— Holden Thorp in Science

 

COVID cases and deaths continue unabated across the globe. A WHO press release says, “As COVID-19 cumulative cases in Africa top 3 million and daily case numbers exceed the first wave peak, the continent is now confronted with emerging variants of the virus. Revamped public health measures are ever more critical to avert a runaway surge in infections that could stretch health facilities to the breaking point. An average of 25,223 cases were reported each day between 28 December 2020 and 10 January 2021 in Africa, which is nearly 39 percent higher than the July 2020 two-week peak of 18,104 daily average cases. The New York Times reports in China, “More than 22 million people in all have been ordered to remain inside their homes—double the number affected last January when China’s central government locked down Wuhan, the central city where the virus was first reported, in a move that was then seen as extraordinary.” The Guardian reports, “More than 100,000 people have died from coronavirus in the UK since the disease first appeared in the country almost a year ago, in what public health experts said is a sign of ‘phenomenal failure of policy and practice’.”
 

If You Are in a Hurry

• Watch a commentary by bioethicist Art Caplan on the “chaotic and failing” vaccine distribution in the US on Medscape.
• Find out why you still need to wear a mask after vaccination and what is known about whether vaccinated people can still be infected at NPR.
• Read Nature on the challenge of developing trials to test new vaccines when there are already highly effective vaccines approved.
• Read Science editor Holden Thorp on why science benefits from public debate.
• Read STAT on the need for a National Hi-Fi Mask Initiative.
• Read about the preliminary good news for J&J’s vaccine in Medscape.
• Find out about concerns about one of the two vaccines that are part of India’s mass vaccination roll out on NPR.
• Read James Krellenstein, Peter Staley and Wafaa El-Sadr on the need for a President’s Emergency Plan for Vaccine Access and Relief, or PEPVAR in the New York Times.

 

Concern Over New Variants Grows

 
Concern continues to grow as the UK and South Africa variants seem to be driving higher cases in those countries and potentially other countries where the variants have spread. As genomic surveillance ramps up in some countries additional variants are being discovered.
 
The Independent reports WHO has warned the variants could make the second year of the pandemic rougher than the first. "’We are going into a second year of this, it could even be tougher given the transmission dynamics and some of the issues that we are seeing,’ Mike Ryan, the WHO's top emergencies official, said during an event on social media. The highly contagious UK variant has so far spread to more than 50 countries, while the South Africa strain has been detected in 20 other nations, the WHO confirmed.”
 
A report in STAT warns, “…new, more infectious variants of the coronavirus have gained toeholds in the United States. If they take off here—which, with their transmission advantages, they will, unless Americans rapidly put a brake on their spread—it will detonate something of a bomb in the already deep, deep hole the country must dig out of to end the crisis…. If there was already an urgency to vaccinate people as widely and quickly as possible, the arrival of the variants adds accelerant. In order to bring the US epidemic to a close, the population needs to develop what’s known as herd immunity—and based on transmission dynamics, getting to that point with a faster-spreading virus will require even more people to be vaccinated.”
 
The New York Times reports on a new variant discovered in four people travelers from Brazil. “it was a separate variant with similarities to those detected in Britain and South Africa. It is also distinct from another variant recently identified in Brazil, according to experts who have analyzed the data.”
 
The Guardian reports, “The technology exists to rapidly tweak vaccines in the face of new coronavirus mutations. But it would take time, and a global strategy is needed to ensure that scientists stay one step ahead….”
 
Bhekisisa quotes Richard Lessells, one of the team that discovered the SA variant: “We’re building on the scientific data available to understand the significance of these mutations but that doesn’t mean we should slow down or change the strategy to get vaccines to South Africa as quickly as possible. In many ways, it makes it more urgent.”
 
