A rush of new vaccines and the rise of new COVID-19 strains offers both hope and hardship for the effort to contain the pandemic and return to some version of normal life.

The effort to vaccinate as many people as possible with the two approved COVID-19 vaccines has been gaining steam, after a slow start.

As of Wednesday, the pace of vaccinations in the US had increased up to about 1.3 million daily. An estimated 8% of the population has received an initial dose and 2% have received both doses.

About 7.3% Arizonans have received at least one dose and 1.3% have received two doses. Epidemiologists say vaccinations won’t contain the pandemic until somewhere between 70% and 90% of the population have either recovered from an infection or gotten a shot. At the current pace, the US won’t hit the 70% threshold until Sept. 11. Perhaps 10% of the US population has recovered from an infection, based on rough estimates that vary from region to region.

Arizona’s close to the national average, an improvement during the past week or two. The state has so far used 60% of the 1 million doses it has received, with 7.3% of the population getting an initial dose and 1.8% the second dose.

Most counties are still limiting vaccinations to the top two risks groups, which include frontline medical workers, nursing home residents and staff, other frontline workers like teachers, police and paramedics and people over 75.

Most Arizona counties remain overwhelmed by the demand for shots, with inadequate systems to make reservations and stop-and-go clinics based on week-to-week swings in the supply vaccines received.

Gov. Doug Ducey last week said the state will cut the allocation to counties that don’t use up their doses every week. That will likely penalize rural counties, since Maricopa County has set up mass vaccination sites in places like football stadiums, making it possible to use far more doses quickly. The Moderna and Pfizer vaccines go bad within an hour of opening a vial, creating major headaches for vaccination sites. The governor’s threat could end up siphoning vaccine doses away from rural counties like Apache, Navajo and Gila. Ironically, several weeks ago the federal government was threatening big sanctions against states that gave shots to people not in high risk groups – which led to wastage of doses especially in smaller clinics and rural areas.

The Biden Administration has vowed to boost the current pace with additional, about-to-be approved vaccines, use of the war powers act to shift resources to vaccine manufacturers and other measures. The most recent stimulus package included billions of added funding for vaccination programs.

Some epidemiologists have advocated delaying the second dose to get more shots out quickly. Moreover, Moderna says it can get more doses into the pipeline simply by retooling its assembly line to use 10-dose vials instead of five-dose vials.

Meanwhile, the rapid spread of new strains of the virus that infect people more easily and evade the immune system more effectively have complicated vaccine planning worldwide. Most of the evidence suggests that the new strains spread 20% to 70% more easily, but aren’t more lethal once you get infected. Some evidence suggests some of the strains may also prove more likely to cause serous illness and death. The current dominant strains have caused death in 1% to 2% of the people who test positive — although perhaps 30% or more of the people who get infected never get tested and so don’t show up in the mortality statistics.

New, more contagious strains have shown up in England, South Africa and California. Versions of those strains have spread all over the world. They tend to replace existing circulating strains once they show up. Some epidemiologist say their models suggest one of the new strains will likely dominate in the US as early as April, although the US doesn’t do the systematic genetic analysis of circulating strains to know for sure.

Cases of the faster-spreading strains have become widespread in California and have been detected in multiple patients in Arizona.

Growing evidence suggests existing vaccines may provide less protection against some of these fast-spreading, more stealthy strains. Recent clinical trials of not yet approved vaccines suggest effectiveness may drop from 90% to about 60% when people encounter some of the fast-spreading strains.

However, vaccine manufacturers area already developing booster shots that would confer better protection against the new virus strains. This may require an additional booster shot as those strains become dominant or even new shots every year, as is the case with the flu virus.

The clinical trials so far have focused on whether the vaccine prevents people from getting infected when exposed to the virus. Most of the trials have not yet determined with certainty whether vaccinated people who don’t get sick can still pass the virus along. Some evidence suggest many of the vaccines will also dramatically reduce the odds of transmission, but experts are still reluctant to make a definitive statement.

So here are some of the latest developments on the vaccine front:

Johnson and Johnson vaccine

A one-shot vaccine produced by Johnson and Johnson offers new hope for the global vaccination effort — but also offers worrisome evidence that new strains of the virus could undercut existing vaccines.

