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Can the spread of COVID-19 variants be controlled by vaccines?

Though hard weeks and months lie ahead, the success of the COVID-19 vaccine development gives me hope that countries can bring the pandemic under control and start to return to normal. Whilst lockdowns continue to do their part in containing the spread, it is evident that this cannot be sustained as a long-term solution. Following a year of scientific breakthroughs, vaccines are the answer to the end of the pandemic. But now we must contend with two new rapidly spreading variants – and what variants and vaccines mean for insurers.  

Vaccine challenges lie ahead

Three vaccines in Europe and North America beat our projected timeline of 12-18 months for the development and regulatory approval of a vaccine. At least 12 more vaccines are in advanced trials, and many more in lab studies.

Number of vaccines in development:

Source: WHO COVID-19 Vaccine Landscape (5 Jan 2021)

We anticipate hiccups as public health agencies solve logistical challenges with the rollout of a mass vaccination programme. Even in advanced countries with good early vaccination data, like Israel, the USA and the UK, potential obstacles remain, such as a growing anti-vaxxer community.

Many countries pre-ordered vaccines, but there are substantial differences in the number of dosages on a per capita basis. Countries with a lower per capita dosage may have to wait longer before beginning vaccinations because of manufacturing limitations. Ordering more doses per capita offers greater choice, which may increase take-up in vaccines. It is important to note that most vaccines will require two doses for full efficacy, many vaccines are yet to be approved and it is possible that some vaccine candidates will not be released at all or for many months to come. While some countries have ordered many doses, they may not be in as good a position as it first appeared.

Per capita vaccine doses, select countries:

Source: Financial Times (11th Dec 2020),  Launch & Scale Faster (29th Dec 2020)

Complications with the new variants

The possibility of mutations and their impact on vaccine efficacy is a key point of discussion in the scientific community. Studies to ascertain if the vaccines being developed would work for all viral lineages in the global population showed a low genetic diversity of the SARS-CoV-2 virus. This reassured scientists that the vaccine development programmes were unlikely to be derailed by mutations.

That conclusion broadly holds true for the B.1.1.7 variant, which was first detected in the UK in November 2020 and has multiple mutations of immunological significance, leading Public Health England to designate it a 'variant of concern'. Initial reports suggest that this mutation is associated with substantially increased transmissibility due to the N501Y mutation in a spike protein which makes it easier to enter cells. More than 50 countries, including Canada and the USA, are now reporting cases with this variant – and worryingly, in some countries there are persons with no travel history to the UK, implying community spread.

Source: cov-lineages.org, Nature Microbiology

The South African variant B.1.351 emerged in October 2020 and is thought to be driving the second wave of infections seen in the country. At least a dozen countries have already reported cases with this variant.

The most pressing concern is that these two strains appear to be 50-70% more infectious than previous strains. As the infection rates rise, the number of hospitalisations will accelerate, thus raising the concern of running out of time to immunise the most vulnerable populations before they get infected.

Will the vaccines be effective against the new variants?

The vaccine developed by Pfizer/BioNTech appears to be successful against the UK and South African variants, with preliminary data appearing to be positive.

Should the current vaccines in production and those in the pipeline provide decreased immune protection from the new strains, they may require modifications in their formulations. The good news is that the current and future group of vaccines can be altered to address mutations relatively quickly.

The mRNA approach, and the manufacturing techniques it requires, means that an altered vaccine with modified genetic codes can be produced much faster than traditional vaccines, if the original vaccine is unable to produce the required antibodies. However, this may create additional delays to the vaccine rollout, but this is a rapidly evolving situation.

Difficult dosage decisions for policymakers

For vaccines requiring multiple dosages, there have been discussions on administering only a single, initial dose to get more people at least partially immunised. This strategy has already been adopted by the UK and is under consideration by the incoming US administration under President-elect Joe Biden.

This approach, however, is not without its downsides. Studies show efficacy drops to between 52% and 89% with one dosage versus 95% after two shots, further prolonging the time to achieve herd immunity. Policymakers will have to weigh the risk of lower immunity from one shot against shorter-term mortality and hospitalisations as the new variants accelerate the spread.  

What does this mean for L&H insurers?

L&H insurers will need to continue to stay cautious in their outlook while the vaccination programmes are implemented. Due to the variant, it is likely that lockdowns and other social control measures will continue in countries across the world. This will also further strain mental health, as reported by multiple European studies during the initial quarantine period in spring last year. Globally, the mutated virus threatens to increase the case count substantially in the coming months – including countries in the Asia Pacific region with early success in controlling the spread. Higher case counts will lead to more hospitalisations, increased mortality rates, and a bigger proportion of people impacted by long-COVID.

My hope is that the insurance industry as whole stands behind the vaccination programmes – this is an important public health initiative that we should support. In time, COVID-19 vaccinations will likely become just like a seasonal flu vaccine: a routine occurrence for millions.  

Let the season of inoculation commence!

While I personally won't miss my spot in the line to get the vaccine and encourage others to do the same, there are many who are vaccine shy. We should do what we can to get the message across that getting vaccinated is not just a personal saviour – vaccination is necessary to return our communities and our industry back to normal.

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