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

• At 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. This means 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. That is why the world needs to develop strategies of maximum suppression of the virus on a global stage.

What are variants of concern?

• These are variants that have the potential to reinfect people who have had a previous infection or vaccination, or are more transmissable or can lead to more disease.
• There are currently at least three documented variants of concern:
• B.1.351 - also known as the South African variant
• B.1.17 - also known as the UK variant
• P.1 also known as the Brazilian variant
• Similar mutations are rising in different countries at the same time, 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 the virus, 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.
• The impact of the new variants on the effectiveness of vaccines is still not clear. Recent evidence suggests earlier COVID-19 infection offers only partial protection against South African variant and it is about 50% more transmissable than pre-existing variants - and it has already been detected in at least 48 countries. It also appears to reduce the efficacy of the AstraZeneca vaccine against mild to moderate illness.
• 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 programmes 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 a global strategy of maximum virus suppression is required.
• Prompt vaccine rollouts alone will not be enough to achieve maximum suppression. There'll need to be face mask wearing, physical distancing, better ventilation of public spaces - which may require adjustment to buildings and public spaces.

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/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.
• Those with control over healthcare resources 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 programmes to identify and quickly characterise emerging variants in as many countries as possible around the world
• Rapid large-scale 'second-generation' vaccine programmes 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

Conclusion

• 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.