Front Burner - A mutating virus and the need for global herd immunity

Episode Date: February 4, 2021

The Brazilian city of Manaus has been dealing with a raging outbreak of COVID-19, one that has left hospitals overrun and oxygen supplies dwindling; and not for the first time. The city was hit so hard by the coronavirus in the spring, that researchers estimated that 75 per cent of the population had been infected, which makes the severity of this recent outbreak unexpected and concerning. Today, Atlantic writer and Yale University public health policy lecturer Dr. James Hamblin explains the potential threat posed by new variants of the coronavirus popping up around the world, how they could upend expectations about herd immunity, and the need for a truly global vaccination response.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. In a city of 2 million people, in Brazil's Amazon rainforest, a terrible outbreak of COVID-19 overwhelmed hospitals and sent victims to mass graves, first in the spring of 2020, and now unexpectedly and concerningly again. I'm Jamie Poisson, and today Atlantic writer and Yale public health policy lecturer Dr. James Hamblin is here to explain how new variants of the

coronavirus could upend expectations around herd immunity and threaten countries' attempts to rein in the virus through vaccination. Hi, Dr. Hamblin. Thank you so much for making the time to chat with me today. Thank you for having me. So I was wondering if you could start by painting me a picture of how COVID-19 is ravaging the Brazilian city of Manaus. What's the situation like there now? Well, it's being hit very hard right now with a surge in cases that overwhelm the hospital system. The last couple of days seem to be seeing a slight decrease, but it's been very tragic there. Places running out of oxygen, people being buried in mass graves. I haven't

personally reported this, but this is widely reported from the scene and by the testament of public health officials in the area. With a death rate four times Canada's, this is one of the worst places in the world for COVID. Where is the help? Yells the daughter of one patient. People are dying here. It's not a game. This doctor says we've got 15 patients and there's two beds.

It's difficult to say that we choose who lives and who dies, but we do try and save the ones with the best chance to live. So what's really drawing global attention here, you know, I mean, obviously any humanitarian tragedy of that scale should. But this has already happened there once. It happened last April. Right, they were already hit very hard by the virus. Can you tell me more about that? Yeah, it was a similar picture. Jorge Akel says the whole system is failing.

Manaus had an average of 28 to 35 burials per day. Now it's more than 120. The bodies are being buried together in these mass graves, and the coffins are stored inside these containers until they can be buried. And at that point in the pandemic, it was more of a common occurrence. You know, this virus was spreading around the world before most countries knew it. We didn't have testing for it. The medical system didn't know how to treat it. Many places were really short on PPE.

You know, it was tragic then, but the system thought they were ready this time. They didn't think this was possible. So many people got sick the first time. Many here simply believed that herd immunity would prevent another round. Brazil's COVID skeptic president, Jair Bolsonaro, said there wouldn't be a second wave.

So I also know that researchers estimated that about 76% of the population had had the virus back in the first wave. And wasn't this something that was thought by experts to confer some level of population immunity to the virus? Like, why is this happening a second time? Well, that's the big question, right? So there were, based on antibody tests,

some extrapolations that about 76% of the city had been infected, not necessarily sick. And we know that if you get very sick, you're more likely to develop a robust, lasting immune response than if you just have an asymptomatic case. But about 76% of people had seen that they had some immune response to the virus, at least. And we know there were a lot of people who were very sick. So it suggested that, by the best estimates of experts in Brazil, that we would not see another catastrophic surge like

this. So there are a couple of factors that could be playing into that. And one is that it has been eight to nine months now. And we know that with other respiratory viruses, you know, your immune response fades. We've seen evidence of fading of the immune response with this coronavirus. Researchers in the UK examined over 17,500 antibody tests, suggesting the number of people with antibodies had dropped by more than a quarter in just three months. And it also could be that there's a variant there known as P1, which seems able to, or at least shares a mutation that the South Africa variant also has, which gives it a propensity to evade immune responses.

So the leading theory right now is that those things combine. Right, and I know that this variant is now dominant in Brazil, right? The P1 variant. And can you tell me a little bit more about it and how it's working? Well, these things are all very new, but it seems to have some element of increased transmissibility just because it's been able to take over so quickly, it appears. And it shares mutations with the strains that we know to be more transmissible, as well as a mutation that is seen in the South Africa variant that is able to not fully evade our immune responses, but seems to make our antibodies work a little less well.

