15 on COVID-19:

SARS-CoV-2 Variants
July 26th, 2021
Daniel Zlott, PharmD, BCOP
SVP, Education & Business Development

Pharmacists strengthening vaccine confidence

in their patients and communities.
Disclosures
Funding Source

This project was funded in part by a collaborative

agreement with the Centers for Disease Control and
Prevention (CDC)

CDC Acknowledgement
This project was funded in part by a collaborative agreement with the Centers for Disease
Control and Prevention (CDC) — CoAg number 1 NU50CK000576-01-00. The CDC is an
agency within the Department of Health and Human Services (HHS). Contents of this
resource do not necessarily represent the CDC or HHS, and should not be considered an 2
endorsement by the Federal Government.
Learning Objectives
1. Describe the current COVID-19 variants
2. Discuss the impact of COVID-19 variants on
monoclonal antibody and vaccine efficacy

CDC Acknowledgement
This project was funded in part by a collaborative agreement with the Centers for Disease
Control and Prevention (CDC) — CoAg number 1 NU50CK000576-01-00. The CDC is an
agency within the Department of Health and Human Services (HHS). Contents of this
resource do not necessarily represent the CDC or HHS, and should not be considered an 3
endorsement by the Federal Government.
COVID-19 Variants

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 COVID-19 Variants
• There are dozens of identified COVID-19
virus variants1
• Only a few are clinically relevant2
• CDC has classified variants into
several categories:
• Variants of Interest
• Variants of Concern
• Variants of High Consequence
• The CDC and WHO closely monitor
COVID-19 variants3,4

1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-

info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.
2. US CDC. About Variants of the Virus that Cause COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html. June 28th, 2021. Accessed 7/11/21.
3. US CDC. COVID Data Tracker; Variant Proportions. https://covid.cdc.gov/covid-data-tracker/#variant-proportions. Accessed 7/11/21.
4. WHO. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/. Accessed 7/11/21.

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 COVID-19 Variants: Why do they Matter?
• Some variants result in clinically relevant
changes to the SARS-CoV-2 virus1-4
• Increased ability to gain entry to cells
• Increased transmissibility
• Increased morbidity or mortality
• Antigenic shift
• Ability to avoid immune detection
• Impact on effectiveness of COVID-19
testing
• mRNA sequence changes
• Protein structure changes

1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-

info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.
2. US CDC. About Variants of the Virus that Cause COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html. June 28th, 2021. Accessed 7/11/21.
3. US CDC. COVID Data Tracker; Variant Proportions. https://covid.cdc.gov/covid-data-tracker/#variant-proportions. Accessed 7/11/21.
4. WHO. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/. Accessed 7/11/21.

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COVID-19 Variants of Concern
Variant WHO Origin Impacts mAb Impacts
Classification efficacy? vaccine
efficacy?
Wild-type N/A China N/A N/A
B.1.1.7 Alpha UK No No
B.1.351 Beta South Africa Yes Yes
B.1.617.2 Delta India Possible No/Pending
P.1 Gamma Japan/Brazil Yes Pending

1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-

info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.
2. US CDC. About Variants of the Virus that Cause COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html. June 28th, 2021. Accessed 7/11/21.
3. US CDC. COVID Data Tracker; Variant Proportions. https://covid.cdc.gov/covid-data-tracker/#variant-proportions. Accessed 7/11/21.
4. WHO. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/. Accessed 7/11/21.

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 COVID-19 Variants of Interest

1. US CDC. COVID
Data Tracker;
Variant Proportions.
https://covid.cdc.go
v/covid-data-
tracker/#variant-
proportions.
Accessed 7/15/21.

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 COVID-19 B.1.1.7 (alpha) Variant
• Increased transmissibility: ~ 50%

α
increased transmission compared to
wild type1
• Impact on morbidity/mortality:
Potential increased severity based
on hospitalizations and case fatality
rates1,2
• Monoclonal antibody efficacy: Similar
to wild type1
1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-
info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html.
July 6th, 2021. Accessed 7/11/21.
2. Horby et al. (Jan 18, 2021). NERVTAG Note on B.1.1.7 Severity. https://www.gov.uk/government/publications/nervtag-paper-on-covid-19-variant-of-concern-
b117. Accessed 7/11/21

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COVID-19 B.1.1.7 (alpha) Variant
• Vaccine Efficacy:
• Pfizer: 87-89% effective at preventing infection;

α
97% effective at preventing severe, critical or fatal
disease (mix of B.1.1.7 & B.1.351 variants in this
population)1
• Moderna: 100% effective at preventing infection2
• J&J: Neutralizing antibodies against B.1.1.7 variant
produced and present at 8 months post
vaccination3
• AstraZeneca (Not Authorized in US): 70% effective
at preventing infection4
1. Abu-Raddad, et al. NEJM. 2021. DOI: http://doi.org/10.1056/NEJMc2104974.
2. Chemaitelly, et al. Nat Med. 2021. DOI: https://doi.org/10.1038/s41591-021-01446-y
3. Barouch, et al. MedRxiv. 2021. DOI: https://doi.org/10.1101/2021.07.05.21259918 [not peer reviewed]
4. Emary, et al. Lancet. 2021. DOI: https://doi.org/10.1016/S0140-6736(21)00628-0.

