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January 17, 2021

Virtual session: Dr Fauci fears about vaccine’s efficacy against S African variant

January 17, 2021

LAHORE: The world-renowned physician and immunologist from the US Dr Anthony Fauci expressed fear about COVID-19 vaccine’s efficacy against South African variant of coronavirus, which seems slightly more complex than the UK variant.

“Since British scientists noted the UK variant tends to increase transmissibility than its virulence, the South African variant is little bit complicated that may render vaccine’s effectiveness vulnerable,” Dr Fauci said while speaking to a group of global health reporters ahead of “HIV Research for Prevention” (HIVR4P) conference. An International AIDS Society’s (IAS) virtual conference, which was originally scheduled for Cape Town last November, is now taking place online over the last week of January and the first week of February.

Dr Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID) since 1984, and someone who has been in the headlines for combating COVID-19 pandemic since its outbreak, believes that the coronavirus will more likely gain virulence with monoclonal antibodies more quickly than it does with vaccines, which induce polyclonal response. “If one of the monoclonal antibodies unluckily happens to bind to the epitope that mutated, which is more likely to occur with South African mutant than with the UK mutant, then we’re in a lot of trouble,” he warned.

Thus far, Dr Fauci says, the existing variants didn’t seem to have a negative impact on COVID-19 prevention by currently available vaccines. “However, we are following it really carefully for it is conceivable that, with another mutation or two, it will negatively impact the vaccine’s effectiveness,” Dr Fauci told The News.

In the light of Dr Fauci’s revelation, Pakistan needs to be extremely careful about vaccine’s vulnerability to South African variant at a time when South Africa’s cricket team is on an official tour for a historic home series after 14 years as foreign teams were stopped coming to Pakistan post-2009 terrorist attack on Sri Lanka’s cricket team in Lahore.

Delivering his talk at a session titled “Meet the expert: Anthony Fauci, US National Institutes of Health” – moderated by AVAC’s (AIDS Vaccine Advocacy Coalition) Mitchell Warren and Catherine Hankins – Dr Fauci said COVID-19 vaccines didn’t come through in a year but were based on a 10-year research platform. “We have considerable experience of decades with coronaviruses as 15 to 30 percent of all common colds are caused by coronaviruses. For instance, we dealt with Severe Acute Respiratory Syndrome (SARS) in 2002, Middle East Respiratory Syndrome (MERS) in 2012, and now third pandemic is caused by novel coronavirus SARS CoV-2, commonly known as COVID-19.

Although COVID-19 vaccine research did not start from scratch in 2019, Dr Fauci believes, these vaccine platforms luckily turned out to work for us within a year following turn of a pandemic around the close of penultimate year. “So speed was not reckless, speed was science,” he said while maintaining, science has designated vaccine platform technology as the breakthrough of the year 2020.

As Pfizer and Moderna received Food and Drug Administration’s (FDA) authorisation, both vaccine platforms exhibit 94 to 95 percent efficacy. The definitive trials, he said, confirmed the vaccine as highly efficacious in preventing clinically recognisable disease, and almost 100 percent effective in preventing advanced disease.

Dr Fauci said the COVID-19 vaccine, though, prevents the clinical disease but does not prevent the infection, adding that it required a lot of sequencing and testing of asymptomatic carriers to know whether he/she will transmit the virus to the other person. “We are months down the pike until we follow the asymptomatic carriers over a year,” he added.

Dr Fauci said besides usual flu like symptoms, COVID-19 manifested unusual symptoms of loss of smell and taste. “While in its severe manifestations, the COVID-19, besides causing serious bodily dysfunctions in adults, causes multisystem inflammatory syndrome in children (MIS-C), which resembles Kawasaki disease,” he added.

