(Bloomberg Opinion) — In the war against the coronavirus, only one weapon has the potential to ease the conflict quickly: a vaccine. With about 164,000 Americans dead from Covid-19, the economy battered and communities forced into recurring lockdowns, the federal government has made a $10 billion wager that public funds and expertise wedded to private research and production can jump-start a vaccine’s arrival — possibly by early next year. Operation Warp Speed, launched in April, is administered by the Department of Health and Human Services, the Biomedical Advance Research and Development Authority, and the Department of Defense, along with several other federal agencies. A handful of pharmaceutical companies, including AstraZeneca Plc, GlaxoSmithKline Plc, Johnson & Johnson, Moderna Inc., Novavax Inc., Pfizer Inc. and Sanofi SA, have received the lion’s share of the federal funding. The companies are spending those billions on vaccine development and clinical trials, as well as the cost of manufacturing and delivering a successful candidate to the government. Companies aren’t required to repay the money, and the government is getting no equity stake or profit participation in return for the taxpayer dollars. But the companies have committed to delivering hundreds of millions of doses of their vaccines directly to the government, which promises free inoculations for Americans. There’s likely to be plenty of wreckage along the way. Many companies may not be able to engineer a vaccine, much less deliver one, and billions of dollars will go down the drain. It’s a calculated risk worth taking, as long as it speeds an effective vaccine to market. Drug companies normally develop drugs slowly in order to minimize pricey failures. A cushion of federal funding allows Big Pharma to begin manufacturing possibly money-losing drugs even while trials are underway, compressing years of work into months. Warp Speed’s upside — saving lives — is well worth any money that may get lost. But the program also has been shrouded in secrecy. The government has good reasons to keep some parts of the program under wraps, particularly negotiations that could affect the stock prices of companies making bids. But the process for deciding which companies were tapped to participate in the public health equivalent of the Manhattan Project has been entirely too opaque. And that lack of transparency is also likely to make the public — the folks who will have to line up for inoculations — skeptical that the government has ensured that we wind up with an effective, safe vaccine.Two of the men overseeing Warp Speed, Moncef Slaoui and Gary Disbrow, say they aren’t cutting any corners around testing or safety protocols before a vaccine is released into the wild, but time is of the essence. “If we were to wait to scale up manufacturing until we had results of Phase 3 clinical trials, we would be looking at a six- to eight-month delay before we even started manufacturing,” says Disbrow, who has worked for Barda since 2007 and is now the agency’s acting director. “The financial burden for lives lost and the financial burden to our overall economy for not allowing our people to go back to a somewhat normal routine is much greater than the financial burden that we’re assuming in developing these vaccines.” Slaoui is a well-regarded, Moroccan-born research scientist who spent three decades at GlaxoSmithKline, most recently as head of the drug giant’s vaccines department, before he retired in 2017. He also served on several corporate boards of directors, including Moderna’s, before President Donald Trump’s administration appointed him as Warp Speed’s chief adviser in May.“As I took the role coming from industry, I had a few hesitations, concerns that I may get myself into some kind of a moving sand and bureaucracy,” he says. “And it’s just in the reverse. It’s incredible. I think the level of focus and alignment and empowerment and lack of interference — it’s just perfect. And I think as an executive team we’re running at a thousand miles an hour.” 

Slaoui also has little patience for critics of Warp Speed’s structure or goals: “Many, many experts are saying, ‘Why, this has never been done,’ and ‘Why, it’s impossible to do.’ I would like to ask them: Please, can you take 10% of your time and help us try to make it work? … Of course its very difficult. Of course it could fail.” That doesn’t address one of the most pertinent criticisms: that Warp Speed’s contracts and spending aren’t transparent. The House Select Committee on the Coronavirus Crisis has just called for Warp Speed officials to provide more information on its operations.In a recent Senate hearing, legislators grilled Disbrow, along with Robert Redfield, director of the Centers for Disease Control and Prevention, and Francis Collins, director of the National Institutes of Health, about how the operation is being run. “The administration still has not provided any explanation of how it is selecting vaccine candidates, what the risks are of narrowing down that shortlist or addressed concerns about potential conflicts in contracts that predate this crisis,” Senator Patty Murray, a Democrat from Washington state, observed during the hearing.

 

The Warp Speed leaders declined to offer specifics to senators on which companies were candidates or how the selection process works. Disbrow noted that Barda has been making Warp Speed investments public as soon as the agency believes it’s appropriate to do so. Collins said his agency convened a panel of experts who reviewed 50 Covid-19 vaccine candidates before the list was winnowed down. All three men told the senators that they hadn’t come under pressure from the White House or anyone else in government to select particular Warp Speed participants or to expedite the delivery of a vaccine to improve President Trump’s re-election prospects. But political controversy has haunted every discussion of Warp Speed and its timeline for delivering a vaccine. And for good reason. Trump has frequently highlighted the possibility that a vaccine will arrive much sooner than experts and Warp Speed’s own leaders predict, and he has forced agencies such as the CDC and the Food and Drug Administration — both part of the Warp Speed effort — to bend to his will or follow his lead on medically dubious initiatives. Slaoui says a vaccine could be available by the end of the year for some at-risk individuals, but that would require emergency approval from the FDA. Stephen Hahn, the FDA commissioner, has said his agency will maintain high standards in its approval process, but Trump has also made his preferences clear. That could put pressure on Hahn, an inexperienced commissioner who already flip-flopped on granting emergency authorization for the use of hydroxychloroquine, a controversial and ineffective drug favored by the president. Members of the medical community have also raised red flags about Warp Speed’s opaque selection process. They contend that some companies appeared to have been selected because they could manufacture a vaccine quickly, not because they demonstrated the most promising scientific approaches. “It’s typical Operation Warp Speed, where everything is sort of cryptic and it’s unclear what they’re actually saying,” Peter Hotez, a vaccine researcher at Baylor College of Medicine, told Science Magazine in June. “What have these vaccines been chosen to do?” Slaoui and Disbrow say transparency is a priority but that they’re negotiating with publicly traded companies and have to be circumspect about disclosure to avoid moving their stock prices. They say they will soon disclose extensive data from trials the companies have conducted.

Continue reading “Covid-19 Vaccine Push Lacks a Key Ingredient: Trust”