So it's right now this really unfortunate combination of seeming to be a little more transmissible and a little more resistant to our responses. Right. Do we have a sense of how widespread this P1 variant is? Certainly, it's not only in Brazil, right? I know, as last that I have known, we have one case identified in the United States. But I think we can assume that when something is this widely spread within one country, it is in many countries. You know, genomic surveillance is just not something that in the US, we do a ton of, I think most countries could do more UK does,

does quite a lot. But it's not an instant rapid test. It's not as easy as running a PCR test, or, you know, quick COVID test. So we just do it occasionally. And so just statistically, it's very likely that it's in many places. But as is the nature with these new variants, just because one becomes dominant in a certain area in a certain population, you know, does not mean necessarily that it will take over everywhere. I think we would need more evidence of that happening other places before we were able to assume that. Could you tell me a little bit more about that? Why would it not take over somewhere else if it was dominate in a different place?

Yeah, you know, it's getting to be more complicated to make these predictions because when SARS-CoV-2, this coronavirus, just first started spreading, the world was a blank slate for it, basically. Everyone was susceptible to this infection. Now it's been around the world. It's been here for a year. And different people in different places have been infected by different strains, and they've been affected differently. So on top of any underlying genetic difference or geographic or weather-related difference, behavioral difference in an area, there are also going to be different patterns of immunity. Does this population have really strong immunity, or does it not? And is that immunity of the sort that might leave people

more prone to this particular strain and not another? And it becomes more, you know, like when there's an invasive species in a lake or in an ocean, just because something takes over and becomes a real problem in one place doesn't mean it's going to become a problem in every lake in the world. And, you know, of course, this variant that, you know, is originated in Brazil, it's not the only variant. And can you tell me a little bit more about this so-called UK and South Africa variants? And are they working differently than the Brazil variant? Well, you know, at this point in the pandemic, everything is a variant. They just get a name when we notice that there's some abnormality in how they're spreading.

And these are noted because they became dominant really quickly in these areas. And that suggested that they had, you know, increased capabilities to spread and infect people. About 1000 cases have already been identified in nearly 60 parts of England. No one in South Africa is underestimating the virus anymore. We may be closer to the beginning than the end. And then you retroactively try to construct, okay, well, how is it doing that? You know, how did this strain take over so quickly? And that's what we're still trying to understand.

But it is also sort of academic, because when you see something spreading this quickly, taking over, it's, you know, a large share of the cases. It's evident it has some evolutionary advantage. This idea of the variants being more transmissible, I wonder if you could explain to me what that means exactly. I wonder if you could explain to me what that means exactly. I can speak about the way that transmissibility can be increased in a virus. So it can mutate in ways that a person carries around a higher viral load.

So if you might be walking around, if you have an asymptomatic case and you were shedding 10 viruses in a single breath, all of a sudden you're shedding 100. You know, that makes it just increases the odds that one of those is going to land in someone else nearby in that exact same scenario. It also could be that the virus sort of gets better at sticking into our cells. So that same person who's infected is breathing out still only 10 particles in a breath, but any one of those, if it does come near you, there's a greater likelihood it's going to stick and replicate quickly and actually lead to an infection versus you just kind of, you know, breathe it out. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization,

empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income. That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money

for Couples. I'm sure also this is a big question on everybody's mind, you know, what do we know so far? Is there any evidence that any of these variants that we've seen so far, or any that could be on the horizon might be resistant to vaccines? Well, it already seems from the Johnson & Johnson data, because they happen to have done part of the trial in South Africa, and they saw a difference in effectiveness there, that the vaccine efficacy will differ depending on what kind of you're constantly exposed to high doses of a very contagious strain, that you are simply not as protected as if you are vaccinated and also happen to be in a pretty safe scenario. We can expect that, as I was saying before, there was no immune pressure on the selection of this virus initially, it was just kind of spreading

everywhere. Now we have populations of people who are immune, and you have a rapidly evolving virus. So it should be expected to, you know, the strains that are going to get passed on are the ones that aren't killed by our immune systems. So we'll expect that it will become better able to escape our immune systems, but we don't have evidence that the vaccines will not be effective. I think we absolutely should be prepared for that possibility and building up all the needed facilities to quickly update a vaccine if need be. It wouldn't surprise me if that happens, but as of now, we don't see that happening. I think there's nothing that should change the guidance that we're getting, which is that we need vaccines to roll out as quickly as possible, that you should take whatever one is available

to you in your area, we know when it becomes appropriate when it's when it's your turn, and that we can expect that we will see dramatic decreases in cases and death. And that if there are escape mechanisms that make the vaccine slightly less effective, if we get enough people vaccinated, they won't matter. And we'll be able to slow the evolution of this virus to such a degree that it can become moot. will be, it can become moot. The problem is if we just have these high levels of transmission, and if people don't take the vaccines, or if they become hesitant to take the vaccines, because they're not sure if they're going to work anyway, that's the worst case scenario. Right. I don't, I don't know, necessarily, if this mass global vaccination is the path that we're on, right? Like, we're having problems with our vaccine distribution here in Canada, listeners can check out our Monday episode for that. But of course, there are countries that have not vaccinated anyone at all. And I know that you cite a statistic in your most recent