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 COVID-19 B.1.351 (beta) Variant
• Increased transmissibility: ~ 50%
increased transmission compared

β
to wild type1
• Morbidity/mortality: Similar to wild
type1
• Monoclonal antibody efficacy:
• Reduced susceptibility to
bamlanivimab &
bamlanivimab/etesevimab2
1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-
info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.
2. US FDA. Fact Sheet for Health Care Providers Emergency Use Authorization (EUA) of Bamlanivimab and Etesevimab. May 14, 2021. https://www.fda.gov/media/145802/download. Accessed 7/11/21.

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COVID-19 B.1.351 (beta) Variant
• Vaccine Efficacy:
• Pfizer: 72-75% effective at preventing infection;
97% effective at preventing severe, critical or fatal

β
disease1 (mix of B.1.1.7 & B.1.351 variants in this
population)
• Moderna: 96% effective at preventing infection2
• J&J: 81% effective at preventing severe/critical
disease in South Africa (94.5% prevalence of
B.1.351 variant in study population)3
• AstraZeneca (Not Authorized in US): Not effective4
1. Abu-Raddad, et al. NEJM. 2021. DOI: http://doi.org/10.1056/NEJMc2104974.
2. Chemaitelly, et al. Nat Med. 2021. DOI: https://doi.org/10.1038/s41591-021-01446-y
3. Sadoff, et al. NEJM. 2021. DOI: https://doi.org/10.1056/NEJMoa2101544
4. Madhi, et al. NEJM. 2021. DOI: https://doi.org/10.1056/NEJMoa2102214.

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COVID-19 B.1.617.2 (delta) Variant
• Increased transmissibility: Increased
transmissibility compared to wild type1

δ
• Impact on morbidity/mortality: More info
needed
• Monoclonal antibody efficacy: Potential
reduction in efficacy compared to wild
type1

1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-

info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.

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COVID-19 B.1.617.2 (delta) Variant
• Vaccine Efficacy:
• Pfizer: 88% effective at preventing
symptomatic disease; 96% effective

δ
at preventing hospitalization1
• Moderna: More info needed
• J&J: Neutralizing antibodies against
B.1.617.2 variant produced and
present at 8 months post vaccination2
• AstraZeneca (Not Authorized in US):
60% effective at preventing
symptomatic disease1
1. Lopez Bernal, et al. MedRxiv. 2021. DOI: https://doi.org/10.1101/2021.05.22.21257658 [not peer reviewed]
2. Barouch, et al. MedRxiv. 2021. DOI: https://doi.org/10.1101/2021.07.05.21259918 [not peer reviewed]

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 COVID-19 P.1 (gamma) Variant
• Increased transmissibility: Similar to
wild type1

γ
• Impact on morbidity/mortality: Similar
to wild type1
• Monoclonal antibody efficacy:
Reduced susceptibility to
bamlanivimab &
bamlanivimab/etesevimab2

1. US CDC. SARS-CoV-2 Variant Classifications and Definitions. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-

info.html?CDC_AA_refVal=https%3A%2F%2Ffanyv88.com%3A443%2Fhttps%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. July 6th, 2021. Accessed 7/11/21.
2. US FDA. Fact Sheet for Health Care Providers Emergency Use Authorization (EUA) of Bamlanivimab and Etesevimab. May 14, 2021. https://www.fda.gov/media/145802/download. Accessed 7/11/21.

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COVID-19 P.1 (gamma) Variant
• Vaccine Efficacy:
• Pfizer: Neutralizing antibodies against P.1 variant
produced and present 4 weeks post vaccination.3

γ
• Moderna: Neutralizing antibodies against P.1 variant
produced and present 1 week post vaccination4
• J&J: Neutralizing antibodies against P.1 variant
produced and present at 8 months post vaccination5
• AstraZeneca (Not Authorized in US): Neutralizing
antibodies against P.1 variant produced and present at
4 wks post vaccination. 6
1. Liu, et al. NEJM. 2021. DOI: https://doi.org/10.1056/NEJMc2102017
2. Wu, et al. NEJM. 2021. DOI: https://doi.org/10.1056/NEJMc2102179
3. Barouch, et al. MedRxiv. 2021. DOI: https://doi.org/10.1101/2021.07.05.21259918 [not peer reviewed]
4. Dejnirattisai, et al. Cell. 2021. DOI: https://doi.org/10.1016/j.cell.2021.03.055.

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Bottom Line
• COVID-19 Variants:
• Have the potential to impact the efficacy of
monoclonal antibody products for COVID-19
• May impact the ability of some tests to detect
COVID-19/COVID-19 antibodies
• Are likely to continue to evolve as long as COVID-19
is circulating amongst the general population
• COVID-19 Vaccines authorized in the US:
• Are effective against currently identified variants of
concern
• Are the best way to prevent the development of
additional variants by stopping the spread of COVID-
19
Image: SARS-CoV-2 emerging from a cell. NIAID RML

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