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01 February 2021 | Story Prof Felicity Burt, Prof Dominique Goedhals & Dr Sabeehah Vawda | Photo istock

Opinion article by Prof Felicity Burt, Prof Dominique Goedhals, and Dr Sabeehah Vawda, Division of Virology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Service, Bloemfontein. 

As we optimistically embarked on a new year with hopes of seeing an end to the global pandemic, masks, and social restrictions, our news channels were consumed with stories about virus variants and vaccine roll-out. What do these variants mean and will the vaccines protect against the changes that have emerged in the virus and save us from the new normal?

The news of a ‘mutated’ virus most likely conjures movie-like images of an invisible, indestructible enemy causing massive disruption. The reality is fortunately much less dramatic, as these changes are actually expected. Just to reiterate, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has an RNA genome that codes for all the proteins which the virus produces. The exact details of how the virus replicates and produces new progeny, although of interest, are beyond the scope of this article. It is sufficient at this point to merely acknowledge that, during replication, the mechanism employed by viruses with an RNA genome allows for the introduction of mutations in the genes that code for the viral proteins. This is expected to occur and there is substantial evidence that the SARS-CoV-2 viral genes have evolved and adapted globally. Some mutations are silent, in other words, they do not change the viral proteins. However, in some instances the changes can affect the proteins encoded by the virus. If these changes occur in regions of the protein responsible for binding to the cell receptors that facilitate entry of the virus into the cell, or in regions of the protein that induce an immune response, the virus may show new characteristics, such as more successful transmission or escape from an existing immune response. 

Second wave of infections

South Africa and the United Kingdom are probably the two countries globally that have methodically sequenced the largest number of SARS-CoV-2 viruses isolated from patients. This technique allows the determination of the complete genome of each isolate and subsequent comparison, using bioinformatic software specifically designed to compare and identify changes and mutations in the nucleotide sequences. As we are all now aware, scientists in these two countries have identified virus variants with an accumulation of mutations and deletions occurring in the gene that encodes for the viral spike protein associated with binding to cell receptors and inducing protective immune responses. These variants have now become the predominant lineages circulating within local communities. 

In December 2020, scientists in South Africa revealed the presence of a variant of concern (VOC), now referred to as 501Y.V2. Sequence data confirmed that this variant initially emerged in October 2020, and by January 2021 it was present in multiple provinces in the country and is considered to be responsible for a significant number of cases occurring in the second wave of infections in the country. A second VOC reported by scientists in the United Kingdom in December 2020, (202012/01) likely emerged during September 2020. A third VOC has been reported from Brazil and is simply known as variant P1. To date, variant 501Y.V2 has been reported from at least 23 countries. VOC 202012/01 has been reported in at least 60 countries, and although the cases were initially associated with travellers, there is an increasing number of clusters of cases occurring in people with no history of travel. The United States, Israel, and India currently have the highest number of cases associated with this variant outside of the UK, keeping in mind that at the rate at which the pandemic unfolds, these statistics quickly become outdated. In contrast, variant P1 has only been reported from Brazil, and outside of Brazil it has been associated with travellers in a small number of countries. 

Immune responses

Changes in viral proteins may or may not influence certain characteristics of a viral infection. Current epidemiological data and modelling have all suggested that the VOC circulating in South Africa and the UK are more transmissible than previous lineages of the SARS-CoV-2. Despite the increased transmissibility, to date the severity of illness and the proportion of severe disease in different age groups appear to be unaffected by the changes in the protein. The increased transmissibility has increased the burden on the public and private health systems, emphasising the importance of rolling out a vaccine to healthcare workers and persons at increased risk of severe illness. 

