The parallel and intertwined stories of vaccines and variants continues to dominate the COVID news this week. Vaccine rollout continues in a minority of countries, but many countries are completely without vaccines and in many others only a handful of people have been vaccinated. Barely more than one percent of the global population has been fully vaccinated.
 
Public health experts continue to stress that we are in a race to get vaccines into arms to stop the spread of the virus and its continued mutations, some of which will very likely outsmart the existing vaccines.
 
Many European countries are entering lockdowns again as cases and hospitalizations, driven by variants, surge. In the US, several states are relaxing or removing mask mandates and other public health guidelines just as cases are seen to be increasing in several parts of the country.
 

If You Are in a Hurry

• Read Slim Karim and colleagues on why naming variants correctly matter in Science.
• Read an excellent explainer in The Washington Post on causation, correlation and vaccine side effects. 
• Read BBC on how disruptions in healthcare increased led to 239,000 maternal and child deaths in South Asia.
• Read about a baby born with antibodies after their mom was vaccinated in The Guardian.
• Watch a Medscape video on challenge studies in the UK.
• Read The Atlantic on “three ways the world has changed for the better during this awful year.”
• Read a comment in Nature Medicine on the importance of Good Participatory Practice for pandemic research.
• Read an editorial in Science about vaccine passports.

 

Correlation Is Not Causation

 
As governments and healthcare providers in an increasing number of countries undertake one of the largest public health campaigns we’ve ever seen, concerns about COVID vaccine safety have arisen and been covered extensively in the media. The story of most concern—prompting multiple countries in Europe to suspend the AstraZeneca vaccine—linked the vaccine with possible blood clots developed by a very small number of people who had recently been vaccinated. 
 
BBC (UK) reports the European Medicines Agency found the AstraZeneca vaccine was "not associated" with a higher risk for blood clots. “The EMA's expert committee on medicine safety…found that ‘the vaccine is not associated with an increase in the overall risk of... blood clots’. But the EMA…could not rule out definitively a link between the vaccine and a ‘small number of cases of rare and unusual but very serious clotting disorders’.” The Washington Post (US) looked at how scientists determine what may be a side effect from a vaccine and how “correlation does not equal causation.”
 

Variants: What’s In a Name?

 
As variants proliferate around the world, what to call them continues to be an issue. Writing in Science (US) Slim Karim and colleagues write, “Unfortunately, variants are widely being referred to by their country of first description. This naming convention should be avoided. Using geographical regions to distinguish variants is harmful, as demonstrated by the term “China” virus, which has been used to blame and stigmatize China. The connotation that the variants were created and spread by their respective first locations has already generated political backlash through travel bans…and negative perceptions of these countries and their people. The risk of being associated with a new variant also disincentivizes country-level genomic surveillance and transparent reporting of their results.”
 
CIDRAP (US) reports, “Two doses of the AstraZeneca-Oxford University COVID-19 vaccine were ineffective against mild-to-moderate infections with the B1351 variant first identified in South Africa, according to a phase 1b-2 clinical trial published today in the New England Journal of Medicine.
 
Reuters (UK) reports on a small laboratory study that suggests, “Antibodies induced by the Moderna Inc and Pfizer Inc/BioNTech vaccines are dramatically less effective at neutralizing some of the most worrying coronavirus variants…Researchers obtained blood samples from 99 individuals who had received one or two doses of either vaccine and tested their vaccine-induced antibodies against virus replicas engineered to mimic 10 globally circulating variants. Five of the 10 variants were "highly resistant to neutralization," even when volunteers had received both doses of the vaccines, the researchers reported in Cell. All five highly resistant variants had mutations in the spike on the virus surface—known as K417N/T, E484K, and N501Y—that characterize a variant rampant in South Africa and two variants spreading rapidly in Brazil.”
 
