To protect communities against an uptick in cases and mortality during an expected U.S. coronavirus variant surge, federal and state officials must continue to prioritize elders for vaccination, according to a group of leading infectious disease and vaccine experts.

In their seventh report from “COVID-19: The CIDRAP Viewpoint,” the group has proposed a plan for thwarting yet another increase in transmission and illness due to the B.1.1.7 SARS-CoV-2 variant, first tracked in the United Kingdom. They predict a new U.S. surge by approximately the end of April.

“There is a narrow and rapidly closing window of opportunity to more effectively use vaccines and potentially prevent thousands of severe cases, hospitalizations, and deaths in the next weeks and months,” the authors write.

To maintain healthcare capacity, officials should strategically target vaccination to those at highest risk, they contend. In the event of a surge, “the vast majority of hospitalizations and deaths would occur in adults 65 years and older,” wrote first author Michael Osterholm, Ph.D., MPH, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

The authors recommend: 

  • Allocating vaccine, with the highest priority given to people aged 65 years and older;
  • Deferring second doses of mRNA vaccines until after the surge, if existing data support vaccine efficacy and short-term protection following one dose (this may delay, but would not involve cancelling, second doses);
  • Deferring the second dose of mRNA vaccines in people with confirmed COVID-19 infections, as one dose may spark high levels of antibodies in individuals who have had a confirmed case; and
  • Authorizing and using half-doses of the Moderna vaccine to help vaccinate twice as many people.

The full report is available here.

In related news:

WHO says J&J vaccine effective against worrisome COVID variants  The World Health Organization’s vaccine advisers on Wednesday recommended that Johnson & Johnson’s COVID-19 vaccine be used in countries where concerning coronavirus variants are circulating, according to a report by Agence France Presse. The vaccine’s efficacy in South Africa is similar to that in the United States, where these variants are not yet predominant. The same is true in Brazil, which has had its own predominant variant in circulation. Across the board, a single dose of the vaccine has 67% efficacy against symptomatic infection, 77% efficacy against severe COVID-19 disease after 14 days, and 85% efficacy after day 28, the news outlet reported.

B.1.1.7 causes more severe illness than earlier coronavirus variants The B.1.1.7 SARS-CoV-2 variant not only is more transmissible than pre-existing variants, but it also may cause more severe illness, according to a new analysis from the London School of Hygiene and Tropical Medicine in the United Kingdom. The variant was detected in the U.K. in September and since has spread to multiple countries worldwide. It previously was found to be more transmissible than earlier versions of the virus, and this study is one of the first to also show a link to more severe outcomes, the authors said.