Reuters reports, “Regeneron Pharmaceuticals Inc’s dual antibody therapy for COVID-19 will likely be effective against new variants of the coronavirus identified so far… Eli Lilly and Co said its coronavirus antibody treatment, bamlanivimab, which is approved for emergency use by the US Food and Drug Administration, is effective against the UK variant, but may not be able to neutralize the one identified in South Africa.”
 

Preliminary Good News for J&J Vaccine

 
Medscape reports on new data from J&J—phase 1/2a trial results published in NEJM. ‘The take-home message [includes] a high neutralizing antibody responder rate to a single dose of our Ad26.COV2.S COVID-19 vaccine candidate. In addition, we see that these responses and antibody titers are stable for at least 71 days,’ senior study author Hanneke Schuitemaker” says. Reuters reports J&J “is on track to roll out its single-shot coronavirus vaccine in March, and expects to have clear data on how effective it is by the end of this month or early February, the US healthcare company's chief scientific officer said.”
 
STAT reports, “A third authorized vaccine—and one that could be given in a single dose—could help reshape the fight against the COVID-19 pandemic, even if supplies are expected to be limited for some time. ‘Part of the complication we have is this two-dose deal,’ [Carlos] del Rio said. ‘If we can have a vaccine that is a single dose, the J&J vaccine would become, without doubt, the vaccine of choice for the world.’”
 
The New York Times reports, “the encouraging prospect of a third effective vaccine is tempered by apparent lags in the company’s production…. [US] Federal officials have been told that the company has fallen as much as two months behind the original production schedule and won’t catch up until the end of April, when it was supposed to have delivered more than 60 million doses,
 

And Bad News for Sinovac

 
The New York Times says, “Scientists in Brazil have downgraded the efficacy of a Chinese coronavirus vaccine that they hailed as a major triumph last week, diminishing hopes for a shot that could be quickly produced and easily distributed to help the developing world. Officials at the Butantan Institute in São Paulo said on Tuesday that a trial conducted in Brazil showed that the CoronaVac vaccine, made by the Beijing-based company Sinovac, had an efficacy rate just over 50 percent. That rate, slightly above the benchmark that the World Health Organization has said would make a vaccine effective for general use, was far below the 78 percent level announced last week.”
 

Vaccine Access and Deployment

 
SABC reports, “The Africa Centres for Disease Control & Prevention has called on member states to strengthen their healthcare systems in preparation for COVID-19 vaccination programme. The African Vaccine Acquisition Task Team has secured 270-million vaccines for the continent with the first batch of 50 million doses expected between April and June this year. The rollout of HIV's antiretroviral treatment is expected to give Africa a strong framework for a successful rollout campaign.”
 
Daily Trust reports, “With the backdrop of inequitable distribution of COVID-19 vaccines, the COVAX Facility is working towards providing about 600 million doses for Africa this year, the World Health Organization (WHO) has said.”
 
A Nature editorial argues, “COVAX has to succeed. It is essential for the lowest-income countries, which lack the purchasing power that comes with economies of scale. A pandemic must be managed at a global scale. Until the virus is controlled everywhere, every nation is at risk of further outbreaks. And until COVAX gets the support it deserves, there is little hope of vaccinating the most vulnerable one-fifth of humanity. Not only would this have an obvious human cost, but, without it, it will take longer for the pandemic to end.”
 
Bioethicist Art Caplan addresses “chaotic and failing” vaccine distribution in the US in a Medscape video commentary. He argues, “public officials all around the country, I think, have failed us. They haven't set out consistent policies. They haven't coordinated their policies. They're letting people act as if, well, it's a plague, but if you need time off because it's a traditional vacation day, you just do that. They're not allowing us to overcome our bias, prejudice, and feelings about people like prisoners, the disabled, or people who are institutionalized because of psychiatric illness, all of whom are exceedingly high-risk and can transmit disease, and we want to make sure that that doesn't happen.”
 
