Biden Covid officials scramble to plan for Omicron subvariant threat

Top Biden health officials are increasingly concerned about the rise of new Covid variants in the U.S. that appear to evade existing treatments used to protect immunocompromised people from severe illness, according to three senior administration officials.

The variants — known as BQ1 and BQ1.1 — have spread swiftly throughout the U.S. over the past few weeks, and now account for more than 11 percent of all cases nationwide, according to the Centers for Disease Control and Prevention, roughly double the proportion they represented a week earlier.

The emergence of the "BQs," as health officials have referred to the variants internally, represents a fresh threat to Biden’s broader pandemic strategy, which has increasingly hinged on shielding vulnerable populations while encouraging a return to normalcy for most other Americans.

The rapid growth of the variants puts them on track to become the dominant strains of Covid within the next month, officials said. While the vaccines and the administration's main Covid treatment, Paxlovid, still work against those strains, the development could leave hundreds of thousands of people with compromised immune systems vulnerable to a winter wave without the two therapies that they've come to rely upon.

Early studies suggest Evusheld, the main treatment used to protect the immunocompromised from Covid, appears likely to be ineffective against the new variants, the officials said. And a second monoclonal antibody treatment known as bebtelovimab is also unlikely to work, meaning the variants' rise could leave cancer and transplant patients forced to rely on the treatments in lieu of vaccines without an immediate option for protecting themselves.

“[Evusheld] is a very powerful tool as a prophylaxis for people who are severely immunocompromised who even if you vaccinate them, they don't mount a very good response,” Anthony Fauci, the White House's chief medical officer, said in an interview. “If you have a variant that does not respond or isn't sensitive to one of the most important tools that we have, that's very concerning.”

Both BQ1 and BQ1.1 are sub variants of BA.5, which has long been the dominant Omicron strain in the U.S. The majority of cases in the country are still BA.5, CDC data shows.

But that share decreased in recent weeks as new strains took hold. BA4.6, a subvariant that appears capable of evading Evusheld but not bebtelovimab, accounts for about 12.3 percent of cases, in addition to the 11 percent combined total of BQ1 and BQ1.1 cases.

The resilience of the vaccines and Paxlovid against the new variants has come as a relief to the administration. In a statement, Kristen Nordlund, a spokesperson for the CDC, urged Americans to sign up for boosters the administration rolled out earlier this fall, saying the updated Covid vaccine “may provide improved protection against newer variants.”

The strains are still likely to be more contagious than previous versions of the virus, raising the odds of a surge of cases and hospitalizations during a winter season when people are more apt to gather indoors and spread the virus.

But for those who are severely immunocompromised, the administration has no contingency plan.

“We were trying to determine what the doubling time is. It should start to have an influence on how dominant it is going to be as we get into the late fall and early winter,” Fauci said, referring specifically to the BQ 1.1 variant. “It's a little bit of a black box, depending upon prior vaccinations, prior exposures and what region of the country you're in.”

Top health officials have spent recent days modeling the variants' likely trajectory and impact on Evusheld and bebtelovimab, with more definitive data expected in the next couple weeks. But early studies show both are likely to be far less effective or fail to work at all, leaving the administration searching for alternatives, including whether it can expand the use of other medicines not currently used to protect the immunocompromised.

There is little federal money available to invest in finding new treatments. The White House has for months sought roughly $23 billion from Congress to maintain its Covid response operations, warning its dwindling funds would cripple the government's ability to respond to new threats. But Senate Republicans have balked at the request, questioning the need for funneling billions more dollars toward a pandemic fight that's no longer as disruptive to daily life for the majority of Americans.

That's left the administration's more substantial pandemic preparedness efforts at a standstill. Health officials currently estimate it will take four to six months to develop updated treatments for the immunocompromised that would work against the new strains.

But that timeline, described by two senior administration officials, depends on first persuading Congress to allocate the additional money it needs to jump-start that development process.

The White House in the coming days is expected to ramp up pressure on lawmakers for more funding again, arguing the variants represent the kind of new threat that officials have long warned was inevitable — and that the U.S. is nonetheless unprepared to combat.

The variants' spread is also likely to ratchet up the urgency of the administration's existing vaccination campaign, which has so far gotten off to a slow start. The U.K. has already experienced a rebound of cases and hospitalizations driven by the existing BA.5 strain. Even though cases in the U.S. remain low, officials have noted signs of an uptick in the Northeast, typically the first region hit by a surge.

The Department of Health and Human Services has launched a national campaign to try and boost vaccination rates. The effort relies on digital outreach, advertising, influencers and paid media, and partnerships with more than 1,000 organizations to reach Americans in minority and rural communities, according to a spokesperson for the department.

Officials are hopeful the updated bivalent boosters will provide enhanced protection against BQ1 and BQ1.1, as well as the existing BA4.6 strain, Fauci said.

Even so, the administration still faces a daunting challenge in persuading people to seek out the shots ahead of a possible surge — and despite most no longer viewing Covid as a front-of-mind concern.

“It's extremely frustrating to see the low uptick uptake of a vaccine that is specifically directed towards the currently dominant circulating variant,” Fauci said. “Even if the sub variants of BA.5 become dominant … it still makes perfect sense to get as many people vaccinated as we possibly can because the bivalent [vaccine] for sure is gonna get cross protection against the sub lineages of BA.5.”