Population impact of SARS-CoV-2 variants with enhanced transmissibility and/or partial immune escape

Cell. 2021 Dec 22;184(26):6229-6242.e18. doi: 10.1016/j.cell.2021.11.026. Epub 2021 Nov 19.


SARS-CoV-2 variants of concern exhibit varying degrees of transmissibility and, in some cases, escape from acquired immunity. Much effort has been devoted to measuring these phenotypes, but understanding their impact on the course of the pandemic-especially that of immune escape-has remained a challenge. Here, we use a mathematical model to simulate the dynamics of wild-type and variant strains of SARS-CoV-2 in the context of vaccine rollout and nonpharmaceutical interventions. We show that variants with enhanced transmissibility frequently increase epidemic severity, whereas those with partial immune escape either fail to spread widely or primarily cause reinfections and breakthrough infections. However, when these phenotypes are combined, a variant can continue spreading even as immunity builds up in the population, limiting the impact of vaccination and exacerbating the epidemic. These findings help explain the trajectories of past and present SARS-CoV-2 variants and may inform variant assessment and response in the future.

Keywords: COVID-19; NPI; SARS-CoV-2; VOC; immune escape; mathematical model; nonpharmaceutical interventions; transmissibility; vaccination; variant of concern.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • COVID-19 / epidemiology
  • COVID-19 / immunology*
  • COVID-19 / transmission*
  • COVID-19 / virology
  • Computer Simulation
  • Humans
  • Immune Evasion*
  • Immunity
  • Models, Biological
  • Reinfection
  • SARS-CoV-2 / immunology*
  • Vaccination

Supplementary concepts

  • SARS-CoV-2 variants