SHORT THREAD: On mutations and vaccine escape. There is a lot of discussion around mutations and the possibility of vaccine escape. Should this concern us? I believe not yet, but there are lessons here about the importance of vaccine rollout. 1/n
What follows are opinions, and they are qualitative ones, and not based on formal modelling of the situation. But I believe them to be broadly correct on the current evidence. 2/n
There is no evidence that the recently identified mutant confers protection to the new vaccines, and we would not expect there to be. Viruses mutate all the time, and they do so at random. 3/n
The chance of any one newly identified mutation being relevant at all to the virus is very small in the first place, let alone being relevant in overcoming a newly developed vaccine. 4/n
The virus doesn’t ‘know’ what the vaccine is targeting. But of course, natural selection is remarkable at finding clear solutions against such challenging backgrounds. 5/n
As we roll out the vaccine, selective pressures on the virus will go up starkly. Eventually, vaccine escape is quite possible. It is not inevitable, but it may happen. We don’t know how soon. 6/n
The higher the selective pressure, the quicker this escape might happen. 7/n
What keeps me awake and worries me regarding vaccine rollout? The speed and heterogeneity (patchiness) of rollout. If the vaccine is rolled out in a patchy way among countries and among countries, that increases the possibility of local adaptation and escape of the virus. 8/n
If this happens, an escape variant could arise in one population or part of the world, that could infect another population before it ever gets the chance to be vaccinated. If this happens, we will not make the most of our vaccines. 9/n
What is the solution? We need to make sure the rollout of the vaccine is as broad across countries and risk groups, and as quick, as is humanly possible. 10/n
We need to make sure the virus goes into decline, before any escape variants arise. This is an incredibly urgent logistical exercise, but also an imperative public health information campaign, to make sure that people take up the vaccine as soon as it is available to them. 11/n
Go out and get your vaccines now; they might not work later. 12/n
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