The third dose: The Delta variant makes massive re-vaccination urgently necessary.
It is likely that the declining effectiveness of vaccines combined with vaccination refusal by sections of the population has opened the door for the Delta variant to spread further.
Evidence suggests that in some cases, fully vaccinated people can spread the delta variant in the same way as unvaccinated infected people.
Time for an emergency plan: mass vaccinating all Americans over the age of 60 with a third dose, combined with a return to masking and social distancing.
This article is available for the first time in German - it was first published on July 30, 2021 by the magazine "Foreign Policy".
Since January 2020, the world has fought many battles against the novel coronavirus.
More than 4.2 million people have lost their lives in the process, but some of the spread has been suppressed.
But the war is still raging and will continue for a long time.
I predicted early last year that, at best, it would be 36 months before COVID-19 could be considered under human control.
We are only in the 19th month.
The United States is again inundated by the virus * as the number of new COVID-19 cases rose 131 percent in the third week of July. To be clear, the vaccines available work well, especially the mRNA technology-based products from Biontech / Pfizer and Moderna. However, it is likely that the declining effectiveness of vaccines, coupled with the persistent refusal of a fifth of the adult population to get vaccinated, has opened the door to the dangerous Delta variant of SARS-CoV-2 among those who have been vaccinated and unvaccinated equally wreak havoc.
So the United States needs a third dose of mRNA vaccines.
For the country's older population, this so-called triple play is already overdue.
"I don't think the virus will just go away," said Stanley Plotkin, who is considered the godfather of vaccine research.
The vaccine developer and immunologist from the University of Pennsylvania told me that the US Food and Drug Administration (FDA) should comply with Biontech / Pfizer's demands and follow the example of Israel and immediately approve third-dose vaccination for adults over 60 years of age. and that a general triple dose for all Americans should follow.
I agree.
Science says everyone needs a COVID-19 booster shot - and soon
The World Health Organization (WHO) has spoken out against a third dose in the richer countries before a primary dose cannot be offered to billions of people in middle-income and poorer countries. That is a perfectly reasonable point in the war against COVID-19 *, both morally and strategically. But now there is new, alarming evidence that fully vaccinated people can carry the Delta variant in their nose and mouth and, in some cases, shed just as much virus to infect others as unvaccinated people.
In addition, a society in which less than 75 percent of adults are fully vaccinated can become a breeding ground for immune volatile mutants of SARS-CoV-2, i.e. mutants against which the existing vaccines are not effective. The vaccine, which hits the market tomorrow in a poorer country, may already have lost effectiveness due to inadequate or misapplication in richer countries.
The FDA, the US Centers for Disease Control and Prevention (CDC), and their counterparts in Europe, Canada and other parts of the world where vaccines are already widely used, urgently need to act.
And the recommendation to use masks is necessary, but no longer sufficient.
The message has to be: when you've got a second shot, it's time to plan a third one.
Israel: First country to vaccinate its population en masse - immunization protection is waning
The example of Israel shows this clearly. Since it was the first country to vaccinate its population en masse, scientists around the world are closely following what is happening there. The government began giving the first doses in January and by July had reached 58 percent of the population over 12 years old with two doses. Although an estimated 1 million adults still refused to be vaccinated, the government relaxed almost all behavioral regulations, including wearing masks.
But in July the Israeli miracle was over: it became clear that fully vaccinated people were protected from serious illness and death, but not necessarily from infection. In early July, the Ministry of Health announced that effective immunity among those fully vaccinated had dropped to 64 percent, from 95 percent two months earlier. Then on July 17, the ministry reported an increase in breakthrough cases with the Delta variant. Most of the cases have occurred in people who either had been fully vaccinated more than four months ago, suggesting the problem of declining immunity, or who had not finished their vaccinations until July, which is too short to be fully effective.
The data from the vaccinated Israeli medical staff show that the breakthrough infections are not life-threatening, but also not harmless: 19 percent of the cases led to so-called "long COVID", which is characterized by difficult symptoms lasting for months, including acute fatigue and depression , Loss of stamina and muscle strength, decreased consciousness, and other serious impairments.
Biontech / Pfizer's two-dose vaccine: Effectiveness wears off over time
A multinational study after six months of administration of the two-dose vaccine from Biontech / Pfizer also found that efficacy decreases over time, from about 97 percent to a low of 86 percent - so it is still robust. But none of the works concerned the delta variant of the exposure. A recent study in Scotland showed that both AstraZeneca's and Biontech / Pfizer * vaccines are significantly less able to prevent delta infection when compared to the alpha strain or the original 2020 forms of the coronavirus. (No comparable data has been published for the nearly identical Moderna vaccine, but most vaccination experts assume that what applies to Biontech / Pfizer also applies to Moderna.)
