Evolution of resistance to COVID-19 vaccination with dynamic social distancing

Abstract

The greatest hope for a return to normalcy following the COVID-19 pandemic is world-wide vaccination. Yet, a relaxation of social distancing that allows increased transmissibility, coupled with selection pressure due to vaccination, will likely lead to the emergence of vaccine resistance. We analyze the evolutionary dynamics of COVID-19 in the presence of dynamic contact reduction and in response to vaccination. We use infection and vaccination data of six different countries. We show that for slow vaccination, resistance is very likely to appear even if social distancing is maintained. For fast vaccination, the emergence of mutants can be prevented if social distancing is maintained during vaccination. We analyze multiple human factors that affect the evolutionary potential of the virus, including the extent of dynamic social distancing, vaccination campaigns, vaccine design, boosters and vaccine hesitancy. We provide guidelines for policies that aim to minimize the probability of emergence of vaccine resistant variants.