Mitigating Covid-19 in the face of emerging virus variants, breakthrough infections and vaccine hesitancy

Abstract

The emergence and rapid global spread of the new Delta and, more recently, Omicron variants of SARS-CoV-2 pose a daunting public health emergency. Being an RNA virus, the Covid-19 virus is continuing to mutate, resulting in the emergence of new variants with high transmissibility, such as the recently discovered Omicron variant. In this paper, we consider the conditions that may facilitate viral mutations and the emergence of variants with the ability to evade immunity. Here, we have discussed the importance of vaccination with the currently available vaccines. These vaccines are highly effective at preventing serious disease, hospitalization, and death from Covid-19. However, the antibody response induced by these vaccines is short-lasting and there are reports of breakthrough infections. A stable and persistent interaction between T follicular helper cells and germinal center B cells is needed for robust B cell memory response. We discussed the potential reasons behind the breakthrough infections and underscored the importance of developing better second-generation vaccines that may not necessitate frequent booster immunizations and are preventive in nature. This may involve the development of multivalent vaccines and creating vaccines against other viral proteins including conserved proteins. Vaccine hesitancy remains a notable hurdle for implementing vaccination. Furthermore, we recommend different approaches to increase vaccine acceptance, which is a critical translational component of a successful vaccine strategy. These perspectives on overcoming the pandemic's current challenges provide strategies to contain SARS-CoV-2 globally.

Keywords: Breakthrough infections; Global vaccination; Mutation; RNA virus; Second-generation vaccines; Transparency; Vaccine hesitancy; Variants.

Fig. 1

Mitigating Covid-19 Now and Beyond. 1. Structure of Covid-19 coronavirus; 2. Vaccine induced immune response: inducing virus-neutralizing antibody response, which is short-lasting and efficient interactions between the germinal center (GC) B cells and GC T follicular helper (Tfh) cells are crucial to induce a potent memory response. Breakthrough infections may still occur in a few individuals after vaccination so testing should be continued to reduce transmission 3. Implementing large-scale vaccination campaigns to combat vaccine hesitancy: the necessity of transparent dialogue with the involvement of trusted community leaders conveying clear evidenced-based messages are critical strategies to combat vaccine hesitancy. Global vaccine coverage is important to contain the Covid pandemic 4. Continuing existing interventions: the currently available tools of vaccination, mask-wearing, and social distancing are proven to be effective and should be continued to reduce transmission and the rate of mutation 5. Continue research to develop better vaccines (second generation): new universal vaccines targeting conserved immunogenic or other viral proteins can protect against current and future variants, additionally, creating preventative, multivalent, or protein-based vaccines may confer better protection.