Having pandemic panic attacks about virus variants? National preparation is the cure

The most frightening aspect of a pandemic, on a primal level, involves the emergence of new strains. If you were writing a thriller about a pandemic, this is what would happen: A mutant strain would emerge that would completely evade scientists’ plans to control it, wreaking havoc around the globe.

The Covid-19 variants we’re facing are not horror movie material yet, despite the emergence of some that cause concern. Many experts agree that the current vaccines, from the team of Pfizer and BioNTech and from Moderna, are still likely to keep people from developing Covid-19 symptoms or severe disease. There’s no reason for panic.

“I think we are building a consensus here,” Akiko Iwasaki, a Yale immunologist and epidemiologist, said in an email. “Now multiple papers show that existing vaccines are likely still protective against the variants.”

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But the lesson that we should be drawing is the one that the pandemic keeps teaching, but that the world and, especially, the U.S., fails to learn. The response to the pandemic so far has been like a fractal pattern that repeats itself over and over again at a different scale. We’re disorganized, we’re not ready, we don’t heed warnings, we don’t plan ahead. And the virus runs rampant, because that is what a mindless, highly transmissible evolution-powered bit of replicating RNA does to living organisms.

It’s entirely possible that, even with the emergence of new strains, none will be able to beat the vaccines, especially the Pfizer/BioNTech and Moderna ones. Those vaccines prevent roughly 94% of symptomatic infections, making them among the most effective inoculations. It’s a gigantic wall that this bat virus has to leap as it randomly mutates and adapts to being in people.

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But that doesn’t mean we shouldn’t plan for a worst-case scenario by making improved vaccines. It should be possible to do that relatively quickly — weeks or months — and to test it in much smaller numbers of people than were needed when the vaccines were first being run through clinical trials. This has always been part of the promise of the mRNA technology that both Moderna and BioNTech use. It can use the genetic code of a virus as instructions for making a new shot. Moderna has already started doing this for the variant first identified in South Africa, the scariest of the current batch, which does seem to somewhat weaken the power of both the vaccines and some monoclonal antibody drugs in laboratory experiments.

But testing a new vaccine may be the easy part. We’ll also have to manufacture it and get it into arms. And that is the miserable experience we are going through right now globally, with not enough doses of vaccine to go around, not to mention the lack of a streamlined plan for getting those shots into the arms of people in a fast and fair way. Everywhere you turn, there are stories of frustration with the current rollout.’

“It’s a production problem,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “Primarily, we need to produce more vaccine.”’

It’s not too late to make enough vaccine for the current rollout. Many more doses will be available in coming months, especially if new vaccines from Novavax and Johnson & Johson prove effective. But it’s also not too late to start tackling the giant logistical and manufacturing problems hobbling this rollout, not only for making more mRNA vaccines but also for needles and glass vials and syringes and freezers. Moncef Slaoui, who helped run Operation Warp Speed, proposed years ago having centralized government manufacturing to be used in case of a pandemic. 

As Scott Gottlieb, the former Food and Drug Administration commissioner, recently pointed out on CNBC, investing in new manufacturing facilities now could bear fruit in six to nine months. And the important thing is that we don’t know that we won’t need them.

A truly scary variant might be an extremely unlikely event. But one reason we’re all having panic attacks is because we now have the hard knowledge that epidemiologists and gamblers live with: unlikely events happen every day.

The solution is not to panic. The solution is to prepare for whatever might be coming.

Source: STAT