Vaccine nationalism and the dynamics and control of SARS-CoV-2

Wagner, Caroline E.; Saad-Roy, Chadi M.; Morris, Sinead E.; Baker, Richard F.; Mina, Michael J.; Farrar, Jeremy; Holmes, Edward C.; Pybus, Oliver G.; Graham, Andrea L.; Emanuel, Ezekiel J.; Levin, Simon A.; Metcalf, Carol; Grenfell, Bryan T.

doi:10.1126/science.abj7364

Cited by 95 publications

(82 citation statements)

References 68 publications

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“… 2-4 Several vaccines that are highly effective in reducing the incidence of hospitalization and death have been authorized; however, vaccine coverage remains insufficient. 5 , 6 Antiviral therapies that reduce the risk of Covid-19 progression are needed. Since trials have shown the need for initiation of treatment as soon as possible after the onset of symptoms, 7-9 such therapies would ideally be readily available and easily administered by the patients themselves.…”

mentioning

confidence: 99%

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

Bernal¹,

Silva

Musungaie³

et al. 2022

N Engl J Med

1,552

1,583

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Background New treatments are needed to reduce the risk of progression of coronavirus disease 2019 (Covid-19). Molnupiravir is an oral, small-molecule antiviral prodrug that is active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We conducted a phase 3, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of treatment with molnupiravir started within 5 days after the onset of signs or symptoms in nonhospitalized, unvaccinated adults with mild-to-moderate, laboratory-confirmed Covid-19 and at least one risk factor for severe Covid-19 illness. Participants in the trial were randomly assigned to receive 800 mg of molnupiravir or placebo twice daily for 5 days. The primary efficacy end point was the incidence hospitalization or death at day 29; the incidence of adverse events was the primary safety end point. A planned interim analysis was performed when 50% of 1550 participants (target enrollment) had been followed through day 29. Results A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, −6.8 percentage points; 95% confidence interval, −11.3 to −2.4; P=0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, −3.0 percentage points; 95% confidence interval, −5.9 to −0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group. Conclusions Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number, NCT04575597 .)

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mentioning

confidence: 99%

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

Bernal¹,

Silva

Musungaie³

et al. 2022

N Engl J Med

1,552

1,583

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“…However, this strategy only works in countries with access to ample vaccine supplies and the ability to administer multiple doses of complex vaccines over time. Without a major investment in equitable global mass vaccination, we cannot exclude the likelihood of significant future evolution of transmissive and immunologically elusive new variants 7 .…”

Section: Impact Of Transmission Heterogeneitiesmentioning

confidence: 99%

“…In the context of the COVID-19 pandemic, inequities in global vaccine distribution 2 , as well as vaccine hesitancy 3 are significant brakes on vaccination rates at different scales. Second, the impact of the vaccine may be reduced by biological factors, notably immunological complexities [4][5][6][7] and viral evolution [6][7][8][9] . We can illustrate these forces by reference to the simplest, most optimistic case where vaccination and natural infection provide lifelong immunity against reinfection.…”

Section: Introductionmentioning

confidence: 99%

“…Recent estimates of the relative transmissibility, α, of the delta strain in vaccinated individuals indicates high transmission, comparable to viral shedding in naive, susceptible individuals 23 ; however, the duration of breakthrough shedding may be shorter 24 . In line with previous work [5][6][7] , we initially make the pessimistic assumption that α = 1, then explore the impact of lower values.…”

Section: Introductionmentioning

confidence: 99%

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Vaccine breakthrough and the invasion dynamics of SARS-CoV-2 variants

Saad-Roy

Levin

Farrar

et al. 2021

Preprint

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Vaccination provides a powerful tool for mitigating and controlling the COVID-19 pandemic. However, a number of factors reduce these potential benefits. The first problem arises from heterogeneities in vaccine supply and uptake: from global inequities in vaccine distribution, to local variations in uptake derived from vaccine hesitancy. The second complexity is biological: though several COVID-19 vaccines offer substantial protection against infection and disease, 'breakthrough' reinfection of vaccinees (and subsequent retransmission from these individuals) can occur, driven especially by new viral variants. Here, using a simple epidemiological model, we show that the combination of infection of remaining susceptible individuals and breakthrough infections of vaccinees can have significant effects in promoting infection of invading variants, even when vaccination rates are high and onward transmission from vaccinees relatively weak. Elaborations of the model show how heterogeneities in immunity and mixing between vaccinated and unvaccinated sub-populations modulate these effects, underlining the importance of quantifying these variables. Overall, our results indicate that high vaccination coverage still leaves no room for complacency if variants are circulating that can elude immunity, even if this happens at very low rates.

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“…), on the trajectory of the epidemic 3,5–10 . More recently, models have explored a wide range of biological and behavioural aspects of COVID-19 vaccination programmes, including vaccine efficacy, emerging variants, social determinants of vaccine access and uptake, waning immunity, and changes in behaviour due to vaccination impact 11–15 . Models have elucidated important epidemiological transmission parameters, and have produced short-term projections of cases, hospitalizations, and deaths that can be expected in different populations 16–19 .…”

Section: Introductionmentioning

confidence: 99%

Four-week forecasts of COVID-19 epidemic trajectories in South Africa, Chile, Peru and Brazil: a model evaluation

Delva

Dominic

Beauclair

et al. 2021

Preprint

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Introduction From the beginning of the COVID-19 pandemic, epidemiological models have been used in a number of ways to aid governments and organizations in efficient planning of resources and decision making. These models have elucidated important epidemiological transmission parameters, in addition to making short-term projections. Methods We constructed a compartmental mathematical model for the transmission, detection and prevention of SARS-CoV-2 infections for regions where Anglo American has mining operations. We fitted the model to publicly available data and used it to make short-term projections. Finally, we evaluated how the model performed by comparing short-term projections to actual confirmed cases, retrospectively. Findings The average forecast errors for four-week-ahead projections ranged between 1% and 8% in all the countries and regions considered in this study. All but one region had more than 75% of the true values falling within the range of four-week-ahead projections. The quality of the projections improved with time as expected due to increased historical data. Conclusion Our model produced four-week forecasts with a sufficiently high level of accuracy to guide operational and strategic planning for business continuity and COVID-19 responses in Anglo American mining sites.

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Vaccine nationalism and the dynamics and control of SARS-CoV-2

Cited by 95 publications

References 68 publications

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

Vaccine breakthrough and the invasion dynamics of SARS-CoV-2 variants

Four-week forecasts of COVID-19 epidemic trajectories in South Africa, Chile, Peru and Brazil: a model evaluation

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