This Viewpoint proposes ways to maximize vaccine efficacy and allocation given the rise of coronavirus variants and authorization of a Johnson & Johnson vaccine, including reserving the latter for younger healthier populations, boosting it with a single-dose messenger RNA (mRNA) vaccination, and single mRNA immunization of people with prior documented SARS-CoV-2 infection.

This Viewpoint reviews circulating SARS-CoV-2 genetic variants and mechanisms of immunity by which they might escape coronavirus vaccine-induced protection and proposes 6 measures to address them, including enhanced variant isolation and testing procedures and continued adherence to mask-wearing and other established public health measures.