Issue 29: U.S. Vaccine Rollout: A Race Against Viral Variants

Apr 01, 2021

By Eric Topol, M.D.

Executive Vice President, Scripps Research

COVID-19 vaccination rates in the U.S. continue to rise, with nearly three million Americans receiving the shot on a daily basis. As of March 29, 37% of the U.S. population over age 18 has received at least one dose of vaccine, according to data from the U.S. Centers for Disease Control and Prevention (CDC).

But the rollout of highly effective vaccines is happening amidst an uptick in COVID-19 cases in the country, fueled largely by the more transmissible B.1.1.7 variant that was first identified as the cause of surging cases in the U.K. This led the CDC’s Director Rochelle Walensky to warn of “impending doom” earlier this week.

To put all of this in perspective, HVP Editor Kristen Jill Abboud recently spoke with Eric Topol, Executive Vice President of Scripps Research and the Director and Founder of the Scripps Research Translational Institute. Topol has been chronicling the epidemiology and science of the COVID-19 pandemic and the efforts to control it on his Twitter account (@EricTopol) and recently co-authored a commentary in
Nature on the need for variant-proof COVID-19 vaccines.

An edited version of the conversation appears below.

How do you think the U.S. is doing today with its COVID response?

The vaccine ramp up has been terrific of late. We’ve had three days of administering over 3.3 million vaccine doses a day, which is astounding. Obviously, it would have been better if we could’ve done that from the start—then we’d have everything contained and have used our best ammunition against the variants. But while everything is going really well with vaccinations, we just can’t do enough, fast enough, to really build a wall of defense against this virus.

We’re seeing cases rise in many parts of the country. Michigan is really looking grim in terms of rising cases, and now the whole Northeast of the U.S. is not looking good. These are all fueled by the U.K. variant. Although New York and New Jersey may have some cases of the New York variant, that is not a superspreader variant. The U.K. variant is the most concerning because it spreads so easily and therefore it will overtake the other variants we know about today. The B.1.1.7 variant will eventually be responsible for all the infections in the U.S., so that’s our big worry. Ultimately, we will prevail, but the sooner we can administer more vaccines, it will help us turn this around.

The other advantage we have is that about 100 million people in the U.S. had COVID and a lot of them are the same people that won’t get a vaccine and won’t wear masks. These individuals, who likely have some level of natural immunity, aren’t factored into a lot of calculations about when we might start to see very strong containment of the virus, which we’ve never had in this country from the very beginning of the pandemic.

What about the B.1.351 variant first identified in South Africa? Does that pose a threat to our current vaccines?

That’s the worst of all the variants we know of today if you look at how it can evade the immune responses in such a way that vaccines could lose efficacy. But trials of the Johnson & Johnson and Novavax vaccines in South Africa show that those vaccines had preserved efficacy against the B.1.351 variant. They didn’t work as well in South Africa as they did in other places, but it was pretty close. And all of the in vitro lab-based studies suggest that the mRNA vaccines should work extremely well against that variant.

In the future there may be a variant that combines the worst features of the B.1.1.7 and the B.1.351 variants, but we haven’t seen that yet. That could be where we’re headed.

Do you expect that booster shots will be required to improve the efficacy of existing vaccines against these or future variants of SARS-CoV-2?

It’s very possible we could go several years without the need for boosters to the existing COVID-19 vaccines. SARS-CoV-1, which is the most closely related virus, circulated in 2003 and there are people 17 years later that still have really great antibodies and T-cells against this virus. The preparation of boosters that are underway now by Moderna and other companies are more as a precaution. The question is really whether we can develop a pan-coronavirus vaccine, which is the most attractive route to getting multi-year protection against the virus and is eminently doable.

Do you foresee SARS-CoV-2 becoming endemic?

It’s not clear; only time will tell. It is dependent on what happens globally. The virus is still raging in many places—infection rates are on a sharp ascent—and it is a global story. If we don’t get our arms wrapped around the virus, it will evolve. The trends we are seeing right now globally aren’t favorable, but if you look at what is happening in Israel, it’s a different story. In Israel, they have basically squashed this virus. But the question is: can the world mimic what happened in a country of nine million people with natural borders and aggressive vaccination campaigns? There are another 7.6 billion people out there that we have to get protected.

What more do you think the U.S. should be doing to ensure COVID-19 vaccines are available globally?

I’ve been promoting that we should ship out all of our excess vaccines because we have a glut—300 million doses of the AstraZeneca vaccine, 100 million or more of J&J’s vaccine, and 100 million more of Novavax’s vaccine. We have 500 or 600 million doses of vaccine that we’re never going to use. We have enough vaccine for everybody in the country and we’re not going to get everybody to take it. Just with the Moderna and Pfizer vaccines, we have enough for the U.S. population.

I don’t really understand the delay in releasing these vaccine doses. Right now, you want to try to get vaccine to the countries in dire need and there is no shortage of those. There are a lot of hot zones that we could help. There is no good excuse that I have heard to not release those vaccines. This is not a national problem, it’s a global and planetary issue. The more we help other countries, the more we help ourselves too.

What do we know now about the ability of the licensed COVID vaccines to prevent viral spread, in addition to preventing disease?

The data on this are very encouraging—it looks like viral spread is really inhibited well. The best data we have are for both the Moderna and Pfizer vaccines, it is more of an unknown for the other vaccines.

How has artificial intelligence (AI) been used in understanding or tackling this pandemic?

AI has overall been a disappointment in this pandemic—it hasn’t really had the impact I would have liked to have seen, which probably reflects that we’re still pretty early in the AI story. It did help contribute to the acceleration of one COVID drug, baricitinib, which got Emergency Use Authorization in combination with remdesivir. AI has also been used to predict who is going to get sick from COVID, who will benefit the most from getting vaccinated, etc., but I haven’t seen anything that’s been a really momentous contribution. But that doesn’t mean AI won’t contribute more in the future. AI, if it’s used properly, would be the way to predict a pandemic. Pinpointing a pandemic before it even happens is, to me, what we’re waiting for with AI. And we can get there.

Interview by Kristen Jill Abboud

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