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'When will it end?': How a changing virus is reshaping scientists’ views on COVID-19

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Chris Murray, a University of Washington disease expert whose projections on COVID-19 infections and deaths are closely followed worldwide, is changing his assumptions about the course of the pandemic, write Julie Steenhuysen and Kate Kelland.

Murray had until recently been hopeful that the discovery of several effective vaccines could help countries achieve herd immunity, or nearly eliminate transmission through a combination of inoculation and previous infection. But in the last month, data from a vaccine trial in South Africa showed not only that a rapidly-spreading coronavirus variant could dampen the effect of the vaccine, it could also evade natural immunity in people who had been previously infected.

“I couldn’t sleep” after seeing the data, Murray, director of the Seattle-based Institute for Health Metrics and Evaluation, told Reuters. “When will it end?” he asked himself, referring to the pandemic. He is currently updating his model to account for variants’ ability to escape natural immunity and expects to provide new projections as early as this week.

A new consensus is emerging among scientists, according to Reuters interviews with 18 specialists who closely track the pandemic or are working to curb its impact. Many described how the breakthrough late last year of two vaccines with around 95% efficacy against COVID-19 had initially sparked hope that the virus could be largely contained, similar to the way measles has been.

But, they say, data in recent weeks on new variants from South Africa and Brazil has undercut that optimism. They now believe that SARS-CoV-2 will not only remain with us as an endemic virus, continuing to circulate in communities, but will likely cause a significant burden of illness and death for years to come.

As a result, the scientists said, people could expect to continue to take measures such as routine mask-wearing and avoiding crowded places during COVID-19 surges, especially for people at high risk.

Even after vaccination, “I still would want to wear a mask if there was a variant out there,” Dr. Anthony Fauci, chief medical advisor to U.S. President Joe Biden, said in an interview. “All you need is one little flick of a variant (sparking) another surge, and there goes your prediction” about when life gets back to normal.

Some scientists, including Murray, acknowledge that the outlook could improve. The new vaccines, which have been developed at record speed, still appear to prevent hospitalizations and death even when new variants are the cause of infection. Many vaccine developers are working on booster shots and new inoculations that could preserve a high level of efficacy against the variants. And, scientists say there is still much to be learned about the immune system’s ability to combat the virus.

Already, COVID-19 infection rates have declined in many countries since the start of 2021, with some dramatic reductions in severe illness and hospitalizations among the first groups of people to be vaccinated.

Murray said if the South African variant, or similar mutants, continue to spread rapidly, the number of COVID-19 cases resulting in hospitalization or death this coming winter could be four times higher than the flu. The rough estimate assumes a 65% effective vaccine given to half of a country’s population. In a worst-case scenario, that could represent as many as 200,000 U.S. deaths related to COVID-19 over the winter period, based on federal government estimates of annual flu fatalities.Slideshow ( 3 images )

His institute’s current forecast, which runs to 1 June, assumes there will be an additional 62,000 US deaths and 690,000 global deaths from COVID-19 by that point. The model includes assumptions about vaccination rates as well as the transmissibility of the South African and Brazilian variants.

The shift in thinking among scientists has influenced more cautious government statements about when the pandemic will end. Britain last week said it expects a slow emergence from one of the world’s strictest lockdowns, despite having one of the fastest vaccination drives.

US government predictions of a return to a more normal lifestyle have been repeatedly pushed back, most recently from late summer to Christmas, and then to March 2022. Israel issues “Green Pass” immunity documents to people who have recovered from COVID-19 or been vaccinated, allowing them back into hotels or theaters. The documents are only valid for six months because it’s not clear how long immunity will last.

“What does it mean to be past the emergency phase of this pandemic?,” said Stefan Baral, an epidemiologist at the Johns Hopkins School of Public Health. While some experts have asked whether countries could completely eradicate any case of COVID-19 through vaccines and stringent lockdowns, Baral sees the goals as more modest, but still meaningful. “In my mind, it’s that hospitals aren’t full, the ICUs aren’t full, and people aren’t tragically passing,” he said.

From the beginning, the new coronavirus has been a moving target.

Early in the pandemic, leading scientists warned that the virus could become endemic and “may never go away,” including Dr. Michael Ryan, head of the World Health Organization’s emergencies programme.

