An imminent surge in vaccine supply suggests that the United States is on the verge of making huge strides against the coronavirus pandemic. But experts say getting those doses into arms as quickly as possible over the next few weeks, while controlling the spread of the virus, will be crucial to tackling the biggest risk on the horizon: a proliferating array of COVID-19 variants, some of them more dangerous than the currently dominant strain, which could fuel a fourth pandemic surge.
“This is a race against time,” said Jennifer Kates, director of global health at KFF (formerly the Kaiser Family Foundation). “If we don’t see any further case surges, and vaccination continues to increase, we will likely get ahead of the variants—this is the winning combo. However, we could ‘lose’ if we open too quickly, vaccinate too slowly, and the variants therefore can take greater hold.”
CDC director Rochelle Walensky gave an even starker warning during a White House pandemic briefing on Monday. After a sharp and long decline in case counts since early January, Walensky said that “we stand to completely lose the hard-earned ground we have gained” against the coronavirus if relaxed safety standards or disruption in the vaccine rollout gives variants time to gain the upper hand.
There is already some sign that recent positive trends are reversing, with the current seven-day rolling average of new cases currently up 2% from a week ago.
The White House says 3.9 million doses of Johnson & Johnson’s COVID-19 vaccine, which received emergency approval from the FDA over the weekend, will be distributed across the country this week. Vaccinations are expected to begin on Tuesday, March 2. That should mean a major expansion over the 13.5 million doses of vaccines from Pfizer and Moderna delivered to states and pharmacies in recent weeks. Johnson & Johnson expects a slight dip in deliveries in the middle of the month, according to White House COVID czar Andy Slavitt, but expects to deliver a total of 20 million doses by the end of March.
That would be a further boost to a vaccination effort that President Joe Biden says is already “weeks ahead of schedule” (though that’s against a timeline that some critics have said wasn’t ambitious enough). KFF estimates that enough doses to vaccinate 130 million Americans will be delivered to states by the end of March.
“The J&J vaccine will be an important contributor to the U.S. (And other countries) being able to bring an ‘end’ to the pandemic,” said Joshua Michaud, a health policy expert also with KFF.
But the surge in vaccine supplies comes as nearly a half-dozen variants of the coronavirus gain a foothold within the United States. Most if not all of them appear to respond well to existing vaccines, but initial studies suggest that several are more infectious, and some may be more deadly.
Most worrisome is the U.K. COVID-19 variant, scientifically known as B.1.1.7. There is a quickly emerging scientific consensus that the variant is more infectious than the primary strain. Research published early in February projected the U.K. Variant would become the dominant strain by the end of March. Some research has also shown the U.K. Variant to be more likely to kill those it infects.
Other variants also pose threats. A variant first detected in California, known as CAL.2C, may also be more virulent and deadly. It surged from 0% to 50% of California’s COVID-19 cases between September 2020 and January of this year.
The good news is that both the California and U.K. Variants appear to respond well to current vaccines.
Other variants may have slightly more ability to evade vaccine protections. The Pfizer vaccine is slightly less effective against a variant from South Africa, which has reached 13 states. A New York variant known as B.1.526 and a Brazilian variant known as P.1—still rare in the U.S.—may have similar resistance.
Despite those worries, experts agree that widespread vaccination is crucial to controlling the variants before their increased infectiousness creates a fourth wave of viral surge. Walensky and others have also emphasized that loosening social distancing and other pandemic controls could make that fourth wave more likely, but states—including New York—are easing those controls anyway.
Finally, Dr. Anthony Fauci warned on Monday that faster vaccination is essential to preventing the emergence of even more variants. That’s because the virus can mutate within individual carriers, especially immunocompromised patients.
Getting vaccinated is “not only important for [patients’] own health, but that could be the breeding ground of the emergence of variants,” said Fauci. “If you don’t clear the virus rapidly, you’re going to have immunological selection within a given individual. And that was probably how all this started with 526.”