Beating COVID will require a 5-part strategy—including mandatory boosters and a drug we don’t have yet

November 22, 2021, 11:30 PM UTC
A patient gets a Moderna COVID-19 booster shot at a pharmacy in La Cañada Flintridge, Calif., on Nov. 16. "As another wave hits in the coming weeks and months, there is a high probability that variants will emerge that are resistant to current vaccines," the authors write.
Irfan Khan / Los Angeles Times via Getty Images

The Delta variant has laid bare the dangers of a vaccine-only approach to ending the COVID-19 pandemic. And the worst is yet to come.

Israel and several countries in Europe—some with greater vaccination coverage than the U.S.—are experiencing the highest levels of new infections since the beginning of the pandemic. Hospitalizations and deaths, including among vaccinated and younger persons, are creeping up. Lockdowns are being reimposed. Throughout COVID-19, the U.S. has trailed behind those countries by about a month. Thanksgiving gatherings might accelerate that timeline by a few weeks.

The increase in infections, hospitalizations and deaths could be attributed to waning immunity in vaccinated and previously infected persons, and to Delta and Delta-plus variants. 

Urgently increasing vaccine access, acceptance, and production, including in lower-income countries, with boosters for all, is essential to limit the coming tide of infections, hospitalizations and deaths. The Biden-Harris administration has been a global leader, but much more needs to be done. Worldwide, only 43% of the population has been fully vaccinated. In Africa—home to 1.3 billion people—the coverage rate is less than 10%.

However, a vaccine-only strategy is doomed to fail. Delta reproduces so rapidly that by the time an infected person’s immune system kicks in, the virus could have already spread to others. That fact, combined with the slow rollout of vaccines, is a recipe for disaster. Like all viruses, every time SARS-CoV-2 reproduces, it mutates. If a mutation occurs that evades the protective effect of vaccines, it is more likely to thrive in a vaccinated person. With Delta, the virus freely ping-pongs between vaccinated and unvaccinated people across the globe, significantly increasing the odds that it will “escape” the effectiveness of vaccines. 

In other words, as another wave hits in the coming weeks and months, there is a high probability that variants will emerge that are resistant to current vaccines.

New vaccines to counter variants can be produced relatively quickly. But they must be produced, distributed, and received. As the current state of global vaccine coverage demonstrates, that is the public health equivalent of chasing your tail.

An easy-to-use treatment that is effective against all current and potential variants and that also significantly reduces transmission, is desperately needed. Recent reports of two drugs that decreased hospitalization and deaths in persons who are at high risk by 50% and 89%, respectively, is a significant advance. However, those drugs require twice-daily pills for five days. And because the products work through the bloodstream, they are as unlikely as vaccines to stop infected people from spreading the virus.

To get back to business as usual, we need a combined approach. First, vaccine boosters every six months should be required for return to work, and for contact in any crowded setting including public transportation—in no small part because that is how many people get to work.

Second, distancing, masking and other public health measures should be enforced in the workplace and other social settings.

Third, where possible, workplace and other settings should be arranged to limit the duration persons are in the direct airflow of others. Infection risk is largely determined by the amount of virus and the duration of exposure, which can be affected by airflow. Masks, distance and exposure could be an effective way to prevent spread of the virus.

Fourth, during surges, interval testing in the workplace, schools and other social settings, with rapid referral and access to existing treatments, should help reduce illness, hospitalization, and death.

Finally, an urgent effort is needed to develop, produce, and distribute novel, easy to use therapies that are effective against all variants, likely administered by inhalation, with triple benefits: limiting hospitalizations and deaths and the spread of infection; and providing protection from infection for six months or more. That last piece is important. If inhaled therapies could prevent infection with any variant for as long as vaccines, we could potentially advance from controlling the pandemic to ending it. We and others are working on products that could achieve those objectives.

The National Institutes of Health recently launched the Antivirals for Pandemics Program to accelerate the development of novel treatments for COVID-19 and other viruses that could cause another global catastrophe. But more is required. The Biden administration should urgently expand Project Warp Speed and lead a global initiative to develop and ensure global access to triple-threat treatments. Of course, global availability of easy-to-use diagnostic tests must be simultaneously advanced. 

Cherry-picking interventions will not work: Now is the time for a kitchen-sink strategy. If we act now, we have a shot at a rough but business-as-usual-adjacent ride through cycles of surges and new vaccine resistant variants through the next two to three years. If we achieve triple-threat therapies during that time, this global nightmare could finally end. 

There is no time to lose.

Mark Dybul is CEO of Enochian BioSciences and professor of medicine, Georgetown University Medical Center. He is a former head of the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria and a former member of the Independent Panel on Pandemic Preparedness and Response. 

Serhat Gümrükçü is the founder and executive director of Seraph Research Institute and co-founder and inventor of Enochian BioSciences.

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