Dr. Richard Feldman: Cases are on the rise, and an update vaccine is needed

For most Americans, the pandemic is behind them; they’ve moved on. Done. It’s obvious from the small percentage of people still masking.

Even public health officials, understanding the realities of pandemic fatigue, now attempt to balance the best public health recommendations with the public’s willingness to comply with mitigation measures. Politically, the days of mitigation mandates are gone.

But the pandemic isn’t over, even though we act like it is. It’s estimated that, nationally, there are a million new cases of COVID-19 daily and nearly 3,000 deaths weekly. Although nowhere near the past pandemic peaks, COVID cases, hospitalizations and deaths are increasing again, and we anticipate a new surge in the fall. The worst of the pandemic, nevertheless, is probably over because of the collective immunity gained from past COVID infections and vaccinations.

However, the immunization rate is disappointing, with 30% of eligible Americans forgoing vaccination and about half not receiving recommended booster doses. They’ve made their decision.

Because of relaxed attitudes, vaccine skepticism and suboptimal vaccination rates, COVID viruses have been free to spread continually, allowing them to mutate into a long progression of challenging variants. The newer variants, especially omicron, have been much more transmissible and evasive of vaccine protection. For now, the days of feeling safe after vaccination are over. Initially, vaccination conferred extremely high protection against infection, hospitalization and death. Unfortunately, the protection gained proved to be relatively short-lived, especially for infection; the protection against severe disease has been more durable.

But now, it’s all about the currently dominant omicron subvariants BA.4 and BA.5. Especially BA.5, the most worrisome variant to date, is extraordinarily transmittable and largely escapes vaccine protection. Immunity from the initial two-dose series and boosters provides little protection against infection from these new subvariants and wanes quickly.

Boosters do renew protection against severe disease—but only for a few months. Breakthrough infections are commonplace among the vaccinated and even boosted; those who were infected with earlier strains are experiencing reinfection.

There is some belief that we don’t need a retooled vaccine that will include the newest omicron variants because the original vaccine (with boosting) still protects well against hospitalization and death. I disagree. Even mild or moderate severity COVID illness can be life-changing. Rare but serious complications can occur, and up to 30% of people can develop long-COVID syndrome.

Time for an updated vaccine. Vaccine manufacturers have initiated developing the new generation of booster vaccines against omicron variants for the fall. The FDA has determined that the new boosters must include protection for BA.4/5. Most promising are “bivalent” vaccines, which will combine the original vaccine for a core of broad protection along with protection against the new variants. But ultimately what is needed is a “universal” or “pan-coronavirus” vaccine that will protect against the entire family of coronaviruses and future emerging variants certain to arise. Research has begun, but this is an extremely complex and difficult task. For example, a universal influenza vaccine has eluded successful development for decades.

For now, the bivalent vaccine should provide better protection for current variants, and by extension, newly evolving related variants. Will the next booster be the commencement of annual retooled COVID vaccines much like the yearly flu vaccine? That would signal the transition from pandemic to endemic disease. Let’s hope so.•

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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

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