Impact of SARS-CoV-2 Subvariants on Vaccination


Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP, leads a discussion on the challenges subvariants of SARS-CoV-2 present in terms of vaccination and approaching optimal communication to the public surrounding vaccination.

Rodney Rohde, PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc: I’m a credentialed specialist in virology and microbiology as well as public health. My background is in testing, including some of the molecular testing that Wendy and Dr JAM were talking about. It’s interesting to hear you talk about it because when I speak to the public, which is what we’re doing now, I can’t overemphasize how critically important it is for good science communication and good health literacy.

To be clear, the CDC and the WHO [World Health Organizations] have these designations of variant of interest. Those are the ones on our radar. We’re watching those. Variant of concern is happening right now: something we’re going to keep our eyes on a little closer. The one we haven’t seen and we don’t want to see is the variant of high consequence. That means we’ve entered the world of vaccines not working, therapies not working, and things spreading out of control. You might have thought about that early on in the pandemic. We never got there, but we probably were close before we had the vaccines roll out.

Thank you for defining those in your patient populations, in your research, and elsewhere. It’s critical that the public continues to understand that as we move forward. Any of you can jump in here: do you think there’s a particular impact of these different variants when you start thinking about the challenges they present to vaccination? Certainly, the public thinks that. Do you have a way to explain that to your populations?

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: For me, it has posed a huge challenge. First and foremost, providers are fatigued. We’re vaccined out. I just saw someone who’s on her fifth vaccine, and she said, “When is this going to end?” I wish I had a magic wand, but those variants have made it tough for us to keep pushing people to continue to booster. We made a mistake when this virus came out and we started giving the vaccines. We needed to have a 3-dose primary series and not call these booster shots. Many experts will say that we probably needed to give 1, give another a month later, and give a third 6 months later, as we do with many other vaccines. Because when people hear the term booster doses, that makes it tough.

For the last 2 years, we’ve been chasing these variants. We’ve got to find a way to get ahead of these variants, which is what we’re trying to do with the more targeted bivalent vaccine that became available in September. It has made it very challenging for all of us clinically but also for patients. They don’t necessarily know what to do. A woman said to me, “I’m going to be very frank with you. I’m taking this vaccine only if you tell me I need it. I’m done with the government. I don’t trust them.” We’re hearing this resounding that people don’t trust science. She said to me, “If you want me to have it, I promise you I’m going to have it.” That’s a nice segue to what we’ll discuss later. But it’s also really hard on people. They don’t always feel well when they get these vaccines.

Madeline King, PharmD, BCIDP: That’s a great point, Wendy. In speaking about that, you made me think about our messaging when we talk about the flu vaccine as well. I’m afraid that people are going to hear about this booster shot with new variants and think, “I have to get a flu shot every year. I’m going to have to get a COVID-19 vaccine every year.” A lot of people don’t get their flu shot anymore because they think it isn’t effective. People still get the flu. A lot of that messaging is going to be crossed. I fear that people are going to get the same impressions with these COVID-19 vaccines going forward.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: You’re right. But the best thing that’s happened from COVID-19 is we’re changing the way we’re communicating about vaccines. We aren’t saying that it’s going to protect you from the disease. We’re saying that the efficacy of these vaccines is around hospitalizations and moderate to severe disease. That’s how we need to change our flu messaging as well. Maybe COVID-19 has set the stage for that.

Rodney Rohde, PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc: Dr JAM, do you have any comments on this?

Jacinda Abdul-Mutakabbir, PharmD: I do have comments on this, and it may interface into what we’ll talk about moving forward. Madeline and Wendy were spot on. It’s communication strategy. Rodney, you said it in a previous topic. At the end of the day, we have to be intentional about how we communicate with the public on what these vaccinations are for, what these variants are, and why increased vaccinations are necessary. We have to position scientists as the experts. We can’t have anyone other than trusted scientists. We have Dr Walensky and Dr Fauci, who have been at the macro level. It’s so important for our communication strategies and increasing vaccine uptake.

Part of the question that you asked was so important: how does vaccination efficacy differ for these boosters or the bivalent or the subvariants? What do we notice with the vaccine efficacy as we saw these variants come to be? That’s what’s most interesting, and that’s what I continue to explain to patients when they ask, “Do I have to get these additional boosters?” I say that we originally had a ton of protection. We saw ridiculous efficacy rates when we looked at the Moderna and Pfizer mRNA vaccines that we could have never imagined to see in this lifetime. But when the Alpha variant came along, we didn’t see as much efficacy. Then we saw the Beta and Delta variants, which we remember being such a barrier to care.

As these subvariants occur, we need to have more protection and we need to make sure that we do what we can to build those antibodies back up. It’s the conversation and the messaging. It’s how we package why these boosters are necessary. It’s bold to say, “I know that we originally said you needed 2 doses, or 1 if you want to do Johnson & Johnson, but guess what? Now we want you to get 2 additional boosters on top of that. And now we have the bivalent booster.” It’s important that we educate alongside these rollouts.

Rodney Rohde, PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc: Those are all great points. The common theme [in this conversation] will be science communication. It’s something I’ve been focused on for the last 2½ to 3 years, and really for my whole career in talking about infectious diseases. There’s 1 comment that I’ll add. As someone who works in this realm of virology, 1 thing I talk about with the public, meeting where they are with respect to knowing what a virus really is, is that it’s a diabolical creature that’s always ahead of us, to Wendy’s point. I don’t know if we’ll get ahead of it, but we’re definitely light years ahead of where we were a decade ago.

The mRNA technology allows us to adjust and pivot. There’s still some vagueness and misunderstanding around mRNA technology. It has been around for over 20 years. It’s a fantastic technology that’s going to allow us to probably stay ahead of that. In a new Lancet publication, over 1.5 million patient data points in that study show that those vaccines absolutely have kept hospitalizations, severe COVID-19, and deaths down if you were vaccinated. We know all about some of the issues around vaccination and some of the hurdles people have to get them, but it shows that it’s critical to have them moving forward.

Transcript edited for clarity

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