Niamh Griffin: Covid variants can change the game

Real-time development of Covid-19 mutations is a challenge

The UK variant, B1.1.7 now makes up 91% of cases and is estimated to be up to 70% more transmissible.

Just over a year into the pandemic, a face-off between vaccines and variants normally played out in laboratories is becoming a topic of conversation in parks and playgrounds.

It is unusual to have so many vaccines at this stage of a pandemic, the first novel coronavirus genome sequence was only seen publicly in January 2020.

The variants started during the second wave late last summer, seemingly out of nowhere.

This was followed by a third wave now linked mainly to the UK variant, B1.1.7. 

This now makes up 91% of cases and is estimated to be up to 70% more transmissible.

Professor Sharon Peacock, chair of the Covid-19 Genomics UK Consortium, recently told the BBC it would “sweep the world”.

Then a P1 variant, first identified in Manaus, Brazil, was reported this week by the Brazil-UK Cadde project to be between 1.4 and 2.2 times more transmissible.

This carries a mutation in the spike protein called E484K, shown to reduce antibody recognition and helping the virus bypass immune protection. This is similar to B1351 identified in South Africa.

The variants could explain why Manaus had two severe outbreaks: May and December.

There are three cases of the Brazilian variant in Ireland, and six in the UK. Fifteen cases of the South African variant were identified here.

There is also one case of the B.1.525 variant, reported by Dr Cillian De Gascun, director of the National Virus Reference Laboratory in late February.

He said at a Nphet briefing the origin is not clear although it is linked with travel from sub-Saharan Africa. It contains, he said, an amino acid change linked with increased transmissibility.

Another variant identified in England on Thursday is not a 'variant of concern’, according to Public Health England.

Others variant — FIN-796H in Finland, B.1.526, B.1.427 and B.1.429 — identified in America are still under study.

Data indicates the three vaccines in use in Ireland are effective against the B117, the P1 and, although AstraZeneca could be less so, against B1351.

Professor Gerry Killeen, AXA Research Chair at University College Cork, said real-time development of variants among huge populations is a challenge.

“The problem is we are in the test tube,” he said.

Vaccine rollout 

There seems to have been naivety at Irish and European levels about the time needed to make and deliver millions of doses.

Israel, also a small country, solved this by paying more and doing a “data for doses” deal with PfizerBioNTech.

However, it is doubtful this would be accepted in Ireland where even the Covid Tracker App caused uproar about data privacy.

Speaking recently at a European Movement Ireland event, John Ryan, a senior Irish official with the European Commission, bluntly said a small country like Ireland could not compete with America or the UK on the vaccine market if it was outside the EU.

The power of the money is starkly illustrated by the Bloomberg Vaccine tracker.

Just 0.3% of the population in Africa are vaccinated compared to 8.8% in Europe and 14.9% in North America.

Britain went solo for emergency vaccine approval and then increased the gap between first and second doses. This meant more people received some protection faster.

Prof Killeen remains dubious about this approach, saying: “This dangerous middle ground where everybody is partially immune is a recipe for trouble.

Ireland is correct in making sure people get their second jab immediately after the first.

He said with variants circulating in the UK: “It is not the country I would be harmonising with.” 

Supply could improve when, as expected, the European Medicines Agency approves a Johnson & Johnson vaccine this month.

Rolling reviews are under way on CureVac AG, Novavax CZ AS, and a new applicant, the Russian Sputnik V.

Meanwhile, Dr Anne Moore, a virologist at University College Cork, said we need to focus on getting vaccines into arms.

Israeli data on the PfizerBioNTech vaccine shows its 89% effective at preventing infection of any kind and 94% effective against symptomatic infection.

In the longer term, the vaccine community is now hopeful a second-generation vaccine would be “broadly effective” against all variants.

“That is entirely possible, this is what happens with influenza. A year ago I would have been very cautious about this,” Dr Moore said.

But until Ireland has higher vaccination rates, it appears travel restrictions and public health guidelines are key to controlling the virus and its variants.

“Public health needs to be resourced,” Dr Moore said. “I have the utmost sympathy for them, they are building a dam while the water is flooding in.” 

Prof Killeen struck a more cautionary tone, warning: “It would be reckless to put all our eggs on vaccines.”