Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said Wednesday it is essential to quickly get vaccination rates to 70 percent in each community to cut chains of virus transmission, because “variants are a wildcard that could reverse this progress we have made and could set us back.”
But with doubts growing about the ability to reach the 70 percent target, the question is whether the country’s luck curbing the pandemic will hold out. Sequencing of the virus to detect mutations may be one of the best public health tools for warding off a potential disaster. But the actual sequencing being done in the U.S. is still below ideal levels, and there are no guarantees that it can provide enough early warning that the stealthy, evolving virus won’t turn into something far more dangerous.
“Every successive transmission is an opportunity for a new variant to emerge,” said Joseph Kanter, Louisiana’s state health officer. “We have been quite fortunate that the variants that have emerged remain fairly good matches to the vaccines we have. We are not guaranteed to be so fortunate in the future.”
While all viruses mutate as they spread, the SARS-CoV-2 virus that causes Covid-19 has evolved relatively slowly compared to HIV and influenza. But occasionally one or more mutations — or random changes — will produce a new variant that behaves differently than existing strains of the virus. The huge number of Covid cases worldwide has fueled numerous “variants of concern,” so named because they appear to be more transmissible, more virulent or render vaccines less effective.
The highly contagious variant B.1.1.7, first identified in the U.K, is now the dominant strain in the U.S. and has been blamed for rising hospitalizations among younger people. Variants that originated in hard-hit places like New York, California and India have also been identified.
“Every time there is a new variant, there is a nervous question we ask: ‘Is this the doomsday scenario?'” said Shereef Elnahal, CEO of University Hospital in Newark, N.J., and a former state health commissioner.
The U.S. to date has been fortunate that all three vaccines authorized for use appear to work relatively well against the known variants, even though the one first identified in South Africa has posed a challenge for some other shots in use elsewhere or still under development.
Anthony Fauci, chief medical adviser to President Joe Biden, told POLITICO Wednesday that the risk of dangerous variants may already be diminished because of the recent pace of vaccinations.
“If an overwhelming portion of the population is vaccinated, it’s unlikely you’ll see the kind of surge like we saw in January,” he said. “That’s why it’s important to get to that end game.”
The states struggling the most to vaccinate are the same ones that have a host of poor public health outcomes, particularly in rural communities. Local and state officials point to conservative-leaning populations often skeptical of government, as well as spotty health infrastructure that leaves lower-income residents struggling to access a medical provider. Mississippi state health officer Thomas Dobbs last week said many rural residents are unaccustomed to seeking care until they are sick, and that it’s going to take more than a few public service announcements to change the culture.
In Alabama, which has one of the lowest vaccination rates in the country, cases have increased slightly over the last month, concerning public health officials who fear it’s only a matter of time before a variant of concern emerges.
“It’s a very real threat,” said Jeanne Marrazzo, director of the infectious disease division at the University of Alabama, Birmingham. “If you have a population that is not well vaccinated and you combine that with a lot of activity likely to spread the virus — where things could take off.”
The Biden administration is still grappling with how to address these pockets of the country with stubbornly high Covid caseloads and low vaccine uptake. During the recent coronavirus spike in Michigan, federal personnel helped with sequencing, testing, tracing and offered more therapeutics in an effort to quell the worst outbreak in the country. The CDC is spending $3 billion to help local officials expand their vaccine programs and, in March, the federal health department sent $250 million to states so they could partner with community organizations to get out the message that the vaccines are safe and effective.
The government is also working to significantly increase sequencing capacity in the coming months with the infusion of $1.7 billion for variant surveillance and response measures included in March’s Covid relief package. The money will help the CDC, state labs and academic researchers develop new ways to sequence the virus and better share information on where and how variants are spreading.
“Our biggest threat to progress would be a variant that was capable of eluding the therapeutics and vaccines that we currently have,” said Sen. Tammy Baldwin (D-Wis.), the lead author of the funding provision. “That’s why I feel like we have to be so vigilant.”
For now, though, public health officials have been reluctant to mandate the vaccine or set up any kind of government passport system to verify a person’s vaccination status. Instead, they’re stressing that the country break down vaccine resistance incrementally and not resign itself to pockets of unvaccinated Americans where Covid spreads.
“This laissez-faire attitude is not the right one,” said Oscar Alleyne, chief of programs at the National Association of County and City Health Officials.