The changes in the spike protein responsible for inducing immune responses have sparked research studies to determine whether the vaccines will be able to protect against the new variants.  It must be remembered that there are two arms to the immune response with complex interactions, and that natural protection will likely be a combination of responses. However, the presence of antibodies that neutralise the virus, in other words, block it from entering cells, and the ability of these neutralising antibodies to block new variants from entering the cells, can be investigated in the laboratory. Although the exact responses required for protection are not fully understood and will require studies that take more time to complete, an indication of neutralising capacity provides some information with regard to the potential efficacy of the vaccine against variants. What we currently know from laboratory research is that there is a reduction in the ability of antibody from people previously infected during the first wave of cases to neutralise the new variant circulating in South Africa. This reduction varied among the cohort of samples tested, but overall, there was a weaker neutralising capability. Similar results were demonstrated using pseudoviruses representing the variant virus. Studies looking at antibodies in people who have been vaccinated show similar reductions in neutralisation. The answer is unfortunately not clear at this stage, with many pieces of the puzzle still to be determined. The reduced capacity to neutralise in a laboratory was not what we wanted to hear, but it must be remembered that vaccines induce a broad immune response and not only neutralise antibody, and hence there are other components to the immune response that will likely contribute to protection. Nonetheless, even a reduced immune response will contribute towards vaccine-induced herd immunity and saving lives by preventing severe disease. 

Vaccine trials

In addition to the vaccines currently in use, results were released from clinical trials using vaccines from Novavax and Johnson & Johnson. Although a lower efficacy was shown among the South African population compared to results obtained in the UK, the efficacy was still in the region of 57% to 60%, which is certainly encouraging in view of the new variant circulating. The differences observed illustrate the importance of conducting vaccine trials in local populations. An efficacy of 60% will still contribute towards herd immunity and the prevention of severe disease, emphasising the importance of a rapid roll-out and hopefully a high uptake of the vaccine. Vaccination will not only protect the vaccinee but should contribute to minimising the risk of further variants emerging. 

The roll-out of vaccine, further research on immune responses in vaccinated communities, epidemiological data, and sequence data will all contribute towards monitoring the evolution of the outbreak. Flu vaccines are modified annually and if the COVID-19 vaccine needs to be modified, manufacturers have the capability to do this, and some have already started this process. 

Additional waves of infection are predicted to occur until herd immunity can be achieved. Whether the current variants will be responsible for the next wave is not possible to predict, and continued research analysing the gene sequences of future isolates will play an important role in determining how the virus is evolving. 

In the interim, until we have sufficient vaccine-induced herd immunity to provide protection, non-pharmaceutical interventions and human behaviour will continue to play the important role of minimising new infections. To quote CS Lewis: “You can’t go back and change the beginning, but you can start where you are and change the ending.”

 

News Archive

Volksblad: Moshoeshoe Memorial Lecture
2006-05-27

27 Mei 2006

Moshoeshoe het mense saamgebind
KONING MOSHOESHOE kon bewys dat verskeidenheid ’n bindende eienskap kan wees. Dit blyk ’n sleutelbeginsel van sy leierskap te wees – en dit is nie ’n maklike een om te begryp nie.

Jy bereik die grootste eenheid tussen onderskeidende entiteite waar jy relatief vrye ruimte aan hulle gee om hul eiesoortige kenmerke na vore te bring.

Dít blyk uit prof. Njabulo Ndebele se gedenklesing oor koning Moshoeshoe.
Lesotho; het; onder Moshoeshoe se leierskap mense van verskeie dele van die subkontinent gelok.
Dié mense het hierheen gevlug van die verwoesting wat as lifaqane bekend geword het toe Shaka sy koninkryk met militêre onderwerping verstewig het.

Ndebele het gesê daar is algemene ooreenkoms dat die oorloë wat hieruit gespruit het, die maatskaplike grondslae van talle samelewings in Suider-Afrika geskud het.

“Dit was in dié konteks dat Moshoeshoe leierskap getoon het.”
Prof. Frederick Fourie, rektor en visekanselier van die Universiteit van die Vrystaat (UV), het gesê die lesing vorm deel van ’n groter debat oor leierskapmodelle, veral die konsep van Afrika-leierskap, en die voortgesette diskoers oor nasiebou en versoening.

Die Moshoeshoe-projek is in 2004 aan die UV begin om met Suid-Afrika se eerste dekade van demokrasie saam te val.
Die projek was deel van die UV se eeufeesvieringe in 2004.
Met dié projek word geprobeer om ’n groot Afrika-leier te vereer en die UV se verbintenis tot transformasie te toon sodat ’n ware inklusiewe en nie-rassige universiteit geskep kan word.

“As die stigter van die Basoeto-nasie, word daar wyd erkenning aan koning Moshoeshoe vir sy buitengewone leierskapstyl gegee.