Epidemiologists were relieved at the release of clinical trial data showing the cheap, easily stored, one-shot vaccine confers 72% protection against the dominant strain of the virus with minimal side effects. However, protection dropped to 57% in Africa, where a new, more-easily-spread strain of the virus dominates. The findings suggest that people who receive any of the current crop of vaccines may need a booster shot to gain added protection against new strains. That’s unsettling but not surprising, say doctors.

The new strain has spread to at least 31 countries and many US states, including Arizona. Epidemiologists suspect that it could become the dominant strain in the US before summer.

The Johnson and Johnson vaccine makes it much simpler to run mass vaccination programs, especially in countries without the capacity to keep the currently approved vaccines made by Moderna and Pfizer super chilled. Johnson & Johnson says it can produce 32 million doses by April for the US, although production is currently lagging behind initial projections.

The company has vowed to make the vaccine available at cost to countries that can’t afford other vaccines, making it perhaps the leading candidate to tame the pandemic globally.

AstraZeneca Vaccine

A highly effective, safe, two-dose vaccine already in use in Great Britain and Europe could soon give the US an additional option. It has also provided intriguing evidence that the US could safely speed up the first round of vaccinations by postponing the booster shot required for the current, two-shot vaccines.

The vaccine developed by AstraZeneca and researchers from the University of Oxford provides roughly 82% protection with few side effects. It requires two doses, but should prove much easier to administer than the Moderna or Pfizer vaccines.

Researchers were initially baffled by clinical test results suggesting the vaccine actually gave better protection with a half-dose first shot and a full-dose second shot about a month later. Further analysis suggests the key to maximum protection actually lies in increasing the time between the first and second dose — to perhaps three months. Doctors say this makes biological sense based on studies in other vaccines. The strategy in a two-dose vaccine relies on arousing the immune system with the first dose, then hitting it again after that initial strong response. The clinical trials showed the first dose alone provided 76% protection. The second dose may also play a role in developing or activating the portion of the immune system dominated by memory T-cells, responsible for remembering an invader so it can act faster upon a later exposure.

The findings suggest that doctors can safely spread out the first and second doses for other COVID-19 vaccines like the Moderna vaccine used in Gila, Apache and Navajo Counties. The Moderna clinical trials found the two shots offered 95% protection, with the second dose coming three weeks after the first. But the trials didn’t test whether delaying the second shot by several months would provide equal protection. Health departments could likely accelerate the first round of shots if they didn’t have to hold back doses for the second shots two weeks later.

Moreover, delaying the second shot could give nimble manufacturers like Moderna a chance to target the new, faster-spreading virus strains with the booster shot.

Novavax

Clinical trials show the two-dose, protein-based vaccine is 90% effective in preventing infection. The vaccine proved only 60% effective against the more contagious strain now dominant in the UK and in South Africa. The vaccine also didn’t work as well in people already infected with the virus that causes AIDS. The Novavax shot also relies on exposing the immune system to a single, crucial viral spike protein, with added material to provoke the immune system.

Like the Moderna and Pfizer vaccine, it’s highly effective with few side effects but harder to store and distributed than traditional vaccines, which usually rely on using some altered or harmless virus to forewarn the immune system against the virus.

The growing number of vaccines nearly approval across the world raise the possibility of a more complex but efficient vaccine strategy. For instance, vaccination plans could reserve the more expensive, harder to handle, two-shot vaccines for people at higher risk and rely on the less expensive, one-shot vaccines for the general population — and for countries without the medical infrastructure to handle the more delicate vaccines.

The rapid spread of the new strains in Africa and elsewhere have underscored the message that only a global effort will beat the pandemic, since unvaccinated countries will serve as a breeding ground for new, more dangerous strains.

Sputnik V vaccine

Russia’s more traditional vaccine has provided 92% protection in clinical trials reviewed by outside experts. The vaccine spawned skepticism when Russia decided to start mass vaccination campaigns before it completed Phase III clinical trials demonstrating safety and efficiency in various groups. The vaccine relies on a harmless cold-type virus that delivers a fragment of the COVID virus, which stimulates immune system antibodies and T-cells.

The virus is easier to store and transport than the Moderna or Pfizer vaccines. The vaccine relies on two slightly different viral proteins administered 21 days apart. Russia has turned the vaccine into a foreign policy triumph, distributing doses to a host of other countries in South America and the Middle East.

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

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