SARS CoV-2 mutations are relatively infrequent although D614G mutation has quickly become dominant globally Adaptive pressures could impact future transmission as well as efficacy of vaccines based upon earlier viral characteristics SARS CoV-2 in Wuhan (D614 in orange) SARS-CoV-2 spike protein Impact of viral mutations: • SNP mutations (green) • Increased likelihood of mutations as infections increase • D614G mutation (red) • Efficacy of vaccines based upon earlier versions of virus • Accuracy of diagnostic tests • Transmission capacity • Severity of infection • Potential need for booster vaccines doi.org/10.1101/2020.04.29.069054doi doi.org/10.1101/2020.04.28.066977doi IQVIA Global Executive Briefing: COVID-19 June 2020; Copyright 2020 IQVIA. 9