Yet they had much to learn, including whether it would be possible to develop a vaccine against the virus and how quickly it would mutate. Would it be more like measles, which can be kept almost entirely at bay in communities with high rates of inoculation, or flu, which infects millions globally each year?

For much of 2020, many scientists were surprised and reassured that the coronavirus had not changed significantly enough to become more transmissible, or deadly.

A major breakthrough came in November. Pfizer Inc and its German partner BioNTech SE as well as Moderna Inc said their vaccines were around 95% effective at preventing COVID-19 in clinical trials, an efficacy rate that is much higher than any flu shot.Slideshow ( 3 images )

At least a few of the scientists Reuters interviewed said even in the wake of those results, they hadn’t expected the vaccines to wipe out the virus. But many told Reuters that the data raised hope within the scientific community that it would be possible to virtually eliminate COVID-19, if only the world could be vaccinated quickly enough.

“We all felt quite optimistic before Christmas with those first vaccines,” said Azra Ghani, chair in infectious disease epidemiology at Imperial College London. “We didn’t necessarily expect such high-efficacy vaccines to be possible in that first generation.”

The optimism proved short-lived. In late December, the UK warned of a new, more transmissible variant that was quickly becoming the dominant form of the coronavirus in the country. Around the same time, researchers learned of the impact of the faster-spreading variants in South Africa and in Brazil.

Phil Dormitzer, a top vaccine scientist at Pfizer, told Reuters in November that the U.S. drugmaker’s vaccine success signaled the virus was “vulnerable to immunization” in what he called “a breakthrough for humanity.” By early January, he acknowledged the variants heralded “a new chapter” in which companies will have to constantly monitor for mutations that could dampen the effect of vaccines.

In late January, the impact on vaccines became even clearer. Novavax’s clinical trial data showed its vaccine was 89% effective in a UK trial, but just 50% effective at preventing COVID-19 in South Africa. That was followed a week later by data showing the AstraZeneca PLC vaccine offered only limited protection from mild disease against the South African variant.

The most recent change of heart was considerable, several of the scientists told Reuters. Shane Crotty, a virologist at the La Jolla Institute for Immunology in San Diego, described it as “scientific whiplash”: In December, he had believed it was plausible to achieve so-called “functional eradication” of the coronavirus, similar to measles.

Now, “getting as many people vaccinated as possible is still the same answer and the same path forward as it was on December 1 or January 1,” Crotty said, “but the expected outcome isn’t the same.”

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Germany wants to use Regeneron's COVID-19 antibody therapy more broadly

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Germany would like to use Regeneron’s COVID-19 monoclonal antibody cocktail as a treatment for this disease more broadly but needs to finalize some details on reimbursement, Health Minister Jens Spahn said on Thursday (15 April), writes Caroline Copley.

“The drug is available in Germany, we need it much more and we want it much more and we are working on rolling it out across the nation,” he told a weekly news conference.

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President von der Leyen on developments in the Vaccines Strategy

EU Reporter Correspondent

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In a press statement on 14 April, President of the European Commission, Ursula von der Leyen, announced an agreement with BioNTech-Pfizer to accelerate the delivery of 50 million vaccine doses to the second quarter of this year, starting this month: “We are in a race against time. The faster we reach our target of having 70% of adults in the European Union vaccinated, the better chances we have of containing the virus. And the good news is: Vaccination is picking up speed across Europe! Member states have received over 126 million doses of vaccines as of yesterday (13 April). And I am happy to say that today we have reached 100 million vaccinations in the EU. This is a milestone that we can be proud of. Of these 100 million vaccinations, more than a quarter are second doses – which means that we have now more than 27 million people fully vaccinated I am pleased to announce that we have reached an agreement with BioNTech-Pfizer to, once again, speed up the delivery of vaccines. 50 million additional doses of BioNTech-Pfizer vaccines will be delivered in quarter 2 of this year, starting in April. This will bring the total doses delivered by BioNTech-Pfizer to 250 million doses in the second quarter. These doses will be distributed pro-rata to the population, among all the member states. This will substantially help consolidate the roll-out of our vaccination campaigns.” As part of preparations for the medium term, the Commission is also entering into a negotiation with BioNTech-Pfizer for a third contract, to foresee the delivery of 1.8 billion doses of vaccine over the period of 2021 to 2023. This contract will entail that not only the production of the vaccines, but also all essential components, will be based in the EU. The President's full statement is available online in English, and French and shortly in German. You can watch it here.