Fierce Biotech reports “Roche launched a new COVID-19 test to help researchers monitor emerging variants and track mutations in the coronavirus’s genome that may make the disease more contagious or more deadly. The test is specifically designed to separate out COVID-19 infections caused by the three growing variants first discovered in the UK, South Africa and Brazil late last year—designated B.1.1.7, B.1.351 and P.1, respectively. It’s designed to be used in diagnostics laboratories to help establish how far the new mutations have spread as well as what impacts the changes in their genetic code may have on the effectiveness of other coronavirus tests, treatments and vaccines.”
 

Racism and Equity

 
NPR (US) reports “There has been a perception that Black Americans are more hesitant than whites to receive a COVID-19 vaccine. But roughly equal proportions of Black and white respondents in a recent poll said they plan to get vaccinated…. Yet in many states, there are racial disparities in who has received the shot. Dr. Rhea Boyd, a pediatrician and public health advocate in the Bay Area, says misinformation and lack of access to health care are bigger impediments for Blacks than a hesitancy to get vaccinated.”
 

Vaccine Access

 
A Business Daily (Kenya) commentary says “Here’s the good news. COVID-19 vaccination is here. Here’s the bad news. Based on current procurement estimates, only 30 percent of Kenyans will have been vaccinated by 2023.” The author argues “Accepting that there many moving parts to this pandemic, our strategy is correctly scientific but hopelessly un-socio-economic. It lazily suggests lives supercede livelihoods while ignoring living (social mobility/interaction, mental health). Lazier still is to offer economic recovery ideation driven by mega-project tropes that are the high-cost, high-debt legacy hallmark of this Jubilee administration.”
 
A Lancet editorial calls for a global vaccine envoy to help ensure better COVID vaccine access, arguing “COVAX is wholly unequipped to resolve many of the most pressing threats to its mission. Global vaccination is central to ending the pandemic, yet it has been dealt with at far too low a political level. Too many obstacles are going unchallenged. A high-level individual or group with political acumen, technical competency, and the ability to advocate for justice is needed to galvanise the effort…. Rich nations have given money to COVAX and paid lip service to the idea of vaccines for all while scrambling to buy up all the doses they can…. Whoever it is, they must above all be able to drive a worldwide movement. Although the roll-out of vaccines brings hope, case numbers are increasing again globally and there is a grave risk of complacency. Progress has been capricious and there are still many uncertainties about COVID-19, not least the impact of new variants. Global vaccination is essential to ending the pandemic but this fact has still not prompted the unity required to deliver it. Far more vision and ambition are needed. They must come from the highest political levels.”

In a statement published in BMJ more than 850 scientists, researchers, and community leaders called on the Biden-Harris administration, European Leaders, and others to take more aggressive action to address global unequal access to COVID-19 vaccines. Leading researchers, many gathered for CROI, called for sharing the know-how to manufacture COVID-19 vaccines in low- and middle-income countries and challenged the suggestion that this would undermine research and innovation. Signatures are still being accepted on the statement.
 

COVID and Lockdown Impacts on Health Systems

 
BBC (UK) reports “The disruption in healthcare services caused by Covid-19 may have led to an estimated 239,000 maternal and child deaths in South Asia, according to a new UN report. It's focused on Afghanistan, Nepal, Bangladesh, India, Pakistan and Sri Lanka, home to some 1.8 billion people. The report found that women, children and adolescents were the worst-hit…. It estimates that there have been 228,000 additional deaths of children under five in these six countries due to crucial services, ranging from nutrition benefits to immunisation, being halted.”
 

A Baby with Antibodies

 
The Guardian (UK) reports “A woman in south Florida who had received one dose of coronavirus vaccine while pregnant recently gave birth to the first known baby born with COVID-19 antibodies ‘after maternal vaccination’, two pediatricians claimed. The doctors presented their finding in a preprint article…. The paper makes clear, however, that further research is needed to determine whether infants are protected by these antibodies, writing: ‘We urge other investigators to create pregnancy and breastfeeding registries as well as conduct efficacy and safety studies of the COVID-19 vaccines in pregnant and breastfeeding woman and their offspring.’”
 

