We can’t keep shooting at moving targets with COVID

I am concerned about the emerging BA.5 omicron SARS-COV-2 subvariant and I am not alone. 

Single-stranded RNA viruses, including this one, are not stable and when there are trillions of copies around the globe there is a high risk of frequent mutations spinning off new variants and subvariants.  

On the one hand, we are fortunate that the last several spinoffs have all been omicron, which affects primarily the upper airways rather than the lungs. On the other hand, with each succeeding subvariant, there is more immune evasion, meaning that the two-year-old vaccine — and especially, natural immunity from prior infection — are less and less effective at preventing reinfection. 

Don’t get me wrong: There is still protection from severe disease, and it continues to make sense to “count” recent infection as being protective and for the public to continue to take vaccine boosters on top of this. But when the Food and Drug Administration and Centers for Disease Control and Prevention recently approved the Pfizer and Moderna vaccine for children as young as 6 months old, one difficult question was exactly how much protection the vaccines offered them against the latest subvariants. Clearly, the answer remains there is some protection, beneficial for most and especially important in kids at high risk of severe outcomes. 

But with the highly transmissible BA-5 omicron subvariant beginning its steady march across Europe, the United Kingdom, and on into the United States, the question raises why can’t existing vaccines be modified rapidly to match it? Wasn’t that what we were promised when they were first approved? The BA-5 subvariant so far seems to be the most elusive and perhaps more severe than other iterations of omicron. So where are our updated tools to fight it?  

The answer is that there are three things in the way of a rapid turnaround that could produce a booster more suited to the current state of the pandemic. The first is too much public resistance to the vaccine and COVID fatigue.  

The second problem is too much regulation. With the old flu vaccine, for example, we rely on experiments done in ferrets to determine coverage for the latest strain. Production then takes about 9 months but using the same animal model the MRNA vaccines and these new boosters could be produced in a matter of weeks. But the FDA first needs to approve this pathway as the road to accelerated emergency use authorization.  

The third problem is a lack of funding. One of the most unique features of the historic Operation Warp Speed was the pre-payment for hundreds of millions of vaccine doses, an unprecedented public-private partnership that bore fruit in less than a year. The Biden administration has offered nothing similar, a huge omission in the face of millions of new cases.

To be clear, the long-term solution is to provide vaccines (currently being studied) to target more of the virus than just the spike protein, vaccines that could be used universally against all coronaviruses, and/or the kind of nasal barrier vaccine being developed by Dr. Akiko Iwasaki at Yale, which could prevent infection altogether. In the meantime, it makes great sense for the government to bolster the development and production of new antivirals and monoclonal antibodies as well as the kind of MRNA boosters to target an emerging variant in real-time, not one which is developed to protect us from a variant which is gone by the time the vaccine comes out.

Yes, the original vaccines continue to keep most of us out of the hospital, but we can and should try to better. Anemic public health policy doesn’t match a virus that is still causing extensive widespread illness and wreaking havoc across the globe. 

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”