Variants vs. Vaccines: Ending the Pandemic in the US and Worldwide

In the United States, COVID-19 cases are dropping overall and reopening is underway, although millions of adults choose to remain unvaccinated and several regions are seeing cases spike. Globally, the pandemic is raging in countries like India, where access to vaccines and oxygen has been far more limited. As variants of concern rise and vaccine hesitancy prevails, we invited experts to discuss how we reach herd immunity, both locally and globally, and navigate the future of this pandemic.

Read the highlights below of our discussion with viral immunologist, physician-researcher, and Pulitzer Prize winner Siddhartha Mukherjee, MD, DPhil, along with epidemiologist, global health expert, and MacArthur Fellow Wafaa El-Sadr, MD, MPH, MPA, and NYSCF CEO & Founder Susan L. Solomon, JD.

What are the current variants of concern?

“There are three variants of great concern: the Gamma variant (first identified in South Africa and South America), the Alpha variant (first identified in the United Kingdom), and the Delta variant (first identified in India),” explained Dr. Mukherjee. “These variants are concerning for two reasons: one is that their transmissibility seems to be higher than the wild type [original] SARS-CoV-2 virus. The second is their pathogenicity, which is related to their immune escape, also seems to be higher. And of course, once you have those two things combined, you get faster disease, more people get infected, and more people severely ill from the infection.”

Do vaccines protect against these variants?

Studies of how effective the vaccines are against these variants have shown encouraging early results.

“Some excellent studies that were done in Qatar at a population level showed that this population that had been vaccinated largely by the Pfizer vaccine are protected against the Alpha variant” noted Dr. El-Sadr. “The second piece of good news is that even though there’s been an increase in the number of delta cases in the UK, there hasn’t been an increase in deaths, which tells me that the vaccines are protecting against severe illness and death.”

“The takeaway is the same: get vaccinated and continue to take precautions, because this is not over yet,” said Dr. Mukherjee.

Will the virus produce more dangerous variants?

“There’s a huge interest in figuring out whether the virus is finished with its tricks [at mutating], or whether it has more tricks up its sleeve,” noted Dr. Mukherjee. 

The good news is that, for now, it seems unlikely.

“If you ask virologists like Dr. Michel Nussenzweig (Rockefeller University) or others across the world, some people believe that there are no further tricks that are of great concern,” remarked Dr. Mukherjee. “The virus will keep mutating, but after a certain point of time, you cannot accommodate more mutations because it bends the protein in a way that it can no longer bind back to the human receptor [to infect our cells].”

Will  booster shots be necessary?

As the COVID-19 vaccines are new, it remains unclear how long they will protect us against infection. Moreover, all of the major COVID-19 vaccine producers have begun testing additional versions of their vaccines targeted at emerging variants in case they are needed to boost our immunity as these variants become dominant. 

“The antibody response against the Pfizer and the Moderna vaccines seems to stay for a while, but these vaccines were designed against the [original] variant, and not against the Delta variant,” said Dr. Mukherjee. “I suspect that we are going to have to get booster shots, and my suspicion is it will probably happen in the winter months.”

Will the US reach herd immunity?

“I think we will probably reach herd immunity in some parts of the country, like in New York State, but I think it’s not going to be universal across the country,” said Dr. El-Sadr. “I think that’s going to be challenging to get there in other parts of the country if there isn’t a higher uptake of vaccination.”

Dr. El-Sadr noted that while the majority of New Yorkers have been vaccinated, it is notable that roughly ⅓ remain unvaccinated.

“I think it’s interesting that even though we had a bumpy road early on in the vaccination, we later achieved large numbers of vaccinations per day. This has really stalled over the past several weeks, which is of concern,” said Dr. El-Sadr. “The number of people who are getting vaccinated on a daily basis has been decreasing.”

How do we encourage more people to get vaccinated?

There are several groups that remain hesitant to be vaccinated: for example, the gap in vaccine uptake splits along political party lines. In addition, the data in New York and other places show that Black and Hispanic/Latino populations are getting vaccinated at significantly lower levels, due to an understandable lack of confidence in the medical community given their historically reprehensible treatment of ethnic minorities.

“What we haven’t done very effectively is reach community groups that are especially resistant. And we have to find out who’s trusted in those groups, and then approach those people to become ministers, if you will, of bringing more people to vaccination,” said Dr. Mukherjee.

“I think it shows that we need to listen to people in their concerns and try to address them using trusted messengers because getting more people vaccinated is ultimately what’s going to protect ourselves and the rest of the world,” added Dr. El-Sadr.

“The other way, which is a bit political, is for employers to administer vaccine mandates – barring religious and medical exceptions – saying you must be vaccinated to work onsite,” said Dr. Mukherjee. “You can work from home if you like, but if you want to come in, you must be vaccinated.”

How is the pandemic looking outside of the United States?

“The world is divided into the haves and the have nots: the people who have access to vaccines, and those who don’t have access to vaccines,” noted Dr. El-Sadr.

One of the hardest hit countries by the pandemic is India, which is ironically limited in its access to vaccines despite being a major global vaccine manufacturer.

“India not only continues to be severely affected by the Delta variant, but it is also one of the world’s largest makers of vaccines,” added Dr. Mukherjee. “And that creates a double disaster because you have the fire and also no fire extinguisher.”

“Production of the AstraZeneca vaccine has now resumed in India, but given the size of the population and the terrifying wave that spread through the country, the government has decided not to release AstraZeneca vaccines for use outside of India. So there is a global shortage of vaccines.”

“President Biden has now released 500 million doses, which I commend him for, but 500 million is a very small number,” he continued. “It sounds like a big number, and it’s a good thing to do, but it’s not enough. My suspicion is that on a worldwide level, we won’t be out of trouble for another one or two years at least.”

In closing, Ms. Solomon reminded attendees to continue taking precautions for the good of the global population.

“We are one person getting off one plane away from more variants arriving, and so we really must be good global citizens, and get vaccinated when we can.”