New variant of COVID-19 reaches Alabama: What that means for vaccines

As Alabama pushes forward in its rollout of vaccines, the state this week saw its first confirmed case of the highly contagious coronavirus strain from the United Kingdom.

And the steady global spread of other variants from Brazil and South Africa, the latter found in South Carolina this week, are raising the stakes to immunize Americans as quickly as possible.

Yet new uncertainties are arising about how effective the existing vaccines will be against the mutations and whether it will be necessary to roll out a modified version of the shots.

“That’s the newest wrinkle with COVID,” said Dr. William Schaffner, professor of infectious disease at Vanderbilt University Medical Center. “Just when we thought we got on top of it and are developing and now deploying the vaccine, here we have some new mutations that come up.”

Experts like Schaffner are hopeful that the existing vaccines will still be effective against the new strains but say more research is needed.

On Friday, Dr. Antony Fauci called the arrival of new variants in the United States “a wake up call” to vaccinate as many Americans as possible as quickly as possible to stymie the virus from spreading and mutating further.

“It is an incentive to do what we’ve been saying all along: to vaccinate as many people as we can, as quickly as we possibly can,” he said.

The current Moderna and Pfizer vaccines appear to be effective against the highly contagious UK variant, which was identified in Montgomery and Jefferson counties this week and is rapidly becoming the dominant COVID-19 strain in the United States. New research this week shows the strain may also cause more severe cases.

Johnson and Johnson announced Friday that its vaccine, which is pending FDA approval, is somewhat less effective, with 57 percent efficacy against the South African variant, compared to 72 percent with the original strain. The South African variant was identified in South Carolina this week in two individuals with no apparent connection and no travel history.

Moderna is modifying its vaccine for use on the South African strain, just in case that turns out to be necessary as more becomes known.

A Brazilian variant is causing particular concern among scientists because of how quickly it has spread so far. This week, the variant was identified in Minnesota in a person who had traveled to Brazil.

“The problem with a novel virus is it’s got so much room to grow and shift and change to optimize itself,” said Harvard School of Public Health’s Dr. Michael Mina. “The question is how quickly is it going to keep updating itself?”

Experts say more research should be conducted into how effective the vaccines are against the South African strain, which has currently deviated the most from the original virus.

“Whatever mutation happens, the vaccine manufacturers can keep up with it, but given the multiplicity of strains circulating at one time, that may be a challenge,” said Dr. Schaffner.

Dr. Mina, from Harvard, said he is less confident that the existing vaccines can be updated for any and all future variants. Assuming it is possible to successfully modify the existing vaccines, it may make sense to first wait and see where the virus is heading,

“If we do make a change to the vaccine, by the time that rolls out, we might have a new virus on our hands again or a new version of this virus,” he said.

But Dr. David Kimberlin, a pediatric infectious disease specialist at the University of Alabama in Birmingham, is hopeful that a modified vaccine will not be needed.

“What we know right now is pretty reassuring. It looks like the people getting the current vaccines have protection,” he said. “What we know today may not be what we know a week from now or a month from now.”

Rolling out an updated vaccine would come with a slate of complications, like whether new trials would be necessary.

And then there would be renewed questions of which vaccine priority groups to give the shots to first, especially if some of the most vulnerable people have already been immunized and younger people have yet to receive any doses, Dr. Mina said.

“It’s going to be a real challenge to do it well and (equitably),” he said.

“We’re already seeing massive difficulties in getting equitability in the distribution of vaccine rollouts.”

And it’s not clear how willing some people will be to line up for a hypothetical third shot, whether it is a booster or a new vaccination. Recent polls show only three-quarters of Americans say they definitely or probably would get a vaccine.

“People have COVID fatigue already,” said Dr. Schaffner. “They’re going to come back to us and say ‘what do you mean, why didn’t you take care of this virus the first time around? Now you are saying there are new strains? Give me a break’”

For now, expanding rapid testing, mask wearing, and social distancing are the most powerful tools to prevent future mutations of the virus, said Dr. Mina.

“The best thing we can possibly do to assist the vaccines, to make sure the vaccines are keeping their protective nature, is to get cases as low as they can get through other means,” he said.

Dr. Kimberlin, at UAB, urged Alabamians to get a vaccine when it’s their turn.

“Between now and then and after then, wear masks,” and stay six feet apart, he said. “Those are going to be the kinds of things that get us through this period as we learn more about the variants.”