Feb. 8, 2021 -- The COVID-19 vaccine developed by the University of Oxford and AstraZeneca doesn’t appear to work well against the coronavirus variant identified in South Africa, prompting health officials to stop using the vaccine in the country.

Scientists from the vaccine’s clinical trial said it didn’t protect participants from mild or moderate COVID-19, according to The New York Times. Previous infection from earlier versions of the coronavirus also didn’t seem to protect people from reinfection with the variant known as B.1.351.

"Everything Has Changed": You're Going to Need a BoosterWebMD's Chief Medical Officer, John Whyte, MD, speaks with Eric Topol, MD, Executive VP, Scripps Research, Editor-in-Chief, Medscape, about the efficacy of the Johnson & Johnson vaccine. 638

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Dr. JOHN WHYTE: Welcome,

everyone.

You're watching Coronavirus

in Context.

I'm Dr. John Whyte, Chief

Medical Officer at WebMD.

Have you heard the news

about the vaccine

from Johnson & Johnson?

How effective is it really?

And if it's less

effective than the current

vaccines,

how do you make the choice

whether or not to get it?

So to provide insights,

I've asked Dr. Eric Topol.

You all know him

from previous episodes.

Dr. Topol, thanks for joining

me.



Dr. ERIC TOPOL: Oh, great to be

with you, John.



Dr. JOHN WHYTE: I have to ask

you, Eric.

I've seen a range of headlines

today.

One says it's 72% effective.

One says it's 60% effective.

One says it's 80% effective.

And they're all parsing

the data, whether we're talking

about moderate

to severe disease,

whether we're talking

about hospitalizations.

Returning to you

to help us understand how

effective is it?

What do listeners need to know ?



Dr. ERIC TOPOL: Well it's

a really good question, John,

because they didn't do

a good job, the company here,

in making it

clear about the data.

We do know there was a drop off

between the US and South Africa.

So it was in the 70s,

72, and down to 57

in South Africa.

So we do know there was that.



We also have been seeing all

these things about suppression

of severe infection.

85%, 100%, well there's no data.

They don't give us any data.

So right now we can say,

with the one shot, which

is good.

Which is out of the deep freeze,

which is good.

There's a vaccine that works.



What we really don't know how it

stands up against the mRNA

vaccines that were very clear

95% efficacy.

Right?

And it was communicated clearly.

This is modeled.

So it's tricky,

it's hard for us,

and I hope in the days ahead

it's going to get much more

clarification because it's

so confusing.

The bottom line is 66%

by the criteria that we usually

use.

But that accounts for South

Africa where there's resistance

now to the new variant.



Dr. JOHN WHYTE: But you've been

educating us about the variants.

First, the UK and South Africa.

And I've got to be honest, when

I'm hearing there's

a decorum of efficacy in South

Africa where there is a variant.

How concerning do we need to be?



Dr. ERIC TOPOL: We have to be

concerned because there has

this immune escape property.



Dr. JOHN WHYTE: Explain that

to people.



Dr. ERIC TOPOL: Yeah.

So this variant is known

as South African.

It's B1351 is the real name.

It-- In the test tube

experiments, it didn't bind

to the antibodies as it should,

as well.

But we had hope that when we get

a vaccine,

we make such large quantities

of antibodies we will override

that.

As it turns out, uh-uh, doesn't.

It drops down from--

so Novavax also reported

with South Africa 4,400 people

yesterday.

And just like with the Johnson

and Johnson, it was a big drop

off.

For Novavax it went from almost

90% to 49% in South Africa.

Here it went from 72 to 57.

These are big drops.



So we do know that that variant,

which is in the US,

it was found in South Carolina

yesterday, two community

transmission cases,

it means there's more here.

Now there's one good thing

about this variant.

Not much.

It may not

be

the hyper-spread or

super-spreader as the one

from the UK.

So maybe we're not as going

to be in such a bad position

to cope with it.

But it's going to provide

a vaccine resistance

to some extent.

The vaccine still works.

It just doesn't work as well.

So we're going to have to do

some tweaking of the vaccines

coming up.



Dr. JOHN WHYTE: Well here's what

people are thinking.

There's a shortage of supply.

And we do know that they still

have to apply for EUA.

But let's be realistic,

the likelihood that it'll

be authorized is very high.

They may have a few million

next month.

30 million roughly by April.

We're trying to figure out,

is it 300 million at the end

of March?

Those are all best case

scenarios in terms

of manufacturing.

And problems happen.

So people are out there thinking

if I can get a vaccine that's

70% effective or 60% effective,

you know,

somewhere in that range,

versus 94-95%

and it's only one shot,

do I take that?

Or am I putting myself at risk

later on?



Dr. ERIC TOPOL: Well first

of all, take a vaccine,

any vaccine.

That's better than getting

COVID, right?

For sure.