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Coronavirus response: Commission proposes to exempt vital goods and services distributed by the EU from VAT in times of crisis

EU Reporter Correspondent

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The European Commission has proposed to exempt from Value Added Tax (VAT) goods and services made available by the European Commission, EU bodies and agencies to Member States and citizens during times of crisis. This responds to the experience gained  during the course of the Coronavirus pandemic. Among other things, it has shown that the VAT charged on some transactions ends up being a cost factor in procurement operations that strains limited budgets. Therefore, today'sinitiative will maximise the efficiency of EU funds used in the public interest to respond to crises, such as natural disasters and public health emergencies. It will also strengthen EU-level disaster and crisis management bodies, such as those falling under the EU's Health Union and the EU Civil Protection Mechanism.

Once in place, the new measures will allow the Commission and other EU agencies and bodies to import and purchase goods and services VAT-free when those purchases are being distributed during an emergency response in the EU. The recipients might be Member States or third parties, such as national authorities or institutions (for example, a hospital, a national health or disaster response authority). Goods and services covered under the proposed exemption include, for instance:

  • Diagnostic tests and testing materials, and laboratory equipment;
  • personal protective equipment (PPE) like gloves, respirators, masks, gowns, disinfection products and equipment;
  • tents, camp beds, clothing and food;
  • search and rescue equipment, sandbags, life jackets and inflatable boats;
  • antimicrobials and antibiotics, chemical threat antidotes, treatments for radiation injury, antitoxins, iodine tablets;
  • blood products or antibodies;
  • radiation measuring devices, and;
  • development, production and procurement of necessary products, research and innovation activities, strategic stockpiling of products; pharmaceutical licences, quarantine facilities, clinical trials, disinfection of premises, etc.

Economy Commissioner Paolo Gentiloni said: “The COVID-19 pandemic has taught us that these kinds of crises are multifaceted  and have a wide-ranging impact on our societies. A rapid and efficient response is essential, and we need to provide the best response now in order to prepare for the future. Today's proposal supports the EU's goal to react to crises and emergencies in the EU. It will also ensure that the financial impact of EU-level relief efforts to fight the pandemic and support the recovery is maximized.”

Next steps

The legislative proposal, which will amend the VAT directive, will now be submitted to the European Parliament for its opinion, and to the Council for adoption.

Member States shall adopt and publish, by 30 April 2021 the laws regulations and administrative provisions necessary to comply with this Directive. They shall apply those measures from 1 January 2021.

Background

The Coronavirus pandemic has thrown into sharp light the importance of coherent, decisive and centralised EU-level preparation and response in times of crisis. In the context of the Coronavirus pandemic, the von der Leyen Commission has already outlined plans to strengthen EU preparedness and management for cross-border health threats, and presented the building blocks of a stronger European Health Union. At the same time, the Commission has proposed to strengthen cooperation between EU Member States through the EU Civil Protection Mechanism with the aim of improving responses to future natural or man-made disasters. For instance, in the context of the new European Health Union, the Commission announced the creation of the Health Emergency Response Authority (HERA) to deploy rapidly the most advanced medical and other measures in the event of a health emergency, by covering the whole value chain from conception to distribution and use.

The EU has already taken action in the field of taxation and customs to support the fight against and the recovery from the coronavirus pandemic. In April 2020, the EU agreed to waive customs and VAT charges for imports of masks and other protective equipment needed to fight the pandemic. This waiver remains in place and plans are underway for its extension. In December 2020, EU member states agreed on new measures proposed by the Commission to allow a temporary VAT exemption for vaccines and testing kits being sold to hospitals, doctors and individuals, as well as closely related services. Under the amended Directive, member states can apply either reduced or zero rates to both vaccines and testing kits if they so choose. 

More information

Commission proposes to exempt vital goods and services distributed by the EU in times of crisis

Council directive amending Council Directive 2006/112/EC as regards exemptions on importations and on certain supplies, in respect of Union measures in the public interest

COVID-19 response in the field of taxation and customs

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