We have new assurances that by July or August the U.S. government will have secured an adequate COVID-19 vaccine supply in order to fully immunize our population, or at least 80 percent, considered by some a threshold for interrupting SARS CoV2 virus transmission.
Achieving such high rates of coverage will not be easy. To begin with, the U.S. does not have an adult national immunization program and current rates of vaccine hesitancy especially among African American and conservative groups are a challenge. Nevertheless there is overall great optimism that we can vaccinate our way out of the COVID-19 pandemic that began in 2020.
Fully vaccinating the U.S. population means that Americans can go to work, hold sporting events, attend concerts, visit family, or enjoy restaurants and outings without fear of hospitalization or death. We have cause for great optimism from a return to normalcy or near normalcy.
Unfortunately, the good news that awaits us this summer and fall must be tempered by a hard reality. We must first figure out how we operate our nation and work to control to COVID-19 over the next few months until the mother lode of vaccine arrives.
The reason is this: The B.1.1.7 variant from the United Kingdom has entered the U.S. and is rapidly accelerating, especially now in Florida and Southern California. Our reason for concern is how this variant spread across the U.K. It went from its first detection in southeastern England in September to become the dominant variant by November. Emerging evidence now shows that the B.1.1.7 variant is 35 to 45 percent more contagious and transmissible than other strains, while also causing higher severity illness.
Beginning sometime next month — roughly the middle of March — and extending throughout the spring, our colleagues with the virus evolution group at Seattle’s Fred Hutchinson Center predict that B.1.1.7 will become a dominant COVID-19 virus variant in the U.S. This portends great hardship. It means that the number of new COVID-19 cases and deaths could accelerate dramatically.
Therefore, while the numbers of new COVID-19 cases have declined by almost 80 percent in recent weeks following our terrible post-holiday surge, our respite is likely temporary. We may be in the eye of the hurricane, with an expectation that a new wave or wall of infection is about to hit us.
Our most pressing issue is whether we can quickly accelerate our national vaccination program ahead of the U.K. variant. While the Biden administration has put in place a steady and long-range plan to immunize our population by the summer, it has not provided a roadmap for how we might hasten efforts to vaccinate as many people as possible in the coming weeks. However, doing so will become essential to save lives.
The "Ides of March" could bring a new phase of the epidemic from B.1.1.7 that results in unprecedented numbers of COVID-19 cases, including long-haul cases, hospitalizations and COVID-19 deaths. Potentially, our national death toll could reach 600,000 to 700,000 or more by late spring or early summer.
A related issue is the opening of schools for in-person classrooms and instruction. While overall, K-12 schools operated with great efficiency and with some degree of success last fall, with the B.1.1.7 virus we will essentially be dealing with a very different virus. The level of virus transmission in the classroom might far exceed anything we have experienced previously. Teachers and staff could become sick and hospitalized at significant levels.
To prepare for the new reality of the B.1.1.7 we must fully consider our options to immediately vaccinate the populations at greatest risk. The Biden administration is doing its best to open up extended vaccination centers and hubs beyond the pharmacies and community hospitals. This includes new sites in low-income neighborhoods. But we must now evaluate expanding our vaccine supply and taking extra measures to open schools safely.
Regarding the former, some of our colleagues favor holding the second dose of the two mRNA vaccines from Moderna and Pfizer, respectively, in order to provide a single dose to a greater number of older Americans. We recognize the merits of their arguments, but we remain unconvinced about the efficacy of single dose vaccines, especially against the B.1.1.7 variant. Alternatively, if sufficient doses of the AstraZeneca Oxford vaccine are currently stockpiled in the U.S. we recommend releasing this now through emergency use authorization, especially given the recent action of the European regulatory authority and the WHO to take this step.
Second, we must prioritize vaccinating K-12 teachers and school staff. Our teachers are national treasures, and we must ensure their health security and prioritize them for immunization.
The B.1.1.7 and other variants have thrown a curve ball to the sound and well considered plan by the Biden administration to vaccinate the nation. We have no choice but to readjust and respond.
Carlos del Rio, MD, is distinguished professor of medicine in the Division of Infectious Diseases at Emory University School of Medicine; Peter Hotez, MD, Ph.D., is Texas Children’s endowed professor of Tropical Pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine, and the author of the newly released “Preventing the Next Pandemic: Vaccine Diplomacy in a time of Anti-Science” (Johns Hopkins Univ Press).