As Alabama makes progress with its vaccine rollout, the state saw the first confirmed case of the highly contagious coronavirus strain from the UK this week.
And the steady global spread of other variants from Brazil and South Africa, the latest found in South Carolina this week, is raising the stakes to immunize Americans as soon as possible.
Still, new uncertainties are emerging about how effective the existing vaccines will be against the mutations and whether it will be necessary to roll out a modified version of the shots.
“That’s the latest wrinkle with COVID,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center. “Just when we thought we were getting on top of it and developing the vaccine and now deploying it, we have some new mutations coming up here.”
Experts like Schaffner are hopeful that the existing vaccines will still be effective against the new strains, but say more research is needed.
On Friday, Dr. Antony Fauci called the arrival of new variants in the United States “a wake-up call” to vaccinate as many Americans as possible as soon as possible to prevent the virus from spreading and mutating.
“It’s an incentive to do what we’ve been saying all along: vaccinate as many people as possible and as soon as possible,” he said.
Current Moderna and Pfizer vaccines appear to be effective against the highly contagious British variant, identified this week in Montgomery and Jefferson counties, and which is rapidly becoming the dominant COVID-19 strain in the United States. New research this week shows the species can cause more serious cases, too.
Johnson and Johnson announced Friday that their vaccine, which is pending FDA approval, is slightly less effective, with 57 percent efficacy against the South African variant, compared to 72 percent with the original strain. The South African variant was identified in South Carolina this week in two individuals with no apparent connection and no travel history.
Moderna is adapting its vaccine for use on the South African tribe, in case the need arises as more becomes known.
A Brazilian variant is of particular concern to scientists because of the speed at which it has spread so far. This week, the variant was identified in Minnesota in a person who had traveled to Brazil.
“The problem with a new virus is that it has so much room to grow and shift and change to optimize itself,” said Dr. Michael Mina from Harvard School of Public Health. “The question is how quickly will it keep updating itself?”
Experts say more research needs to be done on how effective the vaccines are against the South African strain, which is currently most different from the original virus.
“Whatever mutation happens, the vaccine manufacturers can keep up, but given the multitude of strains circulating at the same time, that can be challenging,” said Dr. Schaffner.
Dr. Mina, of Harvard, said he is less sure that existing vaccines can be updated for all future variants. Assuming it is possible to successfully modify existing vaccines, it may make sense to wait and see where the virus will go first,
“If we change the vaccine, by the time it rolls out, we might have a new virus or a new version of this virus,” he said.
But Dr. David Kimberlin, a pediatric infectious disease specialist at the University of Alabama in Birmingham, hopes that a modified vaccine will not be necessary.
“What we know now is pretty reassuring. It seems that the people who receive the current vaccines have protection, ”he said. “What we know today may not be what we know in a week or a month.”
Rolling out an updated vaccine would bring a range of complications, such as whether new studies would be needed.
And then again there would be questions about which vaccine-priority groups should get the injections first, especially if some of the most vulnerable people have already been immunized and younger people have not yet received doses, said Dr. Mina.
“It will be a real challenge to do it properly and fairly,” he said.
“We are already seeing tremendous difficulties in obtaining fairness in the distribution of vaccine rollouts.”
And it’s not clear how willing some people will be to line up for a hypothetical third injection, be it a booster or a new vaccination. Recent polls show only three-quarters of Americans say they would definitely or likely receive a vaccine.
“People already have COVID fatigue,” said Dr. Schaffner. ‘They come back to us and say’ What do you mean, why didn’t you take care of this virus the first time? Now you say there are new varieties? Give me a break'”
For now, rapid testing, mask-wearing, and social distancing are the most powerful tools to prevent future mutations of the virus, said Dr. Mina.
“The best we can do to help the vaccines, to make sure the vaccines maintain their protective nature, is to keep the cases as low as possible by other means,” he said.
Dr. Kimberlin of UAB urged Alabamians to get a vaccine when it’s their turn.
“Wear masks in between and after,” and stay six feet apart, he said. “Those are the things that will get us through this period as we learn more about the variants.”