America’s leaders and health-care elites are fixated on taking the pandemic seriously. President Joe Biden, Anthony Fauci, the Cleveland Clinic, The Washington Post, The New York Times, and, yes, The Atlantic, all agree: We should “take the pandemic seriously.”
I take the pandemic seriously, myself. But at this stage of the crisis, I would like to nail down the terminology. What does it mean for an advanced nation to take a pandemic “seriously”? And are we sure that’s what we’re actually doing?
In the past 13 months, the concept of seriousness has been equated with the level of sacrifice people are willing to stomach. How much of our social and emotional lives are we willing to cancel? How many consecutive days are we willing to stay inside? How many masks are we willing to don? How many schools are our local leaders willing to close? And how many retailers? And how many restaurants? And how many parks, and how many beaches?
Some of these sacrifices are, or at least were, plainly necessary. Some of them were less essential. But the fact that any of these sacrifices was required for more than a year in the most scientifically advanced moment in human history is a catastrophic failure that deserves our fury and attention.
Going forward, “taking a pandemic seriously” should be a matter not of mandatory sacrifice but of creative preparation. We need new laws, new policies, and new scientific processes to ensure that we never have to go through this again. We need to pandemic-proof America—and, just as urgently, to pandemic-proof the world.
So how do we do that? We can (and should) talk about better testing, or better ventilation, or clearer public-health communications. But all of these solutions are provincial compared with the single best way to pandemic-proof the planet: We need to vaccinate the world much, much faster.
Global vaccine inequality is stark. For nations leading the world in rapid vaccination, such as Israel, the pandemic appears to be nearly over. Meanwhile, the coronavirus is still raging in Brazil, and India is dealing with a terrifying explosion in cases. One model suggests that India could be experiencing as many as 7 million COVID-19 infections every day. These outbreaks are tragic for local populations. But their risks affect all of us. As the virus continues to thrive and mutate in other countries, these places can be hot zones for variants, which can spread and threaten the world.
Last year’s vaccine breakthroughs, which led to the speediest authorization of new vaccines in history, might seem like a pinnacle of human achievement. Not everybody is so impressed. “People say, ‘Oh wow, it’s so great that we got a vaccine in a year,’ but almost 3 million people have died,” Florian Krammer, a vaccine scientist at Mount Sinai, told me. “Eleven months isn’t good enough. A novel vaccine in about three months should be the goal.”
A 100-day vaccine: That might sound like some arbitrary, pie-in-the-sky figure. But in the past few weeks, I’ve spoken with Krammer and several other vaccine experts who believe we could make the 100-day vaccine a reality. Developing and distributing a vaccine in that time frame would require a good deal of money, a great deal of planning, and a heroic expansion of vaccine-manufacturing capacity. But compared with the cost of COVID-19—3 million deaths, countless more lives sundered and wrecked, several trillion dollars of global income lost—just about any plan would be the bargain of the century.
The 100-day vaccine plan has three parts: virus surveillance, vaccine research and development, and manufacturing and distribution.
The first step is to build a super-team of virus hunters. “We need to know what viruses are out there, because otherwise we can’t prepare for them, or vaccinate against them,” Krammer said. Several organizations, including the CDC and the World Health Organization, already monitor influenza strains in humans and animals around the world to guide the development of seasonal flu vaccines. Krammer said we should expand that effort to surveil about 100 of the most dangerous virus types, especially those that move from human to human via the respiratory tract, because they tend to be the hardest to stop.
Step two is something like Operation Warp Speed for the pandemics of the future. Once scientists have the resources to identify and track viruses with the gravest pandemic potential, a consortium of countries led by the U.S. should fund Phase 1 and Phase 2 trials around the world to test new vaccines against them. The price tag would likely run into the billions; again, a steal compared with the anguish of the past year.
