Abstract
The greatest hope for a return to normalcy following the COVID-19 pandemic is worldwide vaccination. Yet, a relaxation of social distancing that allows increased transmissibility, coupled with selection pressure due to vaccination, will probably lead to the emergence of vaccine resistance. We analyse the evolutionary dynamics of COVID-19 in the presence of dynamic contact reduction and in response to vaccination. We use infection and vaccination data from six different countries. We show that under slow vaccination, resistance is very likely to appear even if social distancing is maintained. Under fast vaccination, the emergence of mutants can be prevented if social distancing is maintained during vaccination. We analyse multiple human factors that affect the evolutionary potential of the virus, including the extent of dynamic social distancing, vaccination campaigns, vaccine design, boosters and vaccine hesitancy. We provide guidelines for policies that aim to minimize the probability of emergence of vaccine-resistant variants.
Highlights
The greatest hope for a return to normalcy following the COVID-19 pandemic is worldwide vaccination
Several countries display a logistic-shaped vaccine distribution curve, we show that the above linear assumption does not significantly affect the probability of emergence of vaccine resistance during the initial phase of the vaccination campaign (Supplementary Fig. 1 and Extended Data Fig. 1)
We study partial immunity to the mutant virus (MT) strain, which can be acquired by recovery from wild-type virus (WT) infection or by vaccination
Summary
The greatest hope for a return to normalcy following the COVID-19 pandemic is worldwide vaccination. A relaxation of social distancing that allows increased transmissibility, coupled with selection pressure due to vaccination, will probably lead to the emergence of vaccine resistance. Periodical loosening and tightening of social distancing measures, which present an attempt at balancing economical and sanitary considerations, have led to waves of increases and decreases in the number of SARS-CoV-2 infections per day[1] (Fig. 1a). As vaccination around the world progresses, the continued evolution of SARS-CoV-2 could eventually give rise to a fully vaccine-resistant variant. Such a variant could quickly spread due to its ability to infect vaccinated and recovered people in addition to fully susceptible individuals. The question of emergence of vaccine resistance has already been the subject of many research papers[15,16,17,18]
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