A few weeks ago, while chatting with my cousin I randomly asked him whether he had taken the second shot of the vaccine. Very nonchalantly he informed that he did not even bother with the first as he believed that the world is yet to uncover a lot about the disease and vaccine protection. I wondered: If an educated 50-year-old adult, having had Covid once, can remain this ignorant then what was the general sentiment?
After almost 18 months into the pandemic, the emerging variants of the virus continue to create havoc in developing nations. As we watch India battling with a horrific second wave, Nepal being hit with the same, we have ample reason to panic.
What do we know about variants and how do they appear?
Just like any other virus, the coronavirus needs host cells to survive and replicate. The spike protein of the virus binds to the receptor on the human cell and takes over the infected cell to make copies of itself; and while doing so, occasionally, the virus’ genes undergo copying errors known as mutations.
Often with the coronavirus, mutations result in changing the shape of the spike protein which strengthens the virus’ ability to attach tightly and easily with the host cell, and at the same time make it harder for circulating antibodies to stick to the virus and remove it. A group of viruses sharing the same inherited set of specific mutations is called a variant. New variants that spread easily and quickly are variants of concern since they tend to cause the surge in case numbers, which puts a strain on the health care resources, leading to more hospitalization and potentially more deaths.
The UK variant B 1.1.7, the South African variant B.1.351, the Brazilian variant P.1, and now the double mutant Indian variant B.1.617 are all variants of concern. A few of these variants can also evade some of the antibodies generated from past infection or vaccination.
After being hit with a second wave of Covid from the South African strain recently, the Indian variant now poses the greatest concern for Bangladesh.
What are the chances of getting a third wave?
Experts believe that the massive outbreak in India has given the B.1.617 variant ample opportunity to mutate further to new generation variants which might already be in circulation. This may cause a third wave in September-October, and if the countries’ borders remain porous, Bangladesh may expect a third wave around the same time as well.
It will be prudent to anticipate more Covid spikes while the virus remains in circulation.
To tackle new surges, we may encounter short term lockdowns and to avoid health system disaster we will need to ensure a smooth supply of oxygen, ICU beds, non-invasive ventilators, and therapeutics at an optimum level, particularly in Dhaka and the divisional cities. Meanwhile, mass-scale awareness to maintain health guidelines must be strictly monitored.
How do new variants trigger fresh outbreaks?
According to the US Centers for Disease Control and Prevention, emerging variants can have the following features to fuel bigger outbreaks:
Higher transmissibility
- Evade protective antibodies
- Cause more severe disease
- Evade detection by specific diagnostic tests
- Build resistance to therapeutics
- Outpace vaccination program to trigger an outbreak
What can stop this vicious cycle?
Vaccination, along with public health guidelines, can break this cycle of infection, transmission, new variants, and re-infection.
It is now a foregone conclusion that herd immunity will not be achieved from naturally acquired infection as many people are experiencing re-infection, which is possibly due to new variants. Only when 70% of people are vaccinated, we may see the end of the pandemic.
Do the current vaccines work against the new variants?
The vaccines’ effectiveness vary from variant to variant. For instance, AstraZeneca and Johnson and Johnson vaccines are less effective against the South African variant whereas the Pfizer vaccine remains effective.
Experts stressed that the rate of coronavirus mutation is much slower than the influenza or HIV virus and it might take years and many more mutations for the virus to evolve into a strain that can resist the current vaccines.
Even the Indian variant, despite having double mutation, did not become a super mutant and some vaccines are still effective against it. The existing vaccines promise to provide some level of protection against most variants, can prevent hospitalizations and deaths, and lower the rate of transmission.
This is probably because all the variants are related to one another and even if it evades the antibodies, the T-cell response remains effective. Hence, it is advised that individuals should take the first vaccine they are offered and not wait for the ideal vaccine.
Vaccine manufacturers are continuously tweaking their vaccines to ensure they remain effective against new variants. A combination trial is currently underway between the Oxford-AstraZeneca, Pfizer, Moderna, and Novavax vaccines to study a mixture of vaccines’ efficacy in bolstering immunity against emerging variants.
What is Bangladesh’s position on vaccine strategy?
The dependency on just one source of vaccine was not the best strategy. The following chart depicts how smart countries secured a pool of different vaccines which includes the ones waiting for authorization.
With the passage of time, more and more vaccines are becoming available. Other than Pfizer, AstraZeneca, Moderna, Johnson and Johnson, and Sinopharma, six others are being used in different countries, which includes the Sputnik V, CanSinoBio, Sinovac, and Bharat Tech.
Except for Pfizer and Moderna, most vaccines can be stored in normal refrigerators, some only require a single dose, and the majority have efficacy over 60%. To vaccinate 70% of its 170 million people, Bangladesh requires 238 million doses of vaccines (if double dose is required) and at a vaccination rate of 300,000 doses per day, it will take us two and a half years to vaccinate all.
How to redefine vaccine strategy?
Bangladesh can rectify the vaccine conundrum by aggressively procuring vaccines from multiple sources. The Western countries have reserved more vaccines than is needed for their population.
Eventually, they will release the excess supply to either COVAX or to the nations that need them -- we should lobby to be on the priority list of the recipients. If the US manages to lift the patent rights on vaccines with the WTO and EU’s support, then it may open new opportunities to develop vaccines within our country to fulfill the domestic need. Finally, the government should permit the local international standard pharmaceuticals to import vaccines from the global vaccine giants using their network.
New outbreak from a new variant can only be identified from genome sequencing. Since continuous genomic surveillance is difficult in the country, we should individually remain vigilant and do our part to eliminate the virus entirely.
The virus does not survive in a vacuum, it is us who let the virus enter our body, infect us, and give it a shelter to mutate to a stronger variant. Vaccinated or not, people must keep on using masks (preferably double) and maintain a minimum of three feet distance.
Since the coronavirus remains suspended in air, continuous ventilation indoors is especially important when meeting in a group. Stop being ignorant, take the vaccine as soon as it becomes available, and wear masks to avoid getting infected. If infected, isolate yourself, this will stop the transmission and mutation, and arrest the development of new variants to avoid new outbreaks.
Dr Maliha Mannan Ahmed is the Founder and Executive Director of Organikare. She has an MBBS, MBA, and a Master’s in Health Care Leadership.