But secondly, do you want to get

the one that's very high

efficacy

or the one, at this point,

it's still kind of murky?

Maybe it's actually pretty

close.

But the data are so all

over the place as we reviewed.

So if there really is a gradient

in efficacy, then that's

going to make it tricky.

It's going to--

You're going to say I want

the 95% one, I don't want

the 66% one or the 70% one.

Yeah.



Dr. JOHN WHYTE: You predict

people will have a choice?

Or will they just have to get

what's in their county?

Because remember

it's the government buying it

and that's going to be

distributed to the states

and the county.

Do you predict people will even

have a choice?



Dr. ERIC TOPOL: Well, I don't

know because it's been chaotic

as you're well aware, John.

These early weeks

since mid-December when it got

started.

We haven't gotten into groove

yet for getting the shots

in arms.

The point, I guess,

is that we have Novavax which

was almost 90%.

Which is pretty

good against the strain

that we've lived

with for a year.

So we have that.



Dr. JOHN WHYTE: They're going

to have manufacturing issues,

don't they?

They're not going to be

available.



Dr. ERIC TOPOL: Yeah.

And, well--



Dr. JOHN WHYTE: [INAUDIBLE]



Dr. ERIC TOPOL: hopefully we got

the whole world of pharma

to help them.

All these other companies that

can make vaccines like Novartis,

like Sanofi, like GSK,

like Merck.

If we all cooperate, here, we

can get into high production

faster.

Also the J&J, when we get

that final data, how it's just

not there, maybe it's

going to look better than the 66

or what was in the US.



Dr. JOHN WHYTE: Does it ever

look better after a press

release?

[LAUGHING] Let's

be professional.



Dr. ERIC TOPOL: I don't know.

I mean, I only can react to what

I've seen

and it's all over the place.



Dr. JOHN WHYTE: But let's

presume it's around 70%

if we use it's a comparator

to how the mRNA vaccines.

Is it unethical to give it

to populations in the United

States?

Say we're looking

at rural community

so we don't have to worry as

much

about these super cold

temperatures.

Or we're looking

at under-served communities

so then we can bring it to them.

Is there anything wrong

with that to say well, you know

what, 70% is better than nothing

but guess what it could still

be exposing yourself to virus

and you could have a false sense

of security?

Is there equity in that setting

or is it to the point

get whatever is out there?

If you can get it now,

take whatever.



Dr. ERIC TOPOL: Well, two things

on that, John.

You're raising a critical issue.

But number one, everything

changed yesterday.

We're all going to need

another shot so just

get started.

Get a vaccine.

It almost doesn't matter

because remember those 95%--



Dr. JOHN WHYTE: Why do you say

everything has changed?



Dr. ERIC TOPOL: OK.

Because, remember, the mRNA

vaccines, Moderna and Pfizer,

the 95%?

If you tested them in South

Africa they wouldn't be any 95%

anymore.



Dr. JOHN WHYTE: No.

No.

They'll be--



Dr. ERIC TOPOL: Yeah.

So--



Dr. JOHN WHYTE: Do we know where

they are?

They haven't really said what

they were.

They just said there's

a decrease but still enough

for protection.



Dr. ERIC TOPOL: Yeah.

Well they haven't been tested.

They didn't-- [? though ?]

didn't do those trials, those

companies, in South Africa when

it became the 90% strain

in South Africa.

The problem here is we have now

seen this hyper-evolution

of new strains, trouble strains,

and we're all going to need not

just one or two shots

but actually another booster

that's directed

towards the new strains, right?

So you just get started.



Dr. JOHN WHYTE: And people don't

wait.

But people don't wait either.

Some people are saying, "Well,

if you're going to have to make

a booster and fix it,

I'll just wait and do it

all then."



Dr. ERIC TOPOL: No, no,

no because you're going to get

a lot of protection

from the shots

that we have today.

And that's a good place to be

is get protection.

Maybe it's not 100%.

Maybe we're going to keep--

If we get better in our country,

maybe we'll get suppression

of the South African variant

or the Brazil P1 variant.

Wouldn't that be nice?

Because we can probably live

with B117.

It isn't as vaccine-resistant

even though it spreads badly.

That one has--

Unless we gear up now

with better masks and better

mitigation, B117 is destiny

is it's going to become

dominant.

It has a slight drop down

in efficacy too, but the problem

is whatever we've seen

in the pandemic

till now, it could be much

worse.

So that's why we have to gear up

and I'm not worried about people

getting vaccines now

because I got my two doses.

I am sure you as well.

We're going to have to get

extra help from vaccination

as we go forward, whether it's

later this year, next year,

at some point.



Dr. JOHN WHYTE: If people are

offered 70%, do they take it?



Dr. ERIC TOPOL: Oh, absolutely.

I'd take 50.

Better than zero, right?

50% better than--



Dr. JOHN WHYTE: You can't mix it

later.

