will allow researchers to answer important questions about variant spread.

Figuring out where to bolster local testing and sequencing resources is a crucial aspect of surveillance planning. A traditional view of equity would mandate that every corner of the globe should be able to undertake every step in this process. In this view, equity means that every individual and group has equal access to the same facilities and expertise.

But the important point in the pandemic is that every person is able to achieve the same outcome, and recognizing that resources are finite, plans must be made to offer the best solutions for every locale, Dr. Quick said.

No False Choices

New health programs in low-income countries sometimes steal people and resources from other vital health functions. Avoiding this trap requires priority setting and some serious data analytics.  For instance, increased testing of Covid at the front lines might be seen as taking resources away from maternal and child health. But if that testing allows for the separation of the infectious from those without infections, then the effort strengthens essential services.

“The deaths that result from the disruption of primary care and immunization services during a pandemic can equal or even exceed the deaths that result from the pandemic itself,” Dr. Quick said. “You need to look not only at whether the testing is helpful in arresting the spread of Covid-19 but determine how having that testing helps you maintain other health services.”

Another point is that the rapid development of cheaper and more portable testing devices has lessened the intrusion into primary care. Those sorts of technologies appropriately distributed can provide better front-line sequencing.

Making The System Resilient

Pandemics are rare events. Ensuring that a surveillance system is in place for the next one requires making it useful between pandemics. Thankfully, viral and bacterial genomic sequencing is always helpful. There are about 200 significant infectious disease outbreaks in the world every year and thousands of smaller outbreaks. Nearly all of these result from known pathogens, although there is always a steady drip of new pathogens that have never been seen before or are closely related to pathogens that are rarely seen.

Tracking all of these is the basic business of public health. There are food outbreaks and bad flu strains.” A global genomic surveillance system will help track and suppress all of these myriad outbreaks,’ Dr. Quick said. “We just have to figure out the best way to feed those day-to-day samples into the system.

One idea, for instance, is routine waste water sampling.

Making The System Fair

Surveillance is never enough. The developing world must be assured that they will also have access to vaccines and treatments that save lives. The first step in doing that is ensuring in the next six months that the global south receives effective vaccines. Thankfully, there are world-class vaccine producers in every continent but Antarctica. Efforts must be made to boost their capacity and in some cases their technical know-how and supply chain management.

“The other important part is that we need a better political forum for the pandemic issues,” Dr. Quick said. “One of the clear lessons we’ve seen over and over again in pandemics from the 1918 Spanish Flu to Ebola is that these kind of outbreaks require a whole-of-society response. It can’t just be the health sector.”

The World Health Organization has done Herculean work in a situation where the world did not come together in an optimal way.

“We need to see the kind of global unification that we saw with the 2015 Paris global climate accord,” Dr. Quick said. “We need that kind of forum where you can work through some of these issues that can divide the global north from the south.”