If the COVID Threat Grows Again, How Prepared Are We?

We’ve been through this before. A new COVID-19 variant emerges somewhere in the world, grows in strength, and comes to dominate, bringing with it an increase in hospitalizations and deaths. 

It’s happening now. But so far, the JN.1 variant, while causing a spike in cases and worse outcomes, isn’t expected to be the sky-is-falling-variant many have worried about. 

But what if the next one is? Will we be prepared?

What keeps experts up at night is the possibility of something we haven’t seen yet. 

A variant that emerges with little notice, one that gets around all our immune defenses, could us set back to day one. That means facing a virus without an effective vaccine or tailored antiviral treatment again. It’s difficult to predict how likely this threat is, but the risk is not zero. 

Beware anyone who rushes to declare a new variant mild. Many did this for Omicron and got it badly wrong. At very least people should wait until a wave is well over before making any assessment. We also need to include the impact of Long COVID. https://t.co/0V1NVIfHyW

— Dr. Lucky Tran (@luckytran) January 16, 2024

On the plus side, the virus cannot “learn,” but we humans can. We’ve got vaccine technology now that is essential for responding to new COVID variants more quickly. In the past, creating a vaccine, ramping up production, and distributing it could take 6 months or more – as it still does with the flu vaccine each year. The mRNA vaccine technology, however, can be updated at lower costs and deployed much faster, leading experts to refer to them as “plug and play” vaccines.

“We are a lot for further ahead with the mRNA technology and the way those vaccines are made. That makes it really easy to adapt to new variants fairly quickly,” said Kawsar Rasmy Talaat, MD, an infectious disease and international health specialist at Johns Hopkins University in Baltimore. 

“Those are great things,” Talaat said. “We have the tools available to mitigate the health impacts and save lives.”

JN.1 Has the Lead

At the moment, we’re in a surge. The JN.1 variant now accounts for more than 60% of circulating virus in the United States. As of Jan. 6, compared to the previous weeks, hospitalizations were up 3% and deaths were up more than 14% in CDC data.

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So far, while JN.1 has caused a spike in some COVID data, the CDC remains confident it does not present a higher risk to public health. Yes, it has proven capable of evading immunity, but it does not appear to make us sicker than other variants.

When it comes to COVID variants, we’ve already been through several variations – from small ones that don’t change much to variants that transform into household names – like Delta and Omicron. 

Millions to Drive Next-Generation Vaccines

Ideally, COVID vaccines could do more, Talaat said. Current vaccines work well in reducing the risk of severe illness, hospitalization, and death. However, they are not as effective at preventing transmission and new infections. “And the immunity to the vaccine doesn't last nearly as long as we thought it was going to.” So a longer-lasting vaccine that prevents COVID from spreading from person to person would be optimal. Through emergency use authorizations and other regulatory flexibility, the FDA “has shown increased nimbleness” in responding to previous changes to COVID variants, Talaat said.

Speaking of the feds, the Department of Health and Human Services is spending $500 million on 11 promising next-generation COVID vaccines, part of an overall $1.4 billion commitment to clinical trials and other initiatives designed to better prepare us for the future. 

The developing technologies could be good news for people who avoid needles and syringes as much as possible. Strategies in development include a nasal spray, a micro-array skin patch, and self-amplifying mRNA (basically, a way to increase mRNA instructions to the immune system without the need to get into cell nuclei) to deliver COVID vaccines in whole new ways.  

These new formulations are in the early stages, so it could be several years before they gain FDA clearance for widespread use.

Accelerating this research is the government’s public-private Project NextGen, dedicated to “enhancing our preparedness for COVID-19 strains and variants." In October 2023, the HHS, the National Institute of Allergy and Infectious Diseases, and the Biomedical Advanced Research and Development Authority (BARDA) announced the most promising new vaccine technologies to receive initial funding as part of this project. 

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Ensuring that future vaccines are developed quickly at lower cost, that they work better, and that they are accessible to all Americans are additional project goals. 

It Could Take a Village

As potentially promising as these new technologies could be for staying at least one step ahead of any threatening future COVID variant, there is another hurdle to overcome: public acceptance. 

Unlike the original vaccine series that about 80% of U.S. adults received, the most recent updated vaccine series has stumbled. Regarding uptake of the new boosters, for kids, it's under 10%. For adults, it's hardly better, and even among the elderly, it's only about one-third,” said Daniel Salmon, PhD, MPH, a vaccinologist at Johns Hopkins Bloomberg School of Public Health.

As of Dec. 30, 2023, 19.4% of American adults, 8% of children, and 38% of adults 75 or older received an updated 2023-24 COVID booster immunization.

“It's a problem because the vaccine has benefit. I think it's complacency ... that is probably the right word for it,” Salmon said. The benefits of vaccination outweigh the risks, “so people would do well to get vaccinated.”

Asked if we don’t have better herd immunity at this point, Salmon said, “Herd immunity does not work as well with COVID.” In contrast, it does work well with measles, where about 97% of people are vaccinated and where protection remains long lasting. “But in the case of COVID, both from the disease and from the vaccine, the immunity goes down over time.”

“While the acute crisis of the COVID-19 pandemic appears to be behind us, SARS-CoV-2 continues to evolve,” Robert Johnson, PhD, director of Project NextGen, said in a video statement. The vaccines are still effective at preventing serious disease and death, and effective antiviral treatments remain available.

However, “the American people need vaccines that not only protect against current strains but any new variant that comes our way.”