“Diplomasie, versoening en vreedsame naasbestaan is van die kenmerke van sy leierskap, soos getoon in sy pogings om verskillende groepe in een nasie te verenig,” sê Fourie.

KONING MOSHOESHOE, een van Afrika se eertydse groot leiers. Hy is meer as 130 jaar gelede dood. Foto: verskaf

Waarde van openbare spraak ‘nou bedreig’
AANDUIDINGS bestaan dat die waarde van openbare spraak wat hoog deur koning Moshoeshoe van Lesotho op prys gestel is, nou onder ernstige bedreiging kan wees.

Om dié rede dra hy die koning Moshoeshoe-gedenklesing op aan al dié mense in Suid-Afrika en elders wat die moed het om hul oorwoë mening uit te druk oor belangrike sake wat die samelewing in die gesig staar, het prof. Njabulo Ndebele, visekanselier van die Universiteit van Kaapstad, gesê.

Ndebele, wêreldbekende skrywer, het gesê dié lesing kom op ’n kritieke punt in Suid-Afrika se nuwe demokrasie.
Dié lesing, om die buitengewone nalatenskap van een van Afrika se groot leiers te eer, is eergisteraand op die kampus van die Universiteit van die Vrystaat (UV) gelewer en het ’n staande toejuiging deur ’n groot gehoor uitgelok.

Ndebele het gesê die mense wat hul menings uitdruk oor belangrike sake, kan rubriekskrywers, redakteurs, kommentators, alle soorte kunstenaars, akademici, koerantbriefskrywers, nie-gewelddadige optoggangers met plakkate en strokiesprentkunstenaars wees “wat ’n spieël voor ons oë sit”.

“Selfs wanneer hulle dit waag op heilige gebied, soos sommige strokiesprentkunstenaars onlangs gedoen het, herinner hulle ons net dat selfs die heilige misbruik kan word vir doeleindes wat min met heiligheid te doen het.

“Dit is hul manier om ons te help, dalk meer diepsinnig as wat ons besef, om daardie einste ruimte van heiligheid in ons lewe te bewaar.

“Hulle verdiep ons insigte deur ons begrip te verdiep.
“Dit is gepas om hul dapperheid te vier,” het Ndebele gesê.
“Hulle herinner ons dat leierskap nie al is wat ons doen wanneer ons in ’n sekere magsposisie geplaas is om ’n organisasie of ’n sekere instelling te stuur nie.”

Hy het gesê onder die mense wat gevier moet word, sluit hy nie dié in wat deur haatspraak ander aanhits om geweld te pleeg; teen; mense; wat hul andersdenkende menings lug nie.

“Dit is nie met dapperheid dat hulle aanhits nie, maar weens hul toevlug tot die narkotiese beskerming van die skare.”

Mense voel glo ál kwesbaarder
Vise-kanselier lewer Moshoeshoe-gedenklesing
’n TOENEMENDE aantal hoogs intelligente, sensitiewe en toegewyde Suid-Afrikaners oor die klas-, ras- en kulturele spektrum heen bely dat hulle – soos nog nooit tevore nie – onseker en kwesbaar voel sedert 1994.

Só het prof. Njabulo Ndebele, vise-kanselier van die Universiteit van Kaapstad, gesê in die Universiteit van die Vrystaat (UV) se eerste koning Moshoeshoe-gedenklesing.

Die onderwerp was Reflections on the leadership challenges in South Africa.
Wanneer ontembare optimiste beken hulle voel dinge is van stryk, versprei die naarheid van angs. “Dit moet iets te doen hê met ’n ophoping van gebeure wat die gevoel van dreigende inploffing oordra.”

’n Gevoel heers dat Suid-Afrika ’n baie komplekse samelewing het wat liewer eenvoudige, gesentraliseerde beheer voortbring in die hoop dat dienslewering dan beter en vinniger gedryf kan word. Die kompleksiteit van beheer word dan in ’n enkele struktuur van gesag gevestig, eerder as in die afgewentelde strukture soos wat in die Grondwet beoog word.

Dat die afgewentelde strukture nie hul grondwetlik-gedefinieerde rolle verwerklik nie, moenie toegeskryf word aan die mislukking van die beheermeganisme nie.

