Health Tips

SARS-CoV-2, the virus that causes the devastating COVID-19 pandemic, remains a public health threat to many countries. Good news is, such threat is minimized with the introduction of vaccines, which Malaysia has kickstarted its National COVID-19 Immunisation Programme in early 2021. 

Just like how the iPhone gets renewed with upgraded features every year, so does the SARS-CoV-2 virus — only it mutates at a much faster rate. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID-19 pandemic. One can't help but wonder: are the COVID-19 vaccines effective against the variants?

Why do we have variants, at all?

Image credit: This illustration collection was created by Davian Ho, Maya Peters Kostman, and Philippa Steinberg for the Innovative Genomics Institute and is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

A mutation (viral mutation or genetic mutation) of the SARS-CoV-2 virus is a change in the genetic sequence of the virus when compared with a reference sequence such as Wuhan-Hu1 (the first genetic sequence identified) or USA-WA1/2020 (the first identified in the United States). Scientists have documented the various mutation mechanisms of SARS-CoV-2 virus, including change in the shape of spike proteins, altered immunogenicity of spike proteins and better escape mechanisms from the host’s immune system. The mutation results in what we called the variants, which is essentially SARS-CoV-2 virus but with one or more mutations that differentiate it from the reference sequence. Variants of SARS-CoV-2 can have different characteristics, which we will discuss in the section below.

The SARS-CoV-2 virus indeed pulls off many Machiavellian maneuvers to evade the human’s immune system. But mutation is not unique to SARS-CoV-2— many viruses mutate all the time. An example is the influenza virus, which constantly mutates and evolves every year. This is why annual influenza vaccination is recommended to high-risk individuals. 

Most of the time, variants of any virus are harmless, but once in a while, it may hit the “jackpot” and result in a few more formidable variants. 

What are the variants (for now)?

Scientists call variants that could potentially cause harm as variants of concern (VOC). To be qualified as a VOC, the World Health Organization (WHO) states that the variant should demonstrated one or more of the following changes:

• Increase in transmissibility OR

• Increase in virulence or change in signs and symptoms; OR

• Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics

Image credit: The Marvel Hub

Currently, there are three VOCs reported circulating in Malaysian’s society. There are the Alpha (B.1.1.7), Beta (B.1.351, B.1.351.2, B.1.351.3) and Delta (B.1.617.2, AY.1,AY.2, AY.3) variants.

Note: The names “alpha, beta and delta” are the WHO label, whereas the codes “B.1.1.7 etc.” are the Pango lineages’s nomenclature. Both can be used to name and describe SARS-CoV-2 variants.

Both Alpha and Beta variants have 50% increased in transmissibility compared to reference variants. This is even more true for the Delta variant, as shown in a recent study published by Public Health England. Some experts even called the Delta variant as the “2020 version of Covid-19 on steroids”, or in other words, the most contagious variant we have so far. Our Health director-general Tan Sri Dr Noor Hisham Abdullah once said at a media conference:"The Rt of a normal virus is between 2.5 and 3, but that of the Delta variant and other variants that we have identified is between 5 and 8. That means if 100 people are infected, the virus can spread to 500 to 800 people in a short period," These variants are also associated with higher hospitalization and death rates.

PS: To learn more about the Delta variant, read our visually pleasing Instagram post here.

Are the vaccines still effective against the variants?

Vaccines are like the light of the end of the pandemic tunnel, but just when we thought we’re about to be done and dusted with the virus:

With the emergence of variants of the SARS-CoV-2, this begs the question: are our COVID-19 vaccines still effective against them? 

Let’s just put it out there first: Evidence is limited on how the new COVID-19 variants will affect how COVID-19 vaccines work in real-world conditions. Most of the studies we cited below are conducted in controlled, experimental settings. 

As the world continues to vaccinate millions of people each day, we should be able to gain better clarity on the effectiveness of vaccines against the variants as time goes by. For now, here are what scientists know so far:

Pfizer-BioNTech (Comirnaty®) and AstraZeneca vaccines

Image credit: Arne Müseler / www.arne-mueseler.com, CC BY-SA 3.0 DE , via Wikimedia Commons

• In a study of the vaccinated population in Qatar, the Pfizer-BioNTech vaccine has shown to be effective against the Alpha and Beta variants. However, the study also reported that the effectiveness against Beta variant was 20% lower than what is reported in the original clinical trial of the vaccine back in the year 2020, when Beta variant is not the predominant variant just yet. 

• Real-world data in Israel, the very first country that vaccinated most of its populations, also found the vaccine to be effective against the variant, although at a lower effectiveness rate. 

• The same could be said about the AstraZeneca vaccine. The vaccine is still effective against both Alpha and Beta variants, although the effectiveness was reduced against Beta variants. 

• The same study also found that both Pfizer-BioNTech’s and AstraZeneca’s vaccines were 33% effective against symptomatic disease from Beta variant, 3 weeks after the first dose compared to around 50% effectiveness against the Alpha variant. 

