[ExI] COVID-19 needs a Manhattan Project

[John Clark]

A single vaccine factory can cost half a billion dollars and 44
vaccines are in early stage development, and even after you find one that
works and is safe you're going to need billions of doses to vaccinate
everybody. Because nobody else is doing anything Bill Gates picked 7 out of
those 44 that he thought were most promising and decided to build factories
right now for all 7 with full knowledge that he will end up wasting
billions of dollars. Gates said:

"*Even though we’ll end up picking at most two of them, we’re going to fund
factories for all seven, just so that we don’t waste time in serially
saying, ‘OK, which vaccine works?’ and then building the factory. We can
start now by building the facilities where these vaccines will be made.
Because many of the top candidates are made using unique equipment, we’ll
have to build facilities for each of them, knowing that some won’t get
used. Private companies can’t take that kind of risk, but the federal
government can.*"

Gates can take the risk but so can the federal government, and they can do
things on an even larger scale than he can. And we're not going to get back
to normal until a vaccