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. 2021 Jun 23:NEJMsr2105280. doi: 10.1056/NEJMsr2105280

Table 1. Vaccine-Related Priorities to Control Viral Variants.*.

Evaluate existing vaccines for efficacy against variants
Randomize vaccine schedules (e.g., agents and timing) during deployment and study postexposure prophylaxis
Perform observational studies to estimate variant-specific vaccine effectiveness
Expand worldwide capacity for sequencing of virus isolates
Obtain sequences of clinical isolates from postlicensure studies, clinical trials, and vaccinees with serious breakthrough infections
If current vaccines are inadequate, assess the effectiveness of new vaccines or modified vaccines against variants
Evaluate new vaccines, ideally in randomized, placebo-controlled trials with clinical end points
Develop and evaluate modified vaccines to achieve adequate efficacy against variants of concern
Reduce the risk that additional variants of concern will emerge
Promote public health measures (e.g., masking, social distancing, and vaccination) to reduce viral transmission
Avoid the use of treatments with uncertain benefit that could drive the evolution of variants
Consider targeted vaccination strategies to reduce community transmission
Coordinate the worldwide response
Identify and characterize viral variants of concern
Select antigens for modified or new vaccines
Share research results, including methods to link genetic sequence data with the antigenic characteristics of circulating SARS-CoV-2
Decide whether the variant data warrant modification of existing vaccines
Promote convergence of regulatory assessments
Establish a global data repository
*

An existing vaccine is one that has been shown to be effective in clinical trials, a modified vaccine one in which a new antigen is delivered through an existing vaccine, and a new vaccine a completely new vaccine. SARS-CoV-2 denotes severe acute respiratory syndrome coronavirus 2.

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