From the current issue of PNAS that just appeared I want to immediately pass on the entire text of the open source piece by Emanuel Goldman. Its points crystallize my anger at those across the globe whose resistance to vaccination for COVID-19 puts us all at risk by making more likely the emergence of a new variant against which our existing vaccinations are ineffective. The text:
Imai et al. (1)
have characterized yet another variant of severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19,
this one originating in Brazil. The good news is that it appears that
vaccines currently available are still expected to provide protection
against this variant. However, what about the next variant, one we have
not seen yet? Will we still be protected?
In 1859, Charles Darwin published On the Origin of Species (2),
in which he outlined the principles of natural selection and survival
of the fittest. The world presently has the unwelcome opportunity to see
the principles of evolution as enumerated by Darwin play out in real
time, in the interactions of the human population with SARS-CoV-2. The
world could have easily skipped this unpleasant lesson, had there not
been such large numbers of the human population unwilling to be
vaccinated against this disease.
SARS-CoV-2 has shown that it can mutate into many variants of the original agent (3).
An unvaccinated pool of individuals provides a reservoir for the virus
to continue to grow and multiply, and therefore more opportunities for
such variants to emerge. When this occurs within a background of a
largely vaccinated population, natural selection will favor a variant
that is resistant to the vaccine.
So far, we have been
lucky that the variants that have emerged can still be somewhat
controlled by current vaccines, probably because these variants evolved
in mostly unvaccinated populations and were not subject to selective
pressure of having to grow in vaccinated hosts. Nevertheless, the Delta
variant is exhibiting increased frequency of breakthrough infections
among the vaccinated (4).
The
real danger is a future variant, which will be the legacy of those
people who are not getting vaccinated providing a breeding ground for
the virus to continue to generate variants. A variant could arise that
is resistant to current vaccines, rendering those already vaccinated
susceptible again.
Progress we have made in overcoming
the pandemic will be lost. New vaccines will have to be developed.
Lockdowns and masks will once again be required. Many more who are
currently protected, especially among the vulnerable, will die.
This
dire prediction need not occur if universal vaccination is adopted, or
mandated, to protect everyone, including those who are already
vaccinated.
Darwinian selection may also yet solve the
problem with a much crueler calculus. The unvaccinated will either get
sick and survive, and therefore be the equivalent of vaccinated, or they
will die and therefore be removed as breeding grounds for the virus.
The
National Archives in the United Kingdom note that, in 1665, during the
Black Death plague, “to prevent the disease spreading, a victim was
locked in their house with their entire family, condemning them all to
death” (5).
Vaccinations offer a much more humane response to prevent spread of
this disease. The path forward is in the hands of the unvaccinated, and
in the political will of the authorities.