“Dit is te vroeg om te sê dat wat ons sedert 1994 bereik het, nie gewerk het nie,” het Ndebele gesê.
Dit lyk of ’n kombinasie van omstandighede tot die “gevoel van ontknoping” lei.
“Ek wil dit vermy om te sê: ‘Kyk na Khutsong’, asof u sal verstaan wat ek bedoel wanneer ek sê u moet na Khutsong kyk.”
Sulke kennis lei tot wanhoop, want dit roep ’n werklikheid op wat só oorweldigend is dat dit fatalisties kan wees.
Ndebele het gesê niks kon meer vreesaanjaend wees as toe ’n komplot van die Boeremag oopgevlek en sekere Boeremaglede aangekeer is nie.

Sekere Boeremaglede het van ’n maksimum-sekuriteit-tronk ontsnap. “Sover ek weet, is hulle nie weer gevang nie.
“Wat is gedoen om die gaping te oorbrug?” was een van sy vrae hieroor.
“Van só ’n belangrike saak weet die publiek nie baie nie. Die karige kommunikasie kan die gevaarlike boodskap uitdra dat óf niks gedoen word nie, óf die staat in dié saak misluk.”

Hy het gevra: “Hoekom het die kwessie van munisipale afbakening tot die situasie in Khutsong gelei? Dit lyk of die probleem voortgaan, sonder ’n oplossing in sig.”

’n Aantal soortgelyke, oënskynlik plaaslike rebellies het oor die land heen plaasgevind. “Is hier ’n patroon?”
Ndebele het na die onlangse verhoor van oud-adj.pres. Jacob Zuma, wat van verkragting aangekla was, verwys.
Dié drama blyk ver van oor te wees. Dit beloof “om ons almal sonder verligting te hou, in ’n toestand van angs”.
Die gemene draad van dié gebeure is die gevoel van ’n oneindige spiraal van probleme wat vertroue tap. Daar kan ’n sterk suggestie in al dié gebeure wees “dat ons dalk nooit sosiale samehang in Suid-Afrika gehad het nie...”

“Wat ons sekerlik oor dekades gehad het, is ’n mobiliserende visie. Kan dit wees dat die mobiliserende visie onder die gewig van die werklikheid en omvang van maatskaplike heropbouing kraak en dat die legitieme raamwerk om oor dié probleme te debatteer ineenstort?”

‘Swart mense staar hulself in die gesig’
DIE swart meerderheid staar homself nou in die gesig: dalk werklik vir die eerste keer sedert 1994.
Só het prof. Njabulo Ndebele gesê toe hy die koning Moshoeshoe-gedenklesing by die Universiteit van die Vrystaat in Bloemfontein gelewer het.

Hy het gesê dit lyk of Suid-Afrika ’n meganisme nodig het om selfvertroue te bou.
Deur dié meganisme “kan ons die situasie waarin ons is, erken, wat dit ook al is”.
“Ons het ’n meganisme nodig wat die verskillende posisies van die mededingers sal bevestig en hul eerlikheid sal bekragtig op ’n manier wat die publiek vertroue sal gee dat werklike oplossings moontlik is.”

Dit is dié soort “openheid wat nooit maklik kom nie”, wat lei tot deurbraak-oplossings.
Ndebele het gesê ’n komplekse demokrasie soos Suid-Afrika s’n kan nie oorleef met ’n enkele gesag nie.
Net veelvuldige owerhede binne ’n grondwetlike raamwerk “het ’n ware kans”.
“Kan ’n deel van die probleem wees dat ons nie in staat is om die idee van ‘opposisie’ te hanteer nie?
“Ons is verskrik dat enige van ons ‘die opposisie’ kan word.
“Dit is tyd dat ons die koms voorsien van ’n oomblik wanneer daar nie meer ’n enkele, oorweldigende, dominante politieke mag is soos wat nou die geval is nie.”

Ndebele het gesê: “Ek glo ons het dalk ’n oomblik bereik wat nie fundamenteel verskillend is nie van die ontnugterende, tóg hartversterkende nasiebourealiteite wat gelei het tot Kemptonpark in die vroeë jare negentig.”

“Die verskil tussen toe en nou is dat die swart meerderheid nie nou na wit landgenote oor die onderhandelingstafel kyk nie.

“Die swart meerderheid staar homself in die gesig: dalk werklik vir die eerste keer sedert 1994.”
Dit is weer “tyd vir visie”, het Ndebele gesê.

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