Trump’s bet on a vaccine could come at a cost
The federal government has poured $10 billion into Operation Warp Speed.
As coronavirus cases surge to record levels and states backtrack on efforts to reopen their economies, the Trump administration is increasingly pinning its hopes on a vaccine that may never come.
The federal government has poured $10 billion into Operation Warp Speed, the joint project of the departments of Health and Human Services and Defense to accelerate the development of a Covid-19 vaccine. Teams of military and Coast Guard personnel are now stationed at a seventh floor command center in HHS headquarters as the government tries to deliver 300 million vaccine doses by January — a feat that would require shaving years off the normal development process.
But the audacious effort to break speed records on a vaccine comes with a cost.
The White House coronavirus task force has dramatically scaled back its meetings, leaving the public awareness effort as a side show rather than the dominant presence it was earlier in the crisis. Scientists inside HHS say they’re confused by the rapidly changing organizational structure and the role of the outside consultants now dotting the health department.
The pursuit of a vaccine across federal health agencies has also forced trade-offs. The Biomedical Advanced Research and Development Authority, for example, has halted a push for lung treatments to fight the coronavirus, potentially putting a treatment option on the back burner.
The danger of going all in on a vaccine may be that President Donald Trump is pinning hopes on a miracle shot while there’s considerable reason to believe that the outbreak could stretch on for years.
“There’s no guarantee that a vaccine is going to work,” said Luciana Borio, who served as the FDA’s acting top scientist and worked on White House pandemic preparedness efforts earlier in the Trump administration. “And even if it does, there’s no guarantee that it’ll be the right product for most people, or that people will want to take it, or that the virus won’t mutate.”
Vaccines are notoriously difficult to make; the vaccine for mumps, the fastest ever developed, took four years. Many take far longer, and more still fail in animal or human testing and never reach the market. Public health experts say the U.S. government is making a risky bet by focusing so much of its pandemic response on the hope that a shot will end the coronavirus’ devastating march.
This story is drawn from interviews with eight officials inside the administration, who spoke on condition of anonymity because they were not authorized to speak publicly, as well as outside scientists and other public health experts.
Inside Operation Warp Speed, officials are brimming with confidence. Five people involved in the vaccine project insist that there are reasons to be confident it will succeed: Two vaccines may be just weeks away from beginning the late-stage clinical trials; there are as many as six other viable candidates being tested and plans to radically expedite production are well underway.
But outside health experts say federal officials need to level with the public, a task complicated by Trump repeatedly vowing that the vaccine is imminent — perhaps arriving before Election Day.
“The perception of the vaccine politics is damaging,” said a former Trump HHS administration official. “If they approve one quickly, people are going to be skeptical.”
“The White House has consistently looked for magic solutions — hydroxychloroquine, remdesivir, now vaccines — but that’s not how it works,” added virologist Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “Our first Operation Warp Speed vaccines may only be partially protective and reduce severity of illness, which is important, but may not prevent disease or interrupt transmission.”
Even if the administration hits its ambitious vaccine target, tens of thousands of Americans may die from the coronavirus in the interim. The United States smashed the single day record of new cases for five straight days last week and states like California and Texas reported record hospitalizations.
Concerns about political pressure over vaccines have been echoed by Elias Zerhouni, former head of the National Institutes of Health and a finalist for the Operation Warp Speed role that went to Slaoui.
“It was really obvious to me that what they wanted was a vaccine. That’s it. Deliver a vaccine by the end of the year,” Zerhouni told NPR on Monday. “There are political overtones to that, and I said I don’t think I’m the right person for that, because I don’t believe you can do vaccines independent of therapeutics.”
Borio, the former acting FDA chief scientist, said the vaccine sprint should pay off with significant progress toward an effective shot — if not the full vaccine that Trump has sometimes suggested will be available before the election. “If I had to put money on this, I’d say we have some data and doses at the end of the year for a few of the candidates,” she said, singling out a pair of vaccines being developed by Moderna and AstraZeneca.
But both vaccines rely on what’s known as a gene-based approach, which Borio said raised a concern: The newer gene-based vaccines don’t have the same track record of producing potent and durable immune response that traditional protein-based vaccines do.
Scientists also said they’re trying to take the long view on vaccine development, comparing this year’s sprint to a relay race: The vaccines rushed by the Trump administration will likely give way to superior replacements.
“The Operation Warp Speed vaccines may not be replacement technologies but instead companion technologies” to existing tactics to slow the virus, said Hotez, noting that any coronavirus vaccine’s effectiveness will likely improve over time. “It means we will still require to have in place ongoing public health control measures, masks, contact tracing, and some social distancing,” he added.
Meanwhile, senior officials like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Surgeon General Jerome Adams have acknowledged that simply producing the vaccine is not enough: The government will need to overcome vaccine hesitancy in many communities in order to get enough Americans to develop herd immunity, particularly because experts predict that the vaccine may need to be delivered in two separate doses.
Americans “may not like a government person in a suit like me telling them” to get vaccinated, Fauci warned on CNN on Sunday. “They really need to see people that they can relate to in the community — sports figures, community heroes, people that they look up to.”
“We should be enlisting every community leader in disproportionately affected communities,” said Shah, head of the Rockefeller Foundation, calling on the Trump administration to take the lead in setting up an infrastructure to push public health messages now and treatments later. “When the vaccine’s available, that’s your sales force.”