The biology behind it all is important. It explains the worldwide increase in the delta variant. Regardless of whether a person is immunized against SARS-CoV-2 through a natural infection or vaccination, there are four key elements necessary to ensure protection from future reinfection and protection from hospitalization or death. The most important one is a massive antibody reaction against the spike proteins that protrude from the surface of the SARS-CoV-2 virus and attach to ACE2 receptors on the outside of hundreds of human (and all mammalian) cells. The antibodies must be able to neutralize the enemy.
The neutralizing antibodies are formed in the second key element of the immune system - the B cells. These are white blood cells and lymphocytes found in the bone marrow and lymph nodes throughout the body, as well as in the spleen. These B cells must hold what immunologists refer to as “memory”. This is the key to why, for example, a measles vaccination that was given to a two-year-old still protects that person when they are 40 years old if they are exposed to the virus. B-cell memory recognizes measles and triggers the production of these violent neutralizing antibodies.
The third component that is critical to protecting against COVID-19 infections and diseases is the antibodies that target other parts of the virus, specifically the mechanism by which SARS-CoV-2 enters human cells penetrates and infects them.
And the last point is what is known as the CD8 and CD4 cells of the T cell immune response.
They are able to send a multitude of virus-eating cells into battle, releasing chemicals that put the body's defenses on alert.
Different degrees of effectiveness of the vaccines in the Delta variant: World is fighting against mutation
Amazingly, the mRNA vaccines and, to a lesser extent, other non-RNA vaccines from Johnson & Johnson and Astra Zeneca * as well as from Russian and Chinese drug manufacturers have the full range of necessary weapons against SARS-CoV-2. But they do this with very different degrees of efficiency - especially with the Delta variant.
When the first three variants of SARS-CoV-2 were discovered in the UK, South Africa and Brazil, many immunologists and vaccine experts were quick to say that the vaccines were still working, just a little less well. Concern about the variants was called scare tactics at the time. A prominent vaccination expert responded in March to my persistent inquiries about the first wave of variants by saying that I was "obsessed with the variants to a deeply unhealthy degree, which can negatively affect public confidence."
Most of the variant studies carried out around the world in the spring revolved around the question of how well the vaccines withstand the mutants. The studies generally concluded that neutralizing antibodies may act in response to e.g. For example, alpha exposure may be less common but still sufficient to fight off disease, if not infection. A deep breath, but also the warning that it is still dangerous if large parts of society are unable or unwilling to be vaccinated, as this unprotected population will develop a worse form of mutation of SARS-CoV- 2 could arise.
And so it came about that the mutated Delta variant spread like wildfire across India in mid-March, with the country officially recording 400,000 fatalities by July - a number widely believed to be ten times underestimated.
Almost all countries in the world are now fighting the Delta variant, which threatens the athletes in the Olympic Village in Tokyo, triggered a new outbreak in China and fueled the worst COVID-19 epidemic in Africa to date.
Delta variant: Increases rapidly after infection - vaccinated and convalescents are also susceptible
The delta variant has numerous mutations that give it special properties. The spike protein, which is essential for the virus to attach to the cells, is modified in such a way that it is more difficult for the immune system to recognize it and to generate mass neutralizing antibodies - a case of “immune escape” mutation. The proteins it uses to enter human cells are also mutated so that they can bypass the immune system and function efficiently. And the virus is able to make copies of itself much faster and more efficiently. Within three to five days, Delta's viral load reaches a peak value that is up to 1,000 times higher than the 2020 forms of SARS-CoV-2.
The effects of these biological insights on the real world are overwhelming. The virus multiplies rapidly after infection and the dangerous viral load is reached two or three days faster than with the other COVID-19 variants. People carrying the virus have no idea, show no symptoms, or take special precautions to protect others. Worse still, even if they've been immunized from either vaccinations or a previous COVID-19 illness, they can be prone to re-infection themselves.
There are two reasons. First, the sheer amount of virus that hits unmasked faces from a delta-infected individual is three times larger than anything their bodies are prepared for - instead of hitting a few particles in the air, microscopically they take in huge amounts of that stuff up. Second, the virus enters your body faster than your body can mobilize its B-cell memory to produce neutralizing antibodies and other weapons.
According to Israel and Biontech / Pfizer, the immune response triggered by the vaccine changes from a strong form with lots of neutralizing antibodies wandering around the bloodstream to a more sedate B-cell memory type within about four months of the second dose.
The production of neutralizing antibodies decreases by about 6 percent per month, according to Biontech / Pfizer, and reaches 84 percent vaccine effectiveness in the sixth month.
At eight months, it's all about memory, which makes people very susceptible to infection.
Corona: Vaccinated people can become carriers with the Delta variant - danger for unvaccinated people
In other words, the people who have been vaccinated with two doses may have an immune system capable of producing neutralizing antibodies against SARS-CoV-2, but the enemy is approaching and spreading in such large numbers in their bodies so quickly that six to eight months after the vaccination is completed they may not be able to muster adequate defenses to prevent illness or long covid.