piece in The Atlantic that only one of the world's 29 poorest countries has vaccinated anyone at all. And one respected medical journal estimates that vaccines will not be available to more than a fifth of the world's population until next year. And what do you think when you hear those statistics? Yeah, that's hopefully the key takeaway from the story is that a lot of countries are thinking in a nationalistic way about vaccines. You know, how soon do we get our country to herd immunity? You know, there's an ethical framework where that is the obligation of leaders, firstly, to take care of the health of their citizens. But if we do not reach herd immunity globally, and if there are still high rates of transmission

of this virus, and it continues to evolve as we see, we do risk eventually seeing a strain that has significant ability to evade the vaccines and becomes a problem for the entire world. So even if you, you know, just had no care or compassion or empathy or moral framework with which to justify caring about, you know, other countries getting vaccinated, it really needs to be a global effort in order to achieve herd immunity. It's not, herd immunity is not a concept that respects borders. Right. You know, in your piece, you write the coming year could be a story of two worlds undermining each other. And is that, is that what

you're talking about here? I think that, yeah, that's a worst case scenario, right? Where wealthy countries just quickly hoard all the vaccine, you know, buy up as much as they can use the wealth and buying power that we have and try to get, you know, and maybe even do get close to 100% vaccination, and then sort of say, okay, we're declaring the pandemic over, while you see bad surges in much of the world. And the pandemic, you know, there's not that's not an end point and not just because we need to care about um everyone but because it is in everyone's economic and medical interest to get to global herd immunity I know Canada, for example, has been accused of essentially hoarding vaccines. We've ordered enough vaccines to inoculate our population, I think, like five times.

Hundreds of millions of doses of seven vaccine candidates. Canada now has the most diverse portfolio of any country for vaccines. And I know that they're far from being delivered right now, but what do you make when you hear that? It's a really difficult question. That does sound like too much. It sounds like when I know that there are health workers in Africa who are unvaccinated right now, in an ideal world, you

would be able to have a similar distribution framework to what most countries have, where we get it to our global high-risk population, to our global healthcare essential worker population. You know, that's how we could really drive down the death and transmission globally. That's not how our system is designed. So we rely on individual countries to make a concession and say, when have I had enough? And it becomes a political decision too. When is it okay? When can a political leader survive giving some of the doses that could have gone to their own citizens? I understand that can be a complex choice. I mean, this has become a highly politicized issue here.

You know, of course, right now, we don't have enough vaccines to even sort of vaccinate our priority populations. But, you know, as they do start to roll in, I imagine that that debate will grow here. A lot of issues that we've heard about with regards to vaccine distribution, they've been presented, at least in Canada, at least as a scarcity issue. But do you think that it actually has to be that way? These are huge questions. So within our current system, the way we develop vaccines, So within our current system, the way we develop vaccines, it sort of does. If we were to think radically about who has ownership over the intellectual property of vaccines, who can produce vaccines and who funds them and who gets a profit from them, then no. We could have shared intellectual property, funded and made guaranteed buys to all kinds of facilities all over the world that could have scaled up and figured out how to make and distribute these

vaccines, but won't because the intellectual property is tied up in a few companies. You know, Moderna has said they won't sue anyone over who tries to make their vaccine as long as the pandemic is happening. But it's a big investment to get into making mRNA vaccines. And no one's going to do that unless they have the sort of assurances that these companies had when they got in, which is you're not going to lose money. We're going to buy your vaccines. Just please start making them. So if we thought radically about how to remake that system, no, we could have far more

vaccines than we have now. Right. Dr. Hamlin, thank you so much for this conversation. Thank you for having me. All right, so before we go today, one more note on Canada's vaccine supply. On Wednesday, the Globe and Mail reported that Canada is the only G7 country to draw on a supply of COVID-19 vaccines from a supply for developing countries. vaccines from a supply for developing countries. The COVAX program is a global vaccine sharing initiative that pools funds from wealthier countries to buy vaccines for themselves and for countries that can't afford them. The Trudeau government defended the move in a statement to the Globe stating, our contribution to the global mechanism had always been intended to access vaccine doses for Canadians as well as to support lower income countries. We're having a comprehensive approach to fighting the pandemic

as we know the virus won't be defeated until it is defeated everywhere. Canada has promised to share any surplus vaccine doses with the program. We will continue to keep our eye on this story. Also on Wednesday, the drug maker GlaxoSmithKline announced it would work with a German biopharmaceutical company to develop new vaccines that would target emerging variants of the coronavirus. That's all for today, though. I'm Jamie Poisson. Thanks so much for listening to FrontBurner. We'll talk to you tomorrow.