Vaccine vs. Variants: The Race in One State

cleveland.com

For several months, health experts have framed the state of the pandemic as a race to get as many people as possible vaccinated against COVID-19 to limit the spread of more contagious variants of the virus.

The “race” began in earnest four months ago, when Ohio provided its first doses of the Pfizer/BioNTech vaccine to health care workers. Around the same time, variants of the original strain of the coronavirus began emerging in the U.K., South Africa and Brazil.

Experts believe the race between getting people vaccinated and the variants could be the key to our ability to “return to normal” sooner rather than later. So which side is winning?

Ohio, like many other states, is currently at an important crossroads in that race, experts said. The state has made notable progress in vaccinating its population, but not enough to prevent the spread of the variants.

Until enough of the population is vaccinated to reach herd immunity, there is a threat that a variant could take hold and spread throughout Ohio, the same way the B.1.1.7 variant from the U.K. has caused Michigan to become a hot spot for infections, experts said.

Experts worry vaccine hesitancy could be the biggest barrier to reaching herd immunity. Recent polls have suggested more than one-quarter of Americans are hesitant or unwilling to get the vaccine, often because of concerns related to potential side effects. Even some who are willing to get the shot have told pollsters they don’t feel a sense or urgency to get the vaccine. Experts across the U.S. have said they are worried we may be approaching a “tipping point” where supply of the vaccine outpaces the demand.

“Right now, unfortunately, cases have been increasing, mainly because of these variants,” said Dr. Thomas File, an infectious disease physician at Summa Health. “We don’t have enough of the population immune to stop persistent and ongoing transmission. We need to get it higher.”

More than 38% of Ohio residents had received at least one dose of a coronavirus vaccine as of Wednesday, and more than 27% have completed their vaccinations, according to data from the state’s Department of Health. But there are already concerning signs that demand for the vaccine might be slowing down. Summit County Public Health announced Wednesday that it is scaling back the mass vaccination clinic at the Summit County Fairgrounds due to decreased demand for the shots.

Experts have consistently said at least 70% of the population – and possibly more — will need to be vaccinated to reach herd immunity. Meanwhile, coronavirus variants accounted for more than one-third of infections in Ohio when the U.S. Centers for Disease Control and Prevention provided its most recent update back on March 27.

The problem is that the longer many Americans wait to get the vaccine, the greater the chance another coronavirus variant will emerge. Every time the virus is passed to someone new, it has a chance to replicate and mutate, said Dr. Daniel Rhoads, who specializes in pathology and laboratory medicine at Cleveland Clinic. Many of those mutations will be harmless, but there’s always a “dice-roll” it could mutate into a more dangerous variant, he said.

“The likelihood I’m going to be infected by a currently circulating variant is pretty low because I’ve been vaccinated,” he said. “But if the virus continues to mutate, potentially it could get worse than the current variants.”

The Variants in Ohio

Variants already accounted for more than one-third of infections in Ohio when the CDC provided its most recent data for a four-week period ending March 27. The percentage is almost certainly higher now, experts said.

The B.1.1.7 variant first detected in the U.K. is the most common variant in Ohio, accounting for 25.8% of the state’s infections as of March 27. Less common are two coronavirus mutations discovered in California (6.6%), the B.1.351 variant discovered in South Africa (1.4%) and the P.1 variant discovered in Brazil (0.8%).

Those might not seem like high percentages, but they are cause for concern, said Mark Cameron, an infectious disease researcher and associate professor at Case Western Reserve University. Among all 50 states, Ohio has seen the sixth-highest percentage of infections linked to the variants from Brazil and South Africa; and the 16th-highest percentage linked to the variants from the U.K. and California.

“It means that despite our rosy picture of getting the vaccine rolled out … it really is a race. That’s absolutely appropriate,” Cameron said. “Because [infection] numbers have been increasing over the past few months despite the vaccine.”

The data also supports the idea that variants are more transmissible, experts said. Infections have finally started to decline in Ohio; they had been increasing throughout the spring, even as a larger percentage of the state’s population is being vaccinated.

All three vaccines approved for use in the U.S. have been found to be highly effective against the B.1.1.7 variant found in the U.K. It’s less clear how well the vaccines perform against the variants from South Africa, Brazil and California, but experts believe they might be a little less effective against those mutations.

Exactly how effective the vaccines are against each of the variants could change the calculus for reaching herd immunity, File said. In general, a higher percentage of the population needs to be vaccinated to stop the transmission of a more-contagious virus. For example, at least 90% of a population needs to be vaccinated to stop the transmission of measles, but that percentage is much lower for influenza.

The other key question experts are trying to answer is whether someone can still pass on the virus after they’ve been vaccinated. It’s possible that the vaccines might prevent someone from getting sick, but they could still carry the virus and pass it to someone who hasn’t gotten the shot. That’s why it’s important to keep wearing face masks and social distancing until enough of the population has been vaccinated to reach herd immunity, File said.

“If we want to overcome this pandemic and we want to stop all the restrictions we’ve had to go through, the best thing we can do is get the vaccine so we can get back to some semblance of normalcy,” he said.

“We have to overrun the finish line”

Experts said that ultimately, the race between the variants and the vaccines could come down to everyone remaining vigilant long enough as we continue to address any concerns or fears held by those who are still hesitant or unwilling to get the vaccine.

Over the past few months, vaccines have been a scarce resource. But everyone in Ohio is now eligible to get the shot, and the Biden Administration has announced deals to buy enough doses of the vaccines for every adult in America.

Eventually there will come a time when the vaccine is readily available, but we’re still trying to convince hold-outs to get it, Rhoads predicted.

“I think in the very near future in the U.S., vaccines aren’t going to be a limited resource,” he said. “[The challenge] is going to be people’s desire to be vaccinated. That’s my concern.”

Public health experts and government officials have been working to address those concerns through various outreach campaigns. On Tuesday, the Cleveland Clinic and the Mayo Clinic announced they were leading a nationwide effort to promote vaccination. University Hospitals and the Ohio State University Wexner Medical Center are also among the partners who’ve joined the campaign.

It will be particularly important to reach young adults, who are driving surges of coronavirus infections in Michigan and other states, File said. Prior data has shown young adults were less-susceptible to severe illness and death from COVID-19, but the variants are causing more severe disease among those age groups. Hospitals are beginning to see a larger percentage of patients who are young adults, File said.

File said Ohio and other states have done well so far to get the vaccine administered as quickly as possible. But the variants have heightened the need for a quick roll-out, and the need to address vaccine hesitancy as soon as possible.

“The finish line has been extended a bit, so we have to keep running further,” File said. “But I am optimistic we’re going to get there.”

Cameron suggested the race between the vaccines and the variants may actually be more like a relay race, where we need to make several “baton passes” to reach the finish line.

Over the next several months, the first major “baton pass” could be a push to overcome vaccine hesitancy. Another baton pass could be convincing everyone to keep wearing face masks and social distancing until we can reach herd immunity. Eventually, vaccine makers could produce a booster shot that would provide additional protection against the more-contagious variants.

Ultimately, experts think the theoretical race is simply too close to call at this point.

“These vaccines were developed at warp speed, but these mutations have developed at warp speed as well,” Cameron said. “So we have to overrun the finish line.”