Asked as to how to deal with the issue of COVID-19 vaccine skepticism, Dr Fauci said, there’s over 50% refusal and hesitancy even in the US. Therefore, he suggested, the accusatory way should not be adopted to declare anyone stupid not to get vaccinated. Instead, he said one has to explain it through science – the science of vaccine development and approval. “Another way to do is for public figures to get vaccinated publicly as soon-to-be US President Joe Biden, Vice President-elect Kamala Harris and myself did”. He said a highly efficacious vaccine is available now, so there’s no reason not to vaccinate people even in harsh political climates. This is a global problem, everyone has to get vaccinated. “We won’t be free of the threat of COVID-19 until we get 70 to 85 percent to gain herd immunity. We must crush the outbreak like measles, polio, and it is doable,” he stressed.

Dr Fauci informed that many companies were gearing up to make billions of doses. “We are going to have enough vaccines in a year or two for the entire world,” he revealed. Until then, he said the masses need to wear masks, wash hands and adopt public health measures, which clearly inhibit the spread and acquisition. “The Standard Operating Procedures (SOPs) also help avoid imposition of complete lockdowns, which entail economic hardships and intensive COVID-19 fatigue,” he opined.

Dr Fauci, whose talk titled “Ending AIDS: Maintaining Progress through the COVID-19 Pandemic” used simple global figures to illustrate the difference between the two epidemics. Since the start of HIV epidemic in 1981, as many as 76 million people have been infected in 40 years; while only in one year of COVID-19, a staggering 91 million have been infected with coronavirus whereas about two percent of those with COVID-19 have died, the mortality rate among people with HIV, who died predominantly from HIV-related disease, tops 43 percent.

He said after the outbreak of coronavirus, the persons living with HIV among other infections suffered direct as well as indirect consequences of the pandemic outbreak.

Under indirect effects of COVID-19, Dr Fauci predicted the deaths due to HIV, tuberculosis and malaria over five years could increase by up to 10%, 20% and 36% respectively compared with time of before COVID-19 pandemic. The disruptions due to COVID-19 led to decline in ART services by 32% in 101 nations; malaria diagnosis and treatment by 46% in 68 nations; and TB cases detection and treatment by 42% in 101 nations.

While under direct effects of COVID-19, the 51% of persons living with HIV, who are already over 50 years of age, are at great risk as HIV physiologically leads to premature aging, which in turn, is associated with comorbidities. Besides elderly, he said, the people of any age with underlying medical conditions like obesity, smoking and chronic complications, and to some extent those in immunocompromised state, are likely to suffer the consequences.

Accrediting HIV vaccine research to have absolutely enabled development of the COVID-19 vaccines, Dr Fauci said the adherence to scientific discovery and principles provided such tools to anticipate and hopefully someday realise the end of HIV/AIDS epidemic.

“A vaccine generally mimics the body’s natural immune reaction to a virus that usually results in being cleared,” he said. “This is why I predicted that we could develop a COVID-19 vaccine, because in 98% of cases the immune system clears the virus. But in HIV, it doesn’t. As we managed to induce immunological capability to eliminate smallpox, measles, polio, etc, so similarly a vaccine has to elicit an immune response that’s better than nature’s, but that’s hard to do in case of HIV,” he explained.

Dr Fauci said science has made considerable strides around HIV/AIDS since 1981 as median survival rate has risen from 1-2 years from AIDS diagnosis in 1980s to now predict that a newly-infected person in his 20s may live for another 53 years if treated with proper antiretroviral therapy today. Hence, in the light of these scientific developments around HIV/AIDS, he said there’s hope and the search for HIV vaccine will continue with increased effort and commitment.

Asked if the swift development of COVID-19 vaccines held lessons for HIV vaccine development, Dr Fauci said, besides requiring, at least, a moderately effective HIV vaccine to supplement preventive measures, there’s a need to make long-term prevention and treatment capabilities user-friendly and adaptable to the population throughout the world. Then we can turn around the HIV curve like we did in case of so many other diseases. “Soon, we are going to get COVID-19 in the rear view mirror, but we are going to stare HIV in the headlights in front of us,” he concluded his talk.