The Washington Post reports, “the United States should have 200 million doses each from the companies with authorized shots, Pfizer-BioNTech and Moderna—enough to guarantee that more than 70 percent of adults will be able to get the two-shot vaccination by the end of July. That is comparable to the share of adults some polls suggest will be willing to roll up their sleeves…. But doses on paper are different from vials in the freezer—or vaccinations in people’s arms, as the past months have demonstrated. Distribution challenges have received most of the attention, as unused doses stack up. But the risk of raw ingredient shortages, manufacturing delays and other unforeseen production issues loom as the next potential bottleneck as companies work to reach a massive scale of manufacturing.”
 
NPR reports that India is beginning this weekend “what may become the biggest national vaccination campaign in the world…” using two vaccines, “One developed by Oxford University and the pharmaceutical giant AstraZeneca, and another vaccine developed by an Indian company called Bharat Biotech — billed as India's first "indigenous" vaccine. Both vaccines are being manufactured inside India…However, some scientists have expressed concern that the one produced by Bharat Biotech is being deployed prematurely. It still has yet to clear phase three clinical trials, and efficacy data isn't expected until March. Activists also allege unethical practices at one of drug's trial sites.”
 
In an opinion piece in STAT, Patrick Ho writes, “Premature approvals in India, Russia, and China reveal a different side of vaccine nationalism, one that prioritizes political advantage over scientific evidence and risks undermining widely accepted standards for vaccine testing and development…. This new side of vaccine nationalism threatens to undermine scientific and ethical principles that provide the foundation of vaccine development. Scientists employ large-scale controlled trials as the gold standard to provide vital information about a vaccine’s safety and effectiveness. That information allows public health officials to balance the risks and benefits of administering vaccines to healthy people.”
 
James Krellenstein, Peter Staley and Wafaa El-Sadr write in the New York Times, “President-elect Joe Biden can solve the US and worldwide vaccine shortages by using a strategy inspired by the one our country used to address the AIDS crisis. Mr. Biden can marshal the federal government’s resources to manufacture additional vaccine supplies and combine that move with vigorous efforts to boost distribution…. Mr. Biden can help address today’s urgent global health challenge by establishing the President’s Emergency Plan for Vaccine Access and Relief, or PEPVAR, and rapidly building facilities to manufacture vaccines and their constituent components at scale.”
 

Vaccine Rollout Confounds Ongoing Research

 
Nature reports effective COVID vaccines are making it difficult to enroll or maintain participants in other studies. “People are less likely to chance receiving a placebo when they could get one of the various vaccines now authorized, two of which prevent COVID-19 with about 95 percent efficacy. As it is, many people taking part in placebo-controlled trials have already asked to drop out to ensure that they get immunized.” Researchers are looking at other ways of finding answers, including studies comparing an experimental vaccine with an already authorized vaccine, looking for “corelates of protection” in the blood of participants or challenge studies. “Regulatory agencies are now working with scientists and vaccine companies to determine the best development path for next-gen vaccines.”
 

What Happens After Vaccination?

 
NPR reports, “It may seem counterintuitive, but health officials say that even after you get vaccinated against COVID-19, you still need to practice the usual pandemic precautions, at least for a while. That means steering clear of crowds, continuing to wear a good mask in public, maintaining 6 feet or more of distance from people outside your household and frequently washing your hands.” The story notes that, “Before approving the Moderna and Pfizer vaccines, the FDA asked the vaccine manufacturers only whether their products protect people from COVID-19 symptoms. They didn't ask if the vaccines stop people who've been vaccinated from nevertheless spreading the virus to others. The emergency authorizations by the FDA that have allowed distribution of the two new vaccines cite only their ability to keep you—the person vaccinated—from becoming severely sick with COVID-19.”
 
Medpage Today reports, “Some healthcare workers have reported falling ill with COVID-19 after getting their first vaccine dose—but that's not a surprise, as protection can take as long as 2 weeks to kick in, researchers said.
 

