The COVID Surge: Vaccine Development and the Unfolding Crisis in a Post-Pandemic World
An in-depth look at the evolution of COVID-19 vaccines and the recent surge in cases, highlighting the challenges of navigating a 'post-pandemic' world.
As summer comes to an end, so does another COVID surge. According to data from the Centers for Disease Control and Prevention (CDC), wastewater levels throughout the summer were considered “high” or “very high” in 26 states. Nearly two-thirds of new cases were traced back to the FLiRT subvariant, which rose to prominence in the winter of 2024. The two variants, known as KP.2 and KP.3, are more infections than previous strains because of mutations in their spike proteins.
Following the summer surge, the Food and Drug Administration (FDA) approved three updated vaccines from Pfizer-BioNTech, Moderna, and Novavax. The development of these new vaccines highlights the evolution of COVID-19 vaccines, which have been critical throughout the pandemic.
Evolution of COVID-19 Vaccines
In March 2020, the World Health Organization (WHO) announced COVID-19 as a pandemic. After the announcement from the WHO, work on the vaccine from various companies began. Initial estimates for a viable vaccine weren’t until 2021, however, the urgency caused by the pandemic, placed vaccine development, on a speed run.
Messenger RNA (mRNA) was a significant advancement in COVID-19 vaccines. Unlike traditional vaccines, which use a weakened or killed version of the virus, mRNA vaccines use genetic code to instruct cells to produce proteins that help train the immune system.
The growing infection rate of COVID-19, encouraged unified governmental efforts and international collaborations to create multiple vaccines on a tight deadline. By the spring of 2020, four vaccine candidates began entering the three phases of testing.
Phase I trials test safety and preliminary dosing in a small group of people, Phase II trials evaluate the immune response and adverse effects in larger groups, and Phase III trials assess effectiveness in a control group at multiple sites.
In June 2020, China approved the CanSino vaccine for limited use. Russia later announced the approval of its Sputnik V vaccine for emergency use.
In the United States, the FDA issued an Emergency Use Authorization (EUA) to allow the availability of medical countermeasures during public health emergencies. Pfizer-BioNTech submitted an EUA request for its mRNA vaccine in November 2020, and the FDA granted the EUA in December. Moderna’s vaccine also received EUA approval.
During this time, the United Kingdom’s Medicines and Healthcare Products Regulatory Agency (MHRA) approved the Oxford/AstraZeneca vaccine. The European Union authorized the Pfizer vaccine in December 2020 and Moderna in January 2021. Australia granted approvals to AstraZeneca, Pfizer, and Moderna in 2020 and 2021.
The development of the COVID vaccines was essential in mitigating the spread of COVID-19. However, as the virus continues to evolve, so do the challenges. Despite the availability and effectiveness of vaccines, the recent surge in COVID cases highlights the continuing presence of the virus.
The Current COVID Surge
The current surge has brought renewed attention to the pandemic, with recent data from the CDC revealing the highest rates of infection are in the South and Midwest with cases rising in the Northeast. Test Positivity has been at 17% over the past two weeks and wastewater detection is still considered “very high” in most states.
More than 40% of all COVID cases throughout this surge can be attributed to the FLiRT variant of vaccines, a term used to describe the family of these variants including KP.2. While cases across the U.S have seen a rise in infections over the summer, while the new variants are more infectious, there has not been a rise in severe symptoms.
In an interview with Newsweek, Adrian Esterman, an epidemiologist and professor at the University of South Australia reflected on the subvariants and its impact on COVID vaccines,
“Even though the FLiRT subvariants are now quite genetically distant from the XBB subvariants—the current vaccine is based on XBB.1.5—the vaccine will still give some cross-immunity against them. However, there will be a new vaccine available around September. … That will give much better protection,” he said.
Government and Public Health Response
In response to the subvariants, the FDA approved updated versions of the COVID vaccine in August, targeting the KP.2 strain. Moderna and Pfizer were authorized first, with Novavax vaccine being authorized shortly before Labor Day.
“This updated vaccine is not a new vaccine. It's just a strain change. Just like we do for flu vaccine each season, we update the strains each year,” said Sandra Fryhofer, MD in an interview with the American Medical Association (AMA).
The CDC’s Advisory Committee on Immunization Practices (ACIP) recommended these new vaccines in June for everyone ages six months and older.
While the spread of COVID has been mitigated because of vaccines, it’s important to remember that it is still a novel virus, and infection can still cause severe and life threatening illness, especially for people who are immunocompromised. The expiration of the federal Public Health Emergency for COVID in 2023 marked a shift in the emergency response phase of the pandemic.
“We’re not seeing the cases and the morbidity rates from COVID-19 that we did in the past, and so the recommendations for people with COVID-19 today are similar to what we recommend for other respiratory viruses,” said infectious disease physician Steven Gordon, MD, in an interview with the Cleveland Clinic.
Following the release of updated guidelines, the CDC recommends that individuals with COVID-19 stay home until symptom-free for 24 hours and wear N95 masks for five days afterward.
Recent data has shown that 98% of the U.S population has immunity from COVID-19, due to either prior infection or vaccination.
The ‘Post-Pandemic’ World
As we continue to navigate the effects of COVID-19, the shifts in public guidelines and vaccine updates indicate a new phase of the pandemic. However, as we begin to enter a “post-pandemic” world, it’s important to acknowledge the ramifications of COVID-19 on daily life.
Many people who have recovered from COVID-19 have experienced health problems long after having the virus. Long COVID is a chronic condition that is triggered by SARS-CoV-2, the virus that causes COVID-19. It is estimated that up to 35% of people have developed Long COVID following recovering from COVID-19.
The pandemic also exacerbated existing social and systemic inequities. Research from the CDC revealed that Black, Latino, and Indigenous people had higher COVID-19 death rates compared to White people. During the initial rollout of booster vaccines, Black and Latino individuals were half as likely as White people to receive the Omicron variant booster.
School closures during the initial spread of COVID-19 led to a disruption of learning across various communities. Research from the Harvard Graduate School of Education found that there were declines in test scores nationwide, consistent amongst all groups regardless of racial or socioeconomic status. Test scores also declined in places where deaths from COVID were higher and communities where higher rates of mental health struggles were reported. The average public school student in the U.S lost the equivalent of half a year of math learning and a quarter of a year of learning in reading.
Mental health struggles and substance abuse rates increased because of the pandemic, with symptoms of anxiety and depression rising during the pandemic among people who experienced financial stress, and job loss. Deaths from drug overdose and substance abuse increased during the pandemic, with over 106,600 deaths being reported across the U.S. – becoming the highest on record. This rise in deaths has been driven by synthetic opioids such as fentanyl.
As we transition from the initial phases of the COVID-19 pandemic into a post pandemic world, the impacts of the still-novel virus continue to influence our lives. The approval of updated vaccines and shifting public health measures highlight the efforts to manage the impact of COVID-19.
Disruptions in education, increases in substance abuse and mental health struggles, as well as exacerbating pre-existing systemic inequities have underscored the boarder societal impacts that need to be addressed. The ongoing response to COVID-19, has to require a coordinated effort to address both immediate needs and the long term consequences, to ensure that a post-pandemic world is equitable.