• In another study that compares the effectiveness of Pfizer-BioNTech’s and AstraZeneca’s vaccines between Alpha and Delta variants, it was found that both vaccines are still effective against both variants, although they’re less effective against Delta than against Alpha variants.

Image credit: Вакцина CoronaVac від SinoVac Biotech, Flickr under Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

Sinovac

There’s a lack of effectiveness data of the Chinese-developed vaccine against SARS-CoV-2 variants. As the world’s most used vaccine, Sinovac’s effectiveness against the variants concerns many countries. To that, Sinovac’s spokesperson Liu Peicheng said although no data is available on its protective effect yet, studies have proven the vaccine’s efficacy in countries such as Brazil, Indonesia, Chile and Turkey where the vaccine has been widely used. 

The unvaccinated populations are at higher risk

Although Malaysia is gearing up its vaccination rates each day, it does not seem to surpass our case numbers and death tolls anytime soon. Particularly, the rise of variants in our country is hitting the unvaccinated populations worse:  60% of the Delta cases in Sarawak were among the unvaccinated populations. With the Beta and Delta variants becoming the dominant variants in Malaysia, the unvaccinated people are more vulnerable than ever. In the United States, more than 97% of those hospitalized for COVID-19 were unvaccinated.

On the other hand, in countries with high vaccination rates such as Israel, it was found that although Delta is driving its case surge, the infections among vaccinated individuals were less severe. 

I’m vaccinated! That means I shouldn’t worry about the virus anymore?

Vaccination does not make us impervious to the virus. You can still catch COVID-19 even after vaccination. However, vaccination does reduce the severity of symptoms, lower hospitalization and death rates. This is actually a big deal: it reduces the strain we put on our healthcare system, and that means doctors won’t have to choose which patient to save and which one to give up; it also means adequate healthcare resources for non-covid cases. Vaccination can lower the death rates of COVID-19, which means we would lose fewer loved ones, and less broken hearts and families. 

The bottom line is: you can still be infected with COVID-19 after vaccination, but this does not mean that vaccination is useless. In fact, vaccination is our final hope to get out of this pandemic.

What does the future hold?

At the time of writing, our country is in a dire situation— we’ve just surpassed 1 million in COVID-19 caseloads, and have been recording over 10,000 cases daily for the past 1-2 weeks. The positivity rates have also risen and kept constant at approximately 10 percent, which is far from the ideal 5 percent set by WHO.  

Nonetheless, there’s still reason to be optimistic. As states across Malaysia are ramping up its vaccination campaign, more and more people are at least single or double jabbed. Starting from August, vaccination centres in Klang Valley can even accept walk-ins. There is also talk about offering booster shots in the future as more and more variants emerge. But for now, let’s not get too ahead of ourselves. Get yourself vaccinated, practise social distancing and mask up whenever you go out.

Will new variants continue to emerge?

Variants of concern have been evolving since the beginning of the COVID-19 pandemic, with selective advantage generally favoring more transmissible variants. Scientists all over the world are constantly monitoring the emerging variants through genomic surveillance, as well as evaluating its ability to evade vaccine-induced immunity. For now, it’s sufficient to say that vaccination is still able to protect most of us from symptomatic COVID-19. We need to vaccinate as many people as soon as possible, which includes populations from lower socio-economic backgrounds who are often left behind in public health services. Remember, no one is safe until everyone is safe.

A word from Doc2Us

If you have any enquiries related to COVID-19 and its vaccines, you can consult our COVID-19 Task Force, which consists of professional doctors and healthcare professionals, for FREE! You can access free COVID-19 virtual health advisory by downloading the Doc2Us app on http://onelink.to/doc2us or use our web chat https://web.doc2us.com/. Alternatively, go to MySejahtera app> Digital Health> Virtual Health Advisory, and click on Doc2Us.

For more information about COVID-19 vaccination programme in Malaysia, visit https://www.vaksincovid.gov.my/

Disclaimer: COVID-19 is a novel disease. The information and scientific evidence of its development and vaccines are changing as we speak. Some content of this article may be outdated in the future. We encourage you to always speak to a healthcare professional you trust for the latest updates on COVID-19 and its vaccines.

Read more:

A guide to what to do if you think you might have Covid-19

Does the brand of COVID-19 vaccines matter?

Should you receive Covid-19 vaccine if you have a drug allergy?

Side effects of Covid-19 vaccine: should you be worried? 

What you need to know about the COVID-19 vaccine

Should pregnant women take COVID-19 vaccine?

Blood clots and COVID-19 vaccines, explained

Please adhere to your COVID-19 vaccination appointment, here's why

How is COVID-19 patient being treated in the hospital?

Cover image credit: This illustration collection was created by Davian Ho, Maya Peters Kostman, and Philippa Steinberg for the Innovative Genomics Institute and is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Written by

Ms Joyce Toh