The future of Covid-19 vaccinations

Ivor Campbell  managing director of Snedden Campbell discusses the future of Covid-19 vaccination and why testing is crucial amidst falling antibody levels. 

Amid all the ongoing media chatter about vaccine passports and booster jabs, a little read article in Nature recently carried the most important news about the future of the Covid trajectory.

While societies across the world continue steadily on a path towards pre-pandemic normality, and lockdown now seems like a distant memory, the science magazine reported that immunity to the virus is declining.

Despite the self-congratulatory tone of politicians about the success of the vaccine rollout, people immunised against Covid are losing half of their defensive antibodies every 108 days or so.

As a result, those who received their first jab six months ago – offering, at best, 90% protection against mild infection – now have only around 70% immunity.

As it was also reported that uptake of booster shots among the UK population is proving sluggish, should we be concerned about a resurgence of cases and even the spectre of further lockdowns in the future?

As far as anyone can tell, we’ll be living with Covid for some time to come, with all signs pointing to it becoming endemic, similar to the cold, flu, or measles.

So, if the virus is going to be around forever what will it look like, what impact will it have on our lives and what, if anything, is being done to prepare for that future?

The good news is that, to date, existing vaccines have proved effective in dealing with variants of the SARS-CoV-2 strain first detected in Wuhan, China in December 2019.

But that may not always be the case and the three main players in the field – Pfizer, Moderna and AstraZeneca – have spent the past few months wargaming for future strains that may be resistant to current vaccines.

By practising on known variants such as Beta and Delta, and learning from dress-rehearsal trials, scientists have been able to fine-tune their processes, so that they can hit the ground running if and when a genuine ‘escape variant’ emerges.

Pfizer’s chief executive, Albert Bourla, boldly predicted that should the need arise, his company could produce a new, clinically tested vaccine within 100 days.

If experience of the pandemic has taught us anything, it’s that testing is as important as the rollout of vaccines and the quicker our future ability to test large groups of people, the better it will be for the normal functioning of the economy, education, and travel.

Central to the normal functioning of society will be to continue allowing groups to meet in numbers, in offices and classrooms up to larger gatherings at music concerts and sports events.

The Technology Partnership, another Cambridge-based diagnostics company, has developed a pioneering method of significantly speeding-up the screening of large groups of people, using a simple saliva test.

It believes the technology will be particularly useful in helping to keep schools and offices safe and  open by identifying asymptomatic, Covid positive pupils early.

Consultant Giles Sanders said: “We know from our own experience that we can collect the majority of viral RNA from large volume samples – up to 50ml. We can work with up to 50 samples of saliva typically 0.5-1ml per person, using commercial chewing swabs, which are dropped into a cartridge.

“In schools there would be a point every day when the teacher comes round with a cartridge and the pupils drop in a chew swab. The samples can be processed as a whole and, if there is any viral RNA present, it can be collected and amplified within 30 minutes.

“If something is detected in a classroom cohort, you can then proceed to do individual testing or a smaller cohort to identify which pupil or pupils are Covid positive.” 

Yet in many areas of our future lives, particularly travel, what will be as important as our testing negative, will be our level of immunity, according to Brendan Farrell, CEO of Guilford-based Luas Diagnostics.

The World Health Organisation has produced a safe standard of immunity which could soon be adopted by countries as a requirement of entry, according to Farrell.

His company is the distributor of a US-manufactured test to determine a person’s level of Covid antibodies, post infection or vaccination.

He said: “That’s going to become increasingly important with vaccination roll out. Those people who have had their vaccination completed are merrily going around feeling warm and fuzzy, but the reality is that up to 15% of people vaccinated will not be protected because they didn’t produce antibodies.

“And to take that further, people who have produced antibodies, those antibodies can decline quite quickly.”

More concerning is his contention, supported by data from the REACT-2 Study of Antibody Prevalence in England, published by the University of Cambridge, that the AstraZeneca vaccine, used most widely in the UK, is less effective at producing antibodies, than either the Moderna or the Pfizer vaccines.

Farrell said: “Regretfully for the United Kingdom, the AstraZeneca is certainly less effective than the other vaccines. There’s no doubt about that.

“It’s definitely not as effective at all, so Boris and his fellow politicians were flying a very strong flag that they had done a great job in rolling out the vaccine programme, which they did, but their dependence on AstraZeneca is problematic because it definitely does not produce antibodies in the way the Moderna and Pfizer vaccines do.”

He added: “The future for those people and, I don’t know if this will cause political controversy, is to get a booster shot, but not with AstraZeneca.

“It’s a British product and so there was a bit of flag flying nationalism, and that’s understandable, but the public discussion about the efficacy of vaccinations is only just beginning.

“The whole focus until now, and continues to be, let’s get everybody vaccinated. The next stage is going to be, ‘whoops, we’ve got everybody vaccinated but, do they have antibodies and are they protected?.”