The fastest way to develop a vaccine against an emergent outbreak is to already have the necessary research at your fingertips. The recipe for Moderna’s mRNA vaccine against COVID-19 was developed in 48 hours. (That is not a typo.) The company’s scientists weren’t magicians or oracles: They built on four decades of grueling work with mRNA, basic research on coronavirus spike proteins, and a breakthrough in the manipulation of lipid nanoparticles. Basic virology plus vaccinology research accelerated the vaccine’s development. Krammer’s idea is to try to build a vaccine for the next pandemic before it even starts.
Step three, perhaps the hardest, is making the goop, because a vaccine that doesn’t go into any arms is the same as no vaccine at all. “Surveillance is cheap, and the vaccine trials are very doable, but the big challenge is production capacity,” Krammer said. “That’s going to be the heaviest lift and the most expensive part of this.”
Tara Kirk Sell, an assistant professor at Johns Hopkins University, has been thinking about the problem of vaccine manufacturing for a while. In 2018 and 2019, she and a group of researchers interviewed several vaccine manufacturers about their readiness for the next pandemic. “We asked them, if there was a new vaccine that the world needed, could they manufacture half a billion doses in six months? The answer in most cases was no,” she told me.
Sure enough, despite unprecedented cooperation among global pharmaceutical companies to mass-produce mRNA vaccines and other vaccine types from AstraZeneca, Novavax, and CureVac, we are nowhere near on pace to vaccinate the world by the end of 2021.
To be fair, the vaccine supply chain is incredibly complex, and the fact that anybody is vaccinated against COVID-19 today is a heroic achievement. The facilities that engineer biotech ingredients such as cell material are completely different from the ones that fill vials and package vaccines, which are nothing like the plants that manufacture glass vials, stoppers, needles, and syringes. Getting every last vial, needle, and subarctically frozen bag from place to place even before they’re distributed to the public is a logistical feat in itself. For example, Pfizer produced raw materials for its mRNA vaccine at its Missouri plant, which it shipped to a Massachusetts facility to make the final vaccine, which it then transported to Michigan for packaging and distribution in GPS-tracked boxes that had to be kept below –70 degrees Celsius. The Washington Post reported that Pfizer has even had to build its own dry-ice factory to keep its vaccines properly chilled en route to your deltoid.
With AstraZeneca and Johnson & Johnson running into regulatory difficulties, scaling production of the mRNA vaccines is particularly important. The obstacle is not just intellectual property but the dearth of facilities with the human expertise and specially built equipment to manufacture enough synthetic mRNA goop to inoculate the world this year.
One solution for future pandemics is for the U.S. and others to lead a global effort to build many more facilities that can plug into the mRNA-vaccine supply chain. But even that wouldn’t necessarily solve logistical problems in future pandemics, because a future virus might require a totally different vaccine technology that requires a totally different kind of facility. “It’s very hard for an established facility to switch over to a new vaccine technology like mRNA, and then switch over to something else,” Sell said. “This is not like making cars, and you can just switch from green to pink paint. It’s not even like a Ford plant switching from making Prius cars to making tanks in wartime. It’s more like a car factory being suddenly asked to manufacture microchips, and then being suddenly asked to make living-room couches. You need completely different machines and expertise.”
Sell said that governments and vaccine-manufacturing experts need to think about creating something that doesn’t exist yet: a global network of “flexible vaccine-manufacturing” facilities that combine large, permanent systems with smaller-scale tools, such as 3-D printers, to finely engineer mRNA and DNA. Between pandemics, these facilities could pump out vaccines for other diseases and seasonal flus in both hemispheres. And in the event of a global outbreak, they could shift to pandemic-vaccine production within weeks and meet that 100-day vaccine target.
If it sounds as if nobody quite knows how to do this yet, it might be because nobody quite knows how to do this yet. That’s okay. The first 12 months of the pandemic were an accelerant for vaccine-development knowledge. Perhaps the next few years can be an accelerant for global vaccine-manufacturing cooperation. After 600,000 official American deaths, after more than 3 million official global deaths, after trillions of dollars in global economic growth were wiped out, and with new cases still climbing worldwide, the 100-day vaccine is a moral and economic necessity. This is what taking the pandemic seriously looks like.