Worse still, from a public health perspective, these vaccinated people can have billions of viruses in their noses and throats and pass them on to others.
They can be carriers.
And if the unfortunate recipient is an unvaccinated person, it can quickly become fatal.
All of this is why Israel is launching a third round of nationwide vaccination and why Biontech / Pfizer would like the CDC and FDA to approve this for the United States as well.
According to data recently released to shareholders by Biontech / Pfizer, the company estimates that a third booster dose can increase the neutralization of the Delta variant by a factor of 100 compared to the time before the third dose.
Problem of the short time interval between vaccinations - better months than days?
It also appears that the United States made a mistake by setting the interval between the first two doses at 21 days - a decision made by the CDC and FDA under the Trump administration. For reasons less to do with science and more to do with trying to protect as many British people as possible, at least partially, as quickly as possible, Boris Johnson's administration has opted for a much longer interval between doses, namely months. This could also explain why the dire effects of the Delta variant appear to be reversing in the UK and the number of new cases falling rapidly every day.
Plotkin, the vaccine maker, believes that longer periods between vaccinations - maybe six months - give the immune system time to settle into its euthanized memory state before receiving another shock from a fake infection (which, after all, is a vaccine) which stimulates the production of neutralizing antibodies. The problem with the length of the interval has also occurred with other vaccines, he says. It has been shown that months, not days, are required between doses.
There is a big experiment going on in the rich world as countries try to fight their way out of the pandemic with vaccinations.
And, of course, the experiment is being conducted against a changing, evolving target - a shape shifter.
And this offers no target for a single precise shot.
The more people move around in society who carry and spread SARS-CoV-2, the greater the likelihood that the Delta variant or another form of the virus will mutate into an even more sophisticated and dangerous pathogen for humans.
The number of corona cases in the United States is given with a value that is far too low
Americans could have more confidence in national efforts to contain the virus if genomic surveillance were better and the country were intensively screened for new SARS-CoV-2 types. Yet, despite the provision of emergency funding to the CDC for this purpose, the country's ability to detect new variants has barely improved compared to the first appearance of alpha in the UK last September. Even the CDC's target of 20,000 sequenced and analyzed samples per week from collection points across the United States seems pathetic when you consider that approximately 60,000-80,000 new cases of COVID-19 are detected in the United States every day.
A new super-virulent variant could be lurking in Arkansas, and we would have no way of detecting it with the current poor system. In addition, in many parts of the country, the span between the time a person is tested for COVID-19, the sequencing of that sample in a separate laboratory and the subsequent submission of the results to the CDC is several weeks, and even in the best of cases multiple days. So policymakers are trying desperately to change mask rules, vaccine approvals and plans to reopen schools, all based on scant information about the epidemic situation last week or the situation two weeks ago.
Worse still, the number of cases, which is how many people develop COVID-19 symptoms in a given week, is reported to be far too low in the United States. It is possible that up to 60 percent of cases across the country never appear in the public health infection tracking chain and are not included in the CDC's national census. (Most of Europe is not doing much better, according to WHO.)
In Atlanta, CDC scientists are trying to find out what havoc the different tribes are wreaking, how well the vaccines will work, and what forecast should land on the president's desk. For several months now, the CDC has been hosting a type of conference based on artificial intelligence, in which modelers and forecasters from all over the United States *, mostly academics, take part. Each epidemic modeling team uses its own methodology to track the epidemic in the United States and predict its further development. Some of the teams are very cautious and estimate the extent of future trends lower and lower. Some routinely tend to the opposite extreme. The CDC is trying to create some kind of forecast consensus from all of this data.And so far these predictions have been shockingly correct.
Dark prognosis: time for an emergency plan - mass vaccination of all Americans with third dose
In its most recent modeling, the CDC forecast predicts that the new delta-induced tidal wave will not peak before October, and possibly not before Thanksgiving.
At least 2,500 Americans will die every week through August, bringing the total death toll in the country to about 660,000.
With such a bleak forecast, it's time for a contingency plan.
And that would be mass vaccinating all Americans over 60 with a third dose, coupled with a return to masking and social distancing, and a massive escalation in genomic surveillance across the country.
Everything else means leaving the battlefield to the virus.
by Laurie Garrett
Laurie Garrett
is a columnist for
Foreign Policy
and a former Senior Fellow on Global Health with the Council on Foreign Relations and a Pulitzer Prize-winning science writer.Twitter: @Laurie_Garrett
This article was first published in English on July 30, 2021 in the magazine “ForeignPolicy.com” - as part of a cooperation, a translation is now also available to readers of the IPPEN.MEDIA portals. * Merkur.de is an offer from IPPEN.MEDIA.
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