You can't be like I'm going

to do 70% Adenovirus

and then do an mRNA virus later.

We can't do that.



Dr. ERIC TOPOL: Or you can.

What you--



Dr. JOHN WHYTE: Well, we don't

know that.

We don't go that route, OK.



Dr. ERIC TOPOL: I think

the bigger worry than you're

bringing up.

The most likely you'll be able.

The bigger worries using

Adenovirus repetitively.

That's tricky.

But doing a protein and mRNA,

you could do that.

Like--



Dr. JOHN WHYTE: Well, we still

have to double check the match.

Dr. Topol.



Dr. ERIC TOPOL: We're going

to get data on that.



Dr. JOHN WHYTE: I'm going

to follow up with you on that.

You've been very good in helping

explain everything.

I want everyone to follow Dr.

Topol on Twitter and Instagram.

He's terrific.

He and I did an Instagram Live

which was one of our most

popular Instagram Lives

answering your questions.

And we'll check in with you very

soon.

Thank you, Dr. Topol.



Dr. ERIC TOPOL: Thank you, Dr.

Whyte.

Thanks John.



Dr. JOHN WHYTE: And if you have

questions for us,

send them my way

at [email protected]

Thanks for watching.



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John Whyte, MD, MPH, Chief Medical Officer, WebMD.<br>Eric Topol, MD, Executive VP, Scripps Research, Editor-in-Chief, Medscape./delivery/aws/0d/0d/0d0d1655-299e-3d4a-a3ce-33448fe359f9/Topol_012921_v3_,4500k,2500k,1000k,750k,400k,.mp402/01/2021 12:00:0018001200Topol_012921_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Topol_012921_1800x1200.jpg091e9c5e820f99e3

“These results are very much a reality check,” Shabir Madhi, PhD, a virologist who ran the vaccine trial in South Africa, told reporters on Sunday.

In the clinical trial, about 2,000 participants received two doses of the vaccine or placebo shots. In the vaccine group, 19 were infected with the new variant. In the placebo group, 20 people were infected with the new variant. The minimal difference suggests that the vaccine doesn’t protect against the new variant.

However, since the scientists evaluated a low number of cases, it was difficult to assess how effective the vaccine may be against the variant, the news outlet reported. The clinical trial participants were mostly young and unlikely to develop severe COVID-19. Scientists also couldn’t determine whether the vaccine protects against severe illness, hospitalization, or death.

The new findings haven’t yet been peer-reviewed and will be submitted as a pre-print this week. If scientists find that the vaccine protects against the most severe COVID-19 cases, health officials may use the vaccine doses. About 1.5 million doses of the vaccine arrived in South Africa last week, which will now be stored until health officials analyze more data, according to CBS News. The doses, which don’t require the same cold storage as other COVID-19 vaccines, will expire in April.

Now health officials in South Africa will plan to vaccinate health care workers with the Johnson & Johnson vaccine, which has prevented severe COVID-19 and hospitalizations associated with B.1.351. The company has applied for an emergency use authorization in South Africa.

Researchers at the University of Oxford said they’re working on a new version of the vaccine that can protect against the variant. They hope it will be ready by the fall.

“This study confirms that the pandemic coronavirus will find ways to continue to spread in vaccinated populations, as expected,” Andrew Pollard, PhD, the chief investigator on the Oxford vaccine trial, said in a statement.

“But taken with the promising results from other studies in South Africa using a similar viral vector, vaccines may continue to ease the toll on health care systems by preventing severe disease,” he said.

Moderna has also begun developing a new version of its vaccine that could be a booster shot against the B.1.351 variant, The New York Times reported. Moderna and Pfizer have said that preliminary studies indicate their vaccines offer some protection against B.1.351, though at a lower rate than against the original version. Johnson & Johnson and Novavax have also reported some effectiveness against the variant. The U.S. is waiting on clinical trial data for the Oxford-AstraZeneca vaccine, which is expected in March.

The WHO will meet on Monday to discuss the Oxford-AstraZeneca vaccine, CBS News reported. The vaccine is scheduled to make up a large portion of the doses in the Covax global vaccine rollout that will serve low- and middle-income countries.

The B.1.351 variant has become the dominant form of the coronavirus in South Africa and has spread to 32 countries. The U.S. has reported six cases of the variant in Maryland, South Carolina, and Virginia, according to the latest CDC tally.

WebMD Health News Brief

Sources

The New York Times: “AstraZeneca’s Vaccine Does Not Work Well Against Virus Variant in South Africa.”

CBS News: “South Africa halts vaccination plan as AstraZeneca shot appears less effective on variant there.”

University of Oxford: “ChAdOx1 nCov-19 provides minimal protection against mild-moderate COVID-19 infection from B.1.351 coronavirus variant in young South African adults.”

CDC: “U.S. COVID-19 Cases Caused by Variants.”
 

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