What is the future of Covid? Experts on what to expect with the vaccines, virus treatments and new variants

NationalWorld speaks to experts to understand what the future of Covid will look like

Covid experts have given their views on what to expect from the virus in the future - with one telling NationalWorld that a vaccine could be developed to tackle all variants.

The academics also spoke about whether a fourth vaccine is necessary - with suggestions that people could eventually need an annual booster jab.

Here, the experts will give their opinions on the following questions:

  • Will there be regular boosters?
  • Will there be a fourth vaccine?
  • What other treatments will be used?
  • Will there be new variants?
  • Will there be a vaccine to protect against all strains?
  • What is the likely future scenario?

Will there be regular boosters?

Andrew Preston, Professor of Microbial Pathogenesis from the University of Bath, said: “It’s not feasible to continue to try and vaccinate tens of millions on what would be a pretty much continuous basis.

“It would mean a permanent vaccination programme.”

He added: “I don’t think there’s any appetite for that - just logistically and cost wise it’s probably not achievable to do that long term.”

Alternatively “we will need to use vaccines according to risk,” he said.

However, Dr Rebecca Ingram, Senior Lecturer in Infection and Immunity at Queen’s University Belfast, argues giving regular boosters “would be affordable and sustainable if it was decided as a priority.

“It has been shown that these large-scale vaccination programmes can be done,” she added.

Although she is “not sure if it should be done both for scientific and moral reasons.”

Dr Ingram places importance on rolling out the vaccine globally.

She said: “I think it’s very clear that Covid is a global problem and in order to fix it we need to have global solutions.

“It feels morally very wrong to me for people in this country to be considering having a fourth vaccination when there are a huge amount of people around the world who have yet to even have a first vaccine.”

Will there be a fourth vaccine?

Professor Preston said boosting has to be done “in response to a need to boost, not automatically”.

“These vaccinations are an important and precious resource that need to be used for maximum effect,” he added.

He said: “Clearly some people have already received a fourth dose and those will be the extremely clinically vulnerable. I think that will continue to be the case.

“That is where we will be focusing our future booster vaccinations, certainly while the picture stays as it is.”

Azeem Majeed, Professor of Primary Care and Public Health at Imperial College London, agrees that “some people will need a fourth dose of vaccine.

“This may initially be for groups such as older people and healthcare workers,” he added.

Dr Ingram argues giving too many vaccines “will become counterproductive”.

“It will stop driving immunity and start driving immune exhaustion. We can’t just go on giving the same vaccine forever,” she said.

She added: “Our adaptive immune cells are highly specific for the small piece of the virus or bacteria that they recognise, known as the antigen.

“But there is only a certain number of times that they can respond to this antigen, after which they become exhausted.”

“We don’t know how many boosters we can give before we reach this point,” she added.

What other treatments will be used?

Molnupiravir is an anti-viral drug approved for use by the NHS in November.

Professor Preston said it was “originally developed as an anti-flu treatment” and “induces a high rate of mutations when SARS-CoV2 replicates, producing non-viable progeny, or very poor fitness progeny.

“It is indicated for use in the early stages of infection in those people indicated as being at high risk of suffering severe Covid disease,” he said.

He added that Sotrovimab is another anti-viral drug used in the same way to treat Covid and is also approved for use.

Pfizer has also produced an anti-viral drug called Paxlovid - in December the UK government ordered a large number of doses in anticipation of approval for use this year.

He said: “I am not aware of how many patients have been treated with any of these drugs; however all demonstrated a clear effect in trials on reducing the number of patients who required ICU care or who died.”

On nasal sprays, Professor Preston said he has not seen “any actual data to show efficacy of those”.

“I’ve seen quite a few products touted as anti-viral nasal sprays available over the counter or on the internet but I would encourage people to be very wary about resorting to so-called antiviral nasal sprays and relying on those to protect them, particularly against Omicron which is very highly infectious at the moment,” he said.

He added: “At least we now have methods where we can reduce the impact of that illness on them” but “the decision is how best to use them”.

Dr Ingram encourages the use of these treatments alongside the vaccines.

“I don’t think vaccines are the only answer. I think all the protective measures - social distancing, masks - all plays a part in protecting us,” she said.

She encourages the use of nasal sprays “certainly for kids” because “it’s a much more user-friendly way to deliver it and I think parents have less concerns about that.

“Everything that we can develop that limits viral severity and transmission will help in protecting,” she said.

Will there be new variants and how will we protect against them?

Professor Preston said: “It is very likely we will see further variants of this particular virus.

“We’ve seen many of them since its identification two years ago; there have been thousands and thousands of mutations identified across the virus.”

This includes Alpha, Beta, Delta and now Omicron.

He said: “The hope is that as immunity builds and the virus continues to adjust its niche within the human population, future variants even if they are highly infectious, continue to be only mild.

“However we still have to recognise there is still a threat of a variant arising. There’s nothing to suggest that can’t happen,” he added.

Will there be a vaccine that protects against all strains?

Professor Preston said: “If we have a vaccine that targets something that is likely to be common to future coronaviruses we are going some way to perhaps guarding against a future coronavirus mediated pandemic.”

Dr Ingram added: “I imagine that is where we will end up.”

Professor Preston said: “Some of the T-cell mediated immunity gained from exposure to some of the other common cold coronaviruses may have some slight protective effect against SARS-COV-2 (Covid).

“There is great interest now in identifying other regions of the virus that are actually far more conserved - [that] don’t vary between the different variants or types of coronavirus.

“If we can get those regions into a vaccine and be able to induce immunity against them, then the promise for that is that we have an immune response that is not only protective against SARS-COV-2 but many other different types of coronavirus.”

He said: “This is the third coronavirus that has jumped into the population. SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome), and now SARS-COV-2.

“If it has happened three times already it will happen again in the future.”

What is the most likely future scenario?

An annual booster jab, like that of the flu vaccine, is “certainly one of the plausible scenarios but it is just not clear at the moment,” Professor Preston said.

He added: “It depends on the future trajectory of the virus, particularly in terms of whether we get other variants coming through or not.”

“I think we will see it perhaps implemented as a dual flu and Covid booster rollout, but it is just too early to say at the moment,” he said.

Dr Ingram placed emphasis on global monitoring before an annual jab is rolled out.

She said: “We need to get to the point where we have global monitoring in the same way we do for the flu to look at the strains that are emerging and only include antigens for the most recent emerging strains rather than just giving the same thing over and over again.”

“I think that going forward we will eventually get to a position where like the flu, annual vaccines are offered against strains that are most prevalent in that given time.”

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