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Concerns about SARS-CoV-2 evolution should not hold back efforts to expand vaccination.
Cobey, Sarah; Larremore, Daniel B; Grad, Yonatan H; Lipsitch, Marc.
  • Cobey S; Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA. cobey@uchicago.edu.
  • Larremore DB; Department of Computer Science, University of Colorado Boulder, Boulder, CO, USA.
  • Grad YH; BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA.
  • Lipsitch M; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Nat Rev Immunol ; 21(5): 330-335, 2021 05.
Article in English | MEDLINE | ID: covidwho-1164868
ABSTRACT
When vaccines are in limited supply, expanding the number of people who receive some vaccine, such as by halving doses or increasing the interval between doses, can reduce disease and mortality compared with concentrating available vaccine doses in a subset of the population. A corollary of such dose-sparing strategies is that the vaccinated individuals may have less protective immunity. Concerns have been raised that expanding the fraction of the population with partial immunity to SARS-CoV-2 could increase selection for vaccine-escape variants, ultimately undermining vaccine effectiveness. We argue that, although this is possible, preliminary evidence instead suggests such strategies should slow the rate of viral escape from vaccine or naturally induced immunity. As long as vaccination provides some protection against escape variants, the corresponding reduction in prevalence and incidence should reduce the rate at which new variants are generated and the speed of adaptation. Because there is little evidence of efficient immune selection of SARS-CoV-2 during typical infections, these population-level effects are likely to dominate vaccine-induced evolution.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / Vaccination / Off-Label Use / SARS-CoV-2 / COVID-19 Type of study: Observational study / Qualitative research Topics: Vaccines / Variants Limits: Humans Language: English Journal: Nat Rev Immunol Journal subject: Allergy and Immunology Year: 2021 Document Type: Article Affiliation country: S41577-021-00544-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / Vaccination / Off-Label Use / SARS-CoV-2 / COVID-19 Type of study: Observational study / Qualitative research Topics: Vaccines / Variants Limits: Humans Language: English Journal: Nat Rev Immunol Journal subject: Allergy and Immunology Year: 2021 Document Type: Article Affiliation country: S41577-021-00544-9