 The increase in the number of COVID-19 cases in China and other parts of the world has led to a renewed interest in the spread of the pandemic. Among the issues that has come up is the rise of new variants and what authorities can do to combat their spread. The fresh surge of cases has led to questions about how to improve vaccines and the strategies that are being employed to test and track cases. Immunologists Dr. Saty Yitrat explains some of the key questions surrounding the increase in cases. We're discussing the renewed interest in COVID-19 on the background of the Chinese increasing numbers of cases, increasing numbers of hospitalizations and the worldwide response to those increases. So I think it's important to keep three separate issues in mind. The first is what are the factors that are driving the current situation in China? Second, what is all this talk about new virus variants that are emerging? Some are reported to be emerging in China, some are reported to be emerging elsewhere. What is the current situation and what are the current concerns with variants? And thirdly, what should be and should have been our response to the present situation at this stage of the pandemic? So some quick points about all these three issues. Firstly, what's going on in China is driven by the fact that China adopted in zero COVID policy for two and a half years successfully. And as a result, the overwhelming bulk of the Chinese population and communities are vaccinated but with vaccines based on 2020 virus strains. And as a result, the new strains that have been emerging over the past three years, Chinese communities are entirely unexposed to. And therefore, as they begin to lift the zero COVID policy, the new strains are going to spread all through communities left, right and center at relatively high speed. The zero COVID policy that China adopted was calculated in all likelihood based on the transmission efficiency of 2020 strains. Unfortunately for them and for the rest of us, the virus's population has steadily undergone evolution with variants that spread fast more and more and more rapidly, more and more efficiently emerging. And as efficiency of transmission improves, zero COVID policies become less and less sustainable, less and less maintainable. And therefore, China has had no option but to lift the zero COVID policy. The vaccines, whether we are talking about the inactivated virus vaccines in China or the adenoviral vaccines in Europe or in India or the mRNA vaccines in the United States and in some parts of Europe, all of these vaccines are based by and large on 2020 strains. And regardless of what vaccine platforms are used, 2020 strain based vaccines are not particularly good at reducing the efficiency of infection and transmission. And therefore, in communities, whether they are unvaccinated or they are vaccinated with one kind of vaccine or vaccinated with another kind of vaccine, newer variants will spread as infection through these communities. However, it is likely that these old generation, first generation vaccines will still provide some protection against severe illness and death. It remains to be seen how that plays out in China's now emerging outbreaks. And as those numbers come out, we will get some sense of how well those expectations are born. The issue about variants has another layer, which is when variants spread as in the Chinese communities amongst populations which have never been infected with an actual virus and which have been vaccinated a long time ago with the first generation 2020 strain vaccine, the variant selection is going to happen for better and better transmission, but not so much immune dodging or immunity evasion. But on the other hand, in other communities, such as in the global north, such as in the United States, for example, or in parts of Europe, highly vaccinated communities are meeting variants that are now beginning to come up dodging these immune responses. So it's very clear that both kinds of variants are being generated. So Chinese, the current dominant Chinese variant is actually a relatively few changes variant compared to some of the variants that are being seen in the United States, which have many more changes in the virus and which seem to be particularly good at dodging the immune system. So we need to start thinking about what our concerns will be about these various variants. And the final point, which is what should we be doing? So let's start with what we should have been doing, which is globally we needed a systematic community surveillance with statistical sampling so that we can compare numbers from week to week, from month to month between communities and so on and so forth, which we have not done all across the world. Case numbers are no longer really deeply meaningful because systematic testing is not done, systematic data reporting in many places is no longer being done and so on and so forth. What is even worse, the systematic identification of variants by sequencing viruses has been put on a back burner in many places in many different ways. And as a result, we don't know what the current patterns of spread are, what the current speeds of spread are and what the emerging variants from virus communities competing with each other are. And what that means is that when we speak about vaccines, we are still by and large restricted to 2020 or at most 2021 strains of the virus. What we really need is a systematic input from surveillance into a global vaccine development system across all vaccine platforms where new generation vaccines for newer and newer strains are rapidly developed, are rapidly tested for safety, for immune response effectiveness and undergo a globally normalized agreed upon regulatory process for licensing and safe deployment in communities. We know how to do this because a version of this kind of infection tracking vaccine development network, the world has been doing reasonably successfully for influenza. And yet, we as the world have failed to do this for COVID-19. Instead, we are simply pretending that the pandemic is over when as recent developments show us, it's really not. We need a longer term, much more public health and social good oriented point of view for addressing these problems.