What the next-generation of COVID-19 vaccines could look like

The Omicron variant, currently the dominant strain of the novel coronavirus worldwide, is more transmissible and also better now at evading protection conferred by vaccination and prior infection. Meanwhile, protection from our current vaccines has been shown to wane over time. This has given the virus a tremendous advantage and explains why breakthrough infections from Omicron have become more common.

Dr. Monica Gandhi, an infectious disease doctor and professor of medicine at the University of California, San Francisco, explains why at this point in the pandemic we need new vaccines to help us fight the virus more effectively. She also explains what the vaccines could look like.

Video Transcript

MONICA GHANDI: The mRNA vaccine's holding up really well against severe disease. But we got so many breakthrough infections even after being boosted with the mRNA vaccines. And they just don't work as well against the Omicron. In terms of what we need next, these mRNA vaccines are working well with their B and T-cell protection, which protect us from getting COVID pneumonias and severe disease.

But they are not working as well in generating an adequate antibody response to protect us against all symptoms and to stop transmission. And what we really need to do is boost our antibody levels. And we need to boost it up here in what's called the nasal mucosa.

And so the nasal vaccines, which are coming, they're still in all forms of development, would actually be administered directly into the nasal mucosa-- sometimes a spray. And what it would do is it'd show you part of the virus right where you need to get protected, which is your nose and mouth.

We still want that intramuscular vaccine to generate our T and B-cells in the body so you're protected against severe disease. But combine that with the nasal vaccine, that would be much more effective against minor symptoms. And minor symptoms disrupt society, so if you had both, that is really what we're waiting for.

There's two ideas to try to keep up with variants, because right now the mRNA vaccines are actually the one that you can get in a pharmacy are directed against what was called the ancestral strain. The spike proteins that they code for looked like a strain that was circulating in spring of 2020. And so one idea is to update the mRNA vaccines to show you a part of the virus that is the variant spike protein-- so an Omicron-specific vaccine and the Omicron bivalent vaccine, which is the old booster and the Omicron-specific booster has been tested in volunteers-- this was data put out by Moderna just last week-- and they showed that giving Omicron bivalent vaccine did increase neutralizing antibodies against the Omicron strain compared to just giving the old booster.

It sounds good. They're going to make it. It's going to be available in the fall. And we're just going to have to see if it works better than the old booster.

Then, next, what would come up is showing someone the entire virus. We need a vaccine that actually doesn't just give us the spike protein of the virus, because that is the part of the virus that's changing the most, which makes sense. It's the part that sticks to the cell, so it's very motivated to change to become more transmissible.

We need to see the whole virus, I think. And that way we have antibodies against the nucleocapsid, against the cell membrane, not just against that pretty mutated spike protein. We're going to have future variants. Even right now, the particular Omicron-specific bivalent vaccine that Moderna made is to BA1. And we're already on BA2, BA2121, BA4 and BA5 are coming-- so it's hard to keep up if you're only targeting the spike protein. We need other vaccines that are targeted against other, deeper parts of the virus that don't mutate as much.

These pan-coronavirus vaccines, there are many groups working on it. NIH put out funding into this. And so there's no doubt, I would say, in two years time-- not this winter, it's going to be too soon for a whole virus vaccine-- but the next winter I think we're going to have it.

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