Need for Hi-Fi Masks

 
A commentary in STAT notes the need for more effective mask, such as n95 masks to be worn in “high risk” settings. “As the country awaits the scale up of population immunity through vaccination, we need a National Hi-Fi Mask Initiative to churn out masks that provide more protection from droplets and aerosolized virus particles and also reduce the number of them emitted into the environment by people infected with SARS-CoV-2…. As transmission of SARS-CoV-2 once again surges across the country, so do the odds that infectious aerosols are being emitted and linger in the air in indoor venues that people frequent. This may, to an extent, explain infections in people who were otherwise ‘doing everything right’ but still got infected.”
 

African Innovation

 
Daily Maverick reports on “a new study of COVID-19 responses in South Africa, Egypt, Ethiopia, Nigeria and Kenya…The study paints a picture of how five of Africa’s biggest economic and cultural hubs have responded to COVID-19 in the first year of the pandemic and how it should change strategy to strike a balance between protecting health as well as the economy.”
 

Reinfection

 
Nature reports, “Most people who catch and recover from COVID-19 are likely to be immune for several months afterwards, a study of more than 20,000 health-care workers in the United Kingdom has found…. The data suggest that repeat infections are rare—they occurred in fewer than 1 percent of about 6,600 participants who had already been ill with COVID-19. But the researchers also found that people who become reinfected can carry high levels of the virus in their nose and throat, even when they do not show symptoms. Such viral loads have been associated with a high risk of transmitting the virus to others….”
 

Herd Immunity

 
ABC News reports, “The World Health Organization’s chief scientist warned that even as numerous countries start rolling out vaccination programs to stop COVID-19, herd immunity is highly unlikely this year. WHO’s y, Dr. Soumya Swaminathan is quoted: “Even as vaccines start protecting the most vulnerable, we’re not going to achieve any levels of population immunity or herd immunity in 2021. Even if it happens in a couple of pockets, in a few countries, it’s not going to protect people across the world.”
 
In a commentary in Science, Devi Sridhar and Deepti Gurdasani argue that “pursuing herd immunity through naturally acquired infection is not a strategy that can be considered. Achieving herd immunity through infection will be very costly in terms of mortality and morbidity, with little guarantee of success…. Governments need to focus on more precise NPIs, robust test/trace/isolate systems, border control measures, mass testing, better treatments, and development and delivery of vaccines. This is the most sustainable path for countries out of this pandemic.”
 

Saliva Tests May Predict Disease Severity

 
Science reports, “several new tests look for SARS-CoV-2, the pandemic coronavirus, in saliva, and the new work finds a striking correlation between high virus levels there and later hospitalization or death. If the results are confirmed, saliva tests could help doctors prioritize which patients in the early stages of the disease should receive medicines that drive down levels of the virus.”
 

Debating Science in Public

 
Science editor Holden Thorp writes about the recent debates over timing and doses for COVID vaccines and some concerns that “such public speculation might create confusion or lead people to believe that disagreement over the details meant a lack of adequate scientific consensus over the safety and efficacy of the vaccines. Should such discussions take place only in scientific journals? Or only informally on Twitter?” Thorp argues this is misplaced anxiety. “For many scientists, public debate is a new frontier and it may feel like the Wild West (it may well be). But rather than avoiding such conversations, let the debates be transparent and vigorous, wherever they are held. If we want the public to understand that science is an honorably self-correcting process, let's do away once and for all with the idea that science is a fixed set of facts in a textbook. Instead, let everyone see the noisy, messy deliberations that advance science and lead to decisions that benefit us all.”
 

Sweet Syringe

 
HuffPost reports on a German bakery that has created cakes shaped like syringes to commemorate COVID vaccines. The baker says, “First we were a bit skeptical whether it would be a bit too macabre. But then we did it after all. Because even for anti-vaxxers it’s funny. It is a vaccine without any side effects. And you can come back and get another one because it is so yummy.”