Australia is having a major challenge with the Delta variant of concern right now. And it’s understandable some people are feeling uncertain about getting a COVID-19 vaccine when available.
Dr S.S. Vasan, COVID-19 project leader at CSIRO, answers some common questions about the Delta variant and vaccine effectiveness. Last year, Dr Vasan led the preclinical trials of the Oxford-AstraZeneca vaccine at our Australian Centre for Disease Preparedness (ACDP) in Geelong. Since the beginning of the pandemic, Vasan has been closely monitoring new variants of concern of SARS-CoV-2 (the virus that causes COVID-19) and researching whether vaccines will work against them. In conversation with Dr Vasan.
■ What is a SARS-CoV-2 variant?
Simply put, when the virus changes from its original genetic makeup, we call it a variant.
To detect variants, we compare the virus genomes against the original or reference isolate called ‘Wuhan-Hu-1’ and see what’s changed.
Even a single mutation technically makes it a ‘variant’. Viruses like SARS-CoV-2 need to make copies of themselves in order to survive. When they make those copies, sometimes the copies might have errors. Imagine using a photocopier to make a copy of a copy of a copy and so on. Eventually, some letters might look a little different where the ink has smudged, or part of the copy is missing, or new letters have even been added in somehow.
Because mutations are especially frequent for RNA viruses like SARS-CoV-2, we’re looking at tens of thousands of variants. But most of them are not concerning—only a handful are currently of interest or concern (more on this below).
■ How much more contagious is Delta than previous SARS-CoV-2 variants?
The Delta variant of concern is the most important to date.
According to the World Health Organization (WHO), there is increasing evidence of greater transmissibility and secondary attack rate (disease spreading to those close to the person who’s infected).
The Delta variant has spread to at least 135 countries, including Australia.
■ And what is Delta Plus?
Some Delta isolates have a mutation called K417N, which is also present in the Beta and Gamma variants of concern. Some media outlets have dubbed this ‘Delta Plus’. Scientists are studying this mutation’s impact on vaccines and antibody therapies.
■ Is Delta more deadly?
The WHO says this variant of concern has an increased risk of hospitalisation. This is unsurprising because increased transmissibility could go hand-in-hand with case severity until most of the world’s population is vaccinated.
A study from February to June in Canada, yet to be peer-reviewed, compared non-variants of concern with Delta. It found people infected with the Delta variant were:
- 105% more likely to be hospitalised
- 241% more likely to be admitted to an intensive care unit
- 121% more likely to die from the disease.
For the other three variants of concern, these values were 52%, 89% and 51% respectively. This shows the Delta is the most problematic variant of concern to date.
■ Does Delta affect younger people more?
We’re starting to see this, but comprehensive evidence will take time.
One of the largest studies of its kind in India, yet to be peer-reviewed, showed that mortality increased by almost 40% in the second wave. This was particularly in the younger patients of age less than 45 years.
It’s especially sad to see media reports of younger people in Australia dying of COVID-19. This is why vaccinations are so important to protect our entire population.
■ Are the Pfizer and AstraZeneca vaccines effective against the Delta variant?
Yes, both vaccines are effective against the Delta variant. A peer-reviewed study in The New England Journal of Medicine showed that after two doses:
Pfizer-BioNTech vaccine is 85.3 to 90.1% effective against symptomatic disease caused by Delta
Oxford-AstraZeneca vaccine is 61.3 to 71.8% effective against symptomatic disease caused by Delta
If you get infected after you’re vaccinated, it is likely to be mild rather than severe disease. Therefore, vaccination is absolutely worth it – both to protect yourself and to reduce transmission to our family and community.
■ If you’re waiting for your second dose, will your first vaccine provide any protection against Delta?
Absolutely! The New England Journal of Medicine paper reported 25.2 to 35.7% effectiveness after one dose of either vaccine against the Delta variant.
So even one dose of Pfizer or AstraZeneca will give you some protection against Delta. And set you on the path to getting even better protection from your second dose.
■ Do variants happen in populations where the disease is spreading fast?
The more a virus is able to replicate and spread in a population, the greater the likelihood of mutations of consequence. Where the environment permits highly transmissible variants, we also expect disease severity to go up.
But if we halt transmission, we can suppress the spread of variants. This is why vaccinations and lockdowns are an essential part of a pandemic response. They drive transmission down, and drive the virus evolution towards less severe disease outcomes.
“We don’t yet have a SARS-CoV-2 variant of high consequence that significantly reduces the effectiveness of prevention or medical countermeasures. Hopefully most people will be vaccinated before we face that situation. Getting a COVID-19 vaccine is one of the best protections we currently have”
■ What is a ‘variant of concern’ and a ‘variant of interest’?
National ‘concern about a variant’ of SARS-CoV-2 is often justified. But that doesn’t necessarily make it a ‘variant of concern’ to the WHO and the rest of the world.
- The definitions we use in Australia are consistent with the US Centers for Disease Control (CDC) and the WHO.
- Definition of ‘variant of interest’ (sometimes called a ‘variant under investigation’)
- Changes to receptor binding (the way the virus attaches to cells)
- Reduced antibody neutralisation
- Reduced efficacy of treatments
- Potential diagnostic impact
- Predicted increase in transmissibility or disease severity.
- These four variants—Eta, Iota, Kappa, Lambda—are of interest. This is one step below concern.
- A ‘variant of concern’ has a greater impact across all these measures:
- Changes to receptor binding, often targeted by vaccines
- Significantly reduced antibody neutralisation
- Reduced vaccine or treatment effectiveness
- Diagnostic detection failures
- Evidence of increased transmissibility and more severe disease (in terms of hospitalisations or deaths).
Out of tens of thousands of variants, only four are currently of concern to the WHO: Alpha, Beta, Gamma and Delta.
There is one step higher than a variant of concern—called a ‘variant of high consequence’. Thankfully, we don’t yet have one for SARS-CoV-2.
■ Will we need booster shots to keep up with the variants? If so, how soon?
Research is ongoing on this topic, called ‘vaccine matching’. If we take both doses of either vaccine, we should be okay for at least a year, based on neutralisation efficacy studies to date.
New guidelines will emerge based on how the virus evolves, and how the vaccines are performing.
■ What about other variants of concern—do the vaccines work against those too?
Some variants like the D614G (dubbed the G-strain) attract a lot of media attention. But they don’t necessarily affect vaccines, as my team was the first to demonstrate last year.
Others like Beta affect many first-generation vaccines. There are also newer vaccines, such as the Indian Institute of Science’s warm vaccine Mynvax, which withstood all four variants of concern in our laboratory tests.
So we do have positive news. We don’t yet have a SARS-CoV-2 variant of high consequence that significantly reduces the effectiveness of prevention or medical countermeasures.
Hopefully most people will be vaccinated before we face that situation. Getting a COVID-19 vaccine is one of the best protections we currently have.
But you’ll be safe knowing the vaccines available in Australia are effective at protecting against severe disease from the Delta variant.
This article first appeared on CSIROscope
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Australia is having a major challenge with the #Delta variant of concern right now. And it’s understandable some people are feeling uncertain about getting a COVID-19 #vaccine when available. Dr S.S. Vasan, answers some common questions. #TheIndianSunhttps://t.co/jwkietWslz
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