What’s the deal with these new subvariants?
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Here we are, halfway through 2022, and already well past our capacity for bad news. COVID-19 has been with us for over two and a half years, and in that time it has claimed more than 1 million lives in the US alone. Still, every day, we learn more about how we can combat the virus through science and protect each other with cooperation and compassion.
This week, we address the burning questions you may have regarding when to get your next booster shot and how to interpret the Food and Drug Administration’s recent decision to authorize COVID-19 vaccines for children as young as 6 months.
Fast Vaxx Facts
The omicron variant has been with us since November 2021. Its spike protein has more than 30 mutations, which contribute to its notably high transmissibility and immune evasion. This means that infection with omicron is both easier to catch and harder for our bodies’ immune mechanisms to recognize and combat. What’s more, the omicron variant is continuously giving rise to increasingly more transmittable subvariants, the most recent being BA.4 and BA.5.
Thankfully, so far, the severity (by hospitalizations and fatality) of omicron BA.4 and BA.5 infections in the US appears lower than that of previous variants and subvariants. The less reassuring fact, however, is that any immunity gained from prior infections or COVID-19 vaccines does not prevent infection with new omicron variants, just its severest aftereffects. This rise in breakthrough cases — coupled with the new subvariants’ being an estimated 36 percent more transmissible than BA.2 — spells a high likelihood for the coming months to bring more waves of infection. How well different nations will weather these waves depends on variations in their rates of vaccination and population demographics such as age or immunosuppression.
But wait, it’s not all doom and gloom! Due to its distinctions from previous variants, omicron is inspiring serious modifications to the vaccine recipe, which has heretofore remained unchanged across boosters. The next COVID-19 booster, expected to be ready in time for fall 2022, may be a bivalent vaccine. That means it will contain parts of both the original vaccine and the new omicron BA.4/5 spike protein. Clinical trials are ongoing for omicron-containing vaccines, and preliminary data indicates that they may perform as well as or better than the original vaccine alone and protect against more variants. So the question remains: Get the old booster ASAP or wait for the new recipe?
Beyond just our next booster shot, more than 300 vaccines are moving through the preclinical and clinical pipelines. Spanning the gamut of vaccine types, the list includes everything from the currently widespread mRNA (e.g., Pfizer and Moderna) and viral vector (e.g., Johnson & Johnson) vaccines to the much-anticipated protein subunit vaccine (e.g., Novavax), and many others. As these clinical trials come to fruition and the FDA sanctions more vaccines, we may yet encounter even safer and more effective immunization options.
Small Steps and Morale Boosters
The vaccination of children is another crucial but contentious topic, as the FDA has just authorized both Moderna’s and Pfizer’s vaccines for administration to children aged 6 months to 5 years old. It was only a year ago, in May 2021, that the FDA permitted adolescents aged 12 to 15 to receive Pfizer’s COVID-19 vaccine, and five months later that approval was extended to include five to 11 year olds.
Finally, all children 6 months to 17 years old may be vaccinated. Yet, data shows that, since the COVID-19 pandemic began, children have been getting vaccinated less, worldwide. By April 2022, only about a quarter of children aged 5 to 11 in the US and in Israel opted to receive COVID-19 vaccination after FDA authorization. Understandably, even parents willing to vaccinate themselves are wary of submitting their children to vaccines that are, despite widespread application and demonstrated safety in other age groups, still experimental.
Vaccine refusal is at an all-time high. Propelled by a mix of different factors — hesitancy in the health care system itself, safety concerns, and social media misinformation among them — many parents and pregnant women do not trust their providers enough to let their children receive vaccines yet. However, this status quo may be reversed with more, and more accurate, immunization education (check out need-to-knows such as this one).
For one, despite the FDA’s liberal use of Emergency Use Authorizations to make vaccines available throughout the COVID-19 pandemic, the processes for a vaccine to gain accelerated approval versus full approval are similar, and safety is the number one priority in both cases. In fact, both the Pfizer and Moderna mRNA vaccines have obtained full FDA approval despite originally receiving Emergency Use Authorization.
Furthermore, researchers have carefully reviewed the medical problems, or adverse events, that arose following vaccination in children. In both 5–11 year olds and 12–15 year olds, adverse events reported after the primary vaccination were mostly nonserious (≥92 percent), like dizziness or an error with vaccine preparation. Similarly, about 95 percent of most adverse events reported after booster shots were nonserious.
Of the more serious adverse reactions, physicians specifically followed events of myocarditis, inflammation of the heart muscle, to determine whether they were related to COVID-19 vaccination and how patients recovered afterward. So far, it appears that myocarditis is more likely to occur in male children, and more likely to occur after the second dose. It has also been reported more frequently for male adolescents in the 12–17 age group than the 5–11 group.
Promisingly, the vast majority of children who had verified cases of myocarditis after COVID-19 vaccination recovered soon after their symptoms were reported. It is also important to keep in mind that infection with COVID-19 delivers a much higher risk for developing myocarditis than getting vaccinated (which serves to prevent infection).
In addition to the relatively low chance children will experience vaccine-related adverse events, choosing to vaccinate also reduces their likelihood for getting sick with a COVID-19 infection and for transmitting the virus into their family and community.
The Next Wave: Ebb and Flow
As we continue to monitor and respond to COVID-19 infections and mutations, time and research are painting a better picture of what post-COVID life may hold in store for us. From Long COVID to neurological complications — which may manifest as chronic loss of smell or, in severe cases, acute encephalopathy — we are continuously learning that tangoing with COVID-19 isn’t a one-and-done affair.
A vital takeaway, at this two-and-a-half-year mark in the pandemic, is that with every passing moment, we know more than we ever have about how COVID-19 works, and how we can better protect ourselves and each other. If you are ever feeling discouraged by the bleak onslaught of stressful news and data clouding the media, we recommend taking a moment to explore these chronicles of COVID-related good news, or browse more positive news in general. If all else fails, dial it back to the basics and just take two minutes to untense your muscles, look outside, and breathe.