Challenge Studies

 
A Medscape (US) video discussion looks at COVID challenge trials, which have been approved in the UK. Dr. Peter Openshaw, a professor of experimental medicine at the Imperial College in London, says the studies are important: “There's so much that you can learn by these challenge studies. If you just wait for people to become naturally infected, you can only really study the disease in its later course. You can't study the early effects of infection, the interval between inoculation of the virus and the development of symptoms, and you can't establish what's the minimal dose that's needed in order to become infected because those are not controlled studies.” He also outlines the ethical process of approval for such trials.
 

Research

 
WHO’s Soumya Swaminathan tells Bloomberg (US) “New COVID-19 vaccines, including ones that don’t require needles and can be stored at room temperature, may be ready for use later this year or next year…. Six-to-eight new immunizations may complete clinical studies and undergo regulatory review by the end of the year…. The roll out of safe and effective vaccines is also raising questions about how to efficiently and ethically conduct clinical trials of experimental vaccines, she said. Placebos will be replaced with a ‘gold standard’ vaccine in a so-called non-inferiority design when it’s no longer ethical to use a placebo, Swaminathan said.”
 
NPR (US) reports, “Children have now received their first doses of Moderna's COVID-19 vaccine, as the company studies the safety and effectiveness of the vaccine for kids ages 6 months to less than 12 years old. In the study, researchers will give two injections 28 days apart of either the Moderna vaccine or a saline placebo to children. Kids who get the vaccine will receive one of three possible doses, from 25 micrograms up to 100 micrograms—the same dose that received an emergency authorization for use in adults from the Food and Drug Administration.”
 
Nature (UK) reports “The next generation of COVID-19 vaccines will not only tackle viral variants but also provide solutions across the globe at a fraction of the cost…. Whether the pipeline of next-generation COVID-19 vaccines will be needed is as yet unclear, given the uncertainties surrounding both the duration of protection and the level of protection the current vaccines provide against the main pandemic strains and the emerging variants. Real-world data from those countries furthest advanced in their immunization programs will help to clear up some of the uncertainties. In the meantime, the continued flow of finance is vital to place the most promising technologies on a firmer footing. The resounding success of the mRNA vaccines was built on decades of investment—but the solution to bringing this deeply damaging pandemic to an end is likely to require a much broader set of different vaccine platforms that work in various countries with varying resources, have different price points, work in different demographics and neutralize a broad set of viral variants.”
 
The Atlantic (US) looks at “three ways the world has changed for the better during this awful year.” First, “the incredible advances in synthetic messenger RNA (mRNA) biotechnologies” that brought us vaccines very quickly. Second, we learned “how to use our digital infrastructure…. Technology also showed how we could make our society function better in normal times. Consider, for example, the advent of telehealth during the pandemic.” And finally, “a remarkable year of open, rapid, collaborative, dynamic—and, yes, messy—scientific activity, which included ways of collaborating that would have been unthinkable even a few decades ago.”
 
A comment in Nature Medicine (UK) argues creating trust with a broad array of stakeholders is critical for research in a pandemic. “A core element in creating environments of trust is found in ‘good participatory practice’ (GPP) that allows all stakeholders—a broad spectrum that includes both those able to affect the conduct of the research and those liable to be affected by it—to contribute to accomplishing a trial’s research aims. With roots in community engagement for research into human immunodeficiency virus in the 1980s and subsequently developed further these practices allow researchers to bring in all trial stakeholders as essential members of the research team, which makes research a genuinely joint enterprise…. In a pandemic, it might be tempting to imagine that there is simply no time to consult a wide group of stakeholders. That would be a mistake. Minimizing deaths and accelerating the end of the pandemic is the goal of emergency-response research. But the trust that flows from full implementation of GPP is essential to the successful development of new interventions that will actually be used by the target populations. In short, beginning with the end of the pandemic in mind, one must begin with GPP.”
 
BBC (UK) reports on a new COVID vaccine study among people with weakened immune systems. “The coronavirus vaccines approved by UK regulators are safe and still recommended for people with weakened immune systems due to underlying health conditions or prescribed medications, including those having chemotherapy or stem-cell transplants. In the Octave study, up to 5,000 of these patients, from around the UK, will be vaccinated as part of the NHS mass rollout. But blood tests before and after will check their immunity levels and see how well protected they are against COVID.”
 

Some Mostly Good News About Reinfection

 
WebMD (US) outlines a new study from Denmark: “When researchers analyzed results of 4 million coronavirus tests in Denmark and found that less than 1 percent of those who tested positive experienced reinfection. Initial infection was associated with about 80 percent protection overall against getting COVID-19 again. However, among those older than 65, the protection plummeted to 47 percent.”
 

Vaccine Passports

 
As more people are vaccinated and countries begin to open up for more international travel, discussions about what requirements will be for traveling. Many countries are looking at “vaccine passports” as a possible way to open up travel more and some countries, communities and businesses see passports or immunity certificates as an important way to open up communities and businesses. But there are concerns about these.
 
The New York Times (US) reports, “Pressed by member states desperate to save the summer tourist season, the European Union on Wednesday proposed a COVID-19 certificate that would allow people to travel more freely. The proposed document, known as a Digital Green Certificate, would allow European residents and their family members to travel at will across the bloc, so long as they have proof of COVID-19 vaccination, a negative test result or a documented recovery from the virus.”
 
The Hastings Center [US] argues “Governments must act quickly to develop effective and just policy to protect the interests of “all” citizens before private companies implement ad hoc mandates for proof of vaccination.” Such policies “should be evidence informed…should not further entrench inequity, should not exacerbate mistrust…[and] should be aligned with public health objectives.”
 
An editorial in Science (US) notes “As countries grow eager to reignite their economies and people increasingly yearn for mobility and normalcy in life, pressure is mounting for some form of COVID-19 health status certificate that would support these desires. There has already been an explosion of COVID-19 passport initiatives for domestic use and international travel. But scientific, legal, and ethical concerns abound with such documentation.” The authors argue, “COVID-19 is a new human disease. The challenges presented by vaccination passports are also new in detail, but mostly familiar in kind. Adding to current, imperfect certification procedures by diagnostic tests, vaccination passports are likely to be widely adopted during the pandemic and its probable sequel, endemic and episodic disease. The choice about how passports are used should be guided by exemplary science, appropriate technologies, and fair use for all.”
 
The Guardian (UK) reports, “China is resuming visa processing for foreigners from dozens of countries, but only if they have been inoculated against COVID-19 with a Chinese-made vaccine. The move has raised questions about the motivations behind the demand, given China’s vaccines are not approved in many of the countries to which it has opened travel and that it will not accept foreign vaccines made elsewhere, including those approved by the World Health Organization.
 

Essential Journalists

 
IJNET reports, “Over 2,000 journalists in Zimbabwe are included on the COVID-19 vaccination priority list alongside 60,000 frontline health workers who are to be vaccinated before the general public.
 
The country received a donation of 200,000 doses of the Sinopharm vaccine from China in mid-February. In an interview during the vaccine launch in Bulawayo, the director of the city’s Health Services Department, Dr. Edwin Sibanda, confirmed that journalists are frontline workers who have relayed crucial information about COVID-19 to the entire population, and were exposed to the virus as they went about collecting news.”
 

Chimps on Zoom

 
CNN (US) reports “We humans may be tiring of video calls, Zoom birthdays and streamed performances, but the chimps at two Czech zoos are just starting to enjoy their new live online linkup. To make up for the lack of interaction with visitors since the attractions closed in December under COVID-19 restrictions, the chimpanzees at Safari Park Dvur Kralove and the troop at a zoo in Brno, 93 miles away, can now watch one another's daily lives on giant screens. According to the Chimp’s keeper: “’When they see some tense situations, it gets them up off the couch, like us when we watch a live sport event.’ The chimpanzees have also adopted other human behaviors such as grabbing goodies like nuts to chew on while watching the action.”