New variants of COVID-19 are emerging across the globe and accelerating the transmission of the virus. Meanwhile, governments have come under intense scrutiny for their handling of vaccine rollouts.

In many states, vaccines have been purchased but not distributed. In others, governments have elected to roll out a first dose of the vaccine to a larger populous, at the cost of delaying the recommended second dose.

In early January, GLG’s VP & Content Team Lead for Healthcare, Michael Weissman, spoke with Lawrence Gostin, Michael Osterholm, PhD, MPH, and Stephen Ostroff, MD, to discuss these challenges and the outlook for COVID-19 safety measures in 2021. Though much has changed since the conversation, we’ve chosen a few select excerpts to limn the broader discussion.

 Are the new variants in the UK and South Africa more or less worrisome than previous situations?

 Dr. Stephen Ostroff: Anybody that looks at the UK data should be concerned by what they see. While the variant was circulating at low levels and picking up steam, it got exported into several parts of the world, similar to what happened originally with the circumstances in Wuhan. And so now there are more than 30 different places around the world that have seen or identified this variant.

How important is sequencing to figure out truly how widespread the new variant is in the U.S.?

Dr. Michael Osterholm: Sequencing really doesn’t make any difference if we’re talking about trying to prevent transmission. Variants are transmitted in the same ways as the nonvariant strains of this virus. But sequencing is critical if we’re trying to follow what the challenges are with vaccines or immunotherapy.

Would you favor vaccinating as many people as you can with the first dose, or saving some to be able to have the full regimen, as was in the trials?

Dr. Stephen Ostroff: There are something like 17 million doses floating around the United States and we’ve vaccinated only 4 or 5 million people. So we need to step up the rate of vaccination. But, I am really cautious about promising a vaccine that hasn’t yet rolled off the assembly line. You never know what sort of quality control problems could enter into the equation, especially relatively early on.

Would a new trial that could be 70-plus percent effective warrant potentially trying to use now?

Dr. Stephen Ostroff: There is a role for all these vaccines, I think. We shouldn’t be in a circumstance where we have to rely on two vaccines to solve this problem. And, ultimately, the job is to get as many of these vaccines to as many places around the world as we possibly can, because unless we have the same type of effort that we see in the United States elsewhere in the world, we’re not going to be very successful.

What can we expect vaccine rollouts to look like in low- and middle-income countries?

Lawrence Gostin: There are two key challenges here. One, low- and middle-income countries need a vaccine that’s affordable, hopefully single dose, and hopefully doesn’t need extraordinary freezing capabilities. Two, vaccine nationalism in high-income countries is going to leave a supply scarcity, unless we can really ramp up production with AstraZeneca, Johnson & Johnson, and other kinds of diverse vaccination technologies.

We have a global system that’s been set up jointly by the World Health Organization; Gavi, The Vaccine Alliance; and CEPI, which is called the Covax Facility. Covax Facility’s aim is to get every low-income country 20% of its vaccine population needs by the end of 2021. But Covax is badly underfunded. It’s possible that low-income countries won’t be vaccinated at sufficient levels for two to four years.

Who can mandate vaccines? Can employers mandate for the safety of their employees?

Lawrence Gostin: The Equal Employment Opportunity Commission recently came out with guidance saying if employers gave religious- and disability-based accommodations, they would be within their power to mandate a vaccine as a condition of return to work. The federal government has very limited power to mandate vaccines, except perhaps in the military. It’s conceivable that CDC might have the power in relation to interstate or international travel, but it’s very limited. States undoubtedly have the constitutional power to mandate, but historically, our mandates have been all at the childhood vaccination level.

From an ethics point of view, though, when we’re struggling with vaccine hesitancy, it would be extraordinarily unwise for anybody to mandate a vaccine.

At what point in time do we start to see this progression back toward what a lot of people are calling “a normal life”?

Lawrence Gostin: I expect that we’re going to continue to see COVID disease in clusters, maybe even endemic, in many parts of the world for many, many years to come. We’ll certainly never eradicate it. Although in some places perhaps, like measles, we could eliminate it, if we were extraordinarily vigilant.

In the United States, it just depends upon what you mean by “getting back to normal.” I do think things will start to look a lot better than they are now by the autumn, but it won’t be normal. I see us masking, distancing well into the autumn. We should have enough of the population vaccinated, though, that it won’t look quite as alarming and dire as it does now.

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This healthcare industry article is adapted from the January 5, 2021, GLG webcast “U.S. and Global Response to COVID-19.” If you would like access to this teleconference or would like to speak with any of our healthcare industry experts, contact us.