This might be the only way to defeat COVID for good

The novel coronavirus mutates and evolves like all viruses. Quickly. Variant upon variant. Subvariants between the variants.

The virus is active. But our efforts to contain it are reactive. Thirty-four months into the COVID-19 pandemic, we still haven’t found a way to stay ahead of the virus — and provide people with immunity that lasts as the virus evolves.

That needs to change, experts told The Daily Beast. And there are many ways it could change if we can focus our resources.

Broad-spectrum nasal vaccines that provide long-term immunity. Universal vaccines designed to work against current and future variants. Or at least faster ways to introduce new boosters.

But even the best new drug is useless if people don’t take it. The public’s willingness to get vaccinated, rather than the availability of a new and better vaccine, may be the main reason we continue to lag behind the virus.

“How do we break out of the Groundhog Day Loop?” asked James Lawler, an infectious disease expert at the University of Nebraska Medical Center, referring to Bill Murray’s 1993 comedy about a man trapped in an endlessly repeating day. “I’m not sure we’ll do it that soon.”

The novel coronavirus has been evolving steadily since it first jumped from animals to humans in China in late 2019. A year later, the early forms of the virus gave way to a more severe variant, Delta, which in turn was replaced by the more contagious Omicron variant and its succession of subvariants – BA.1, BA.2, BA.4 and BA.5 – from last Autumn.

All of the major variants and subvariants have changes in the spike protein, the part of the virus that helps it attach to and infect our cells. Recently, more and more mutations have also appeared in other parts of the virus.

Yes, more than two-thirds of the world’s 7.8 billion people are at least partially vaccinated. Billions have fresh natural antibodies from a recent infection. This wall of immunity prevented the worst consequences. Hospitalizations and deaths have declined from their last peak in February.

But there is no sign that the SARS-CoV-2 virus is slowing down. New variants come as mutations accumulate. Anticipating a future where COVID is more or less a permanent problem, health officials around the world are trying to find strategies not to defeat it the virus, but manage it.

US President Joe Biden is beginning to portray COVID as an annual problem like the flu. On Tuesday, Biden encouraged Americans to get hold of the new messenger RNA boosters that vaccine makers Pfizer and Moderna have tailored for Omicron and its subvariants.

Biden announced that further variant-specific boosters could follow. “As the virus continues to evolve, we can now update our vaccines annually to target the dominant variant,” he said. “Just like your annual flu shot, you should get it sometime between Labor Day and Halloween.”

But there’s a problem with an annual approach to COVID mutations. Antibodies from even the best mRNA vaccines tend to fade after about four months. If you’re only boosted once a year, you could be underprotected for up to eight months at a time.

Maybe. The fact is, we don’t know exactly how well – or for how long – the new boosters will work. “We still need that information to know if that’s a viable strategy,” Baylor College vaccine development expert Peter Hotez told The Daily Beast.

Equally problematic, health authorities and the pharmaceutical industry are currently searching for variants and formulating new boosters based on the dominant form of the virus. But it takes months to reformulate the vaccines, get approval from health officials in each of the nearly 200 countries, and then manufacture and distribute doses.

We move slower than the virus. A new variant could emerge within a few months. But it took almost a year for an Omicron-specific booster to hit the market. There is a risk that a new variant has so many mutations that it evades the antibodies of a vaccine developed for the previous variant. In this case, the annual top-up could result in an even longer protection gap.

There are a number of ways the virus can catch up, experts told The Daily Beast. Industry could formulate new boosters faster — and government regulators could approve them faster.

Another approach is a vaccine that you inhale rather than inject. A nasal vaccine could stimulate a broader and longer-lasting immune response by targeting the parts of the body — the nose and throat — where SARS-CoV-2 prefers to lodge before it spreads to the lungs and other organs.

There is also the prospect of a universal “pan-coronavirus” vaccine designed to induce immunity against SARS-CoV-2 and related coronaviruses, of which there are dozens.

These universal antibodies may be slightly less effective than antibodies to just one virus, but this somewhat reduced immunity should persist even if a particular virus mutates into a radically different form. “Any potent set of antibodies that can neutralize an RNA virus like CoV-2 can select escape mutants,” Barton Haynes, an immunologist at Duke University’s Human Vaccine Institute who is working on a universal sting, told The Daily Beast.

There are several nasal vaccines in development, including one at the University of Iowa — and about a dozen major universal vaccines in development. The two leading efforts are with the Coalition for Epidemic Preparedness Innovations in Norway and the US National Institute of Allergy and Infectious Diseases.

But all of these efforts depend in part on government support. And the country with the deepest pockets, the United States, is shutting its purses after years of generously supporting COVID research.

Accelerating the introduction of boosters would also depend on government funding — as well as major reforms to licensing processes in countries whose regulators tend to lead the way. That, in turn, means the United States, a country not necessarily known for its regulatory efficiency.

But there is an even greater obstacle. Vaccine and booster uptake has plateaued globally as the pandemic nears its fourth year and fatigue sets in. In the US, only a quarter of people ages 50 to 64 received their first two booster shots. Even if the industry rolled out a new booster every few months and regulators approved it quickly, would enough people get bitten fast enough to slow transmission of the virus?

Lawler said he was skeptical. “The problem is that we are likely to have very poor uptake of the new vaccines. Each booster dose had a decreasing uptake.”

Government news could help, but that too depends on tightening funding. “We need an advocacy program to get people to accept annual or regular booster shots, but so far that’s not happening,” Hotez said.

So the world is getting used to an annual approach to COVID, but without the tools to ensure an annual strategy works. That’s not necessarily a big problem right now, as billions of people still have antibodies from previous infections.

But when those antibodies fade, we’re faced with a choice. Induce antibodies with better and faster vaccines or endure another major wave of infections.

The alternative — to pretend COVID will just go away — is naïve. “I’m really puzzled by the widespread assumption that the future of the pandemic is bright,” Lawler said. “This repeats exactly the same mistakes in foresight that we have shown together over the last two years. I suppose I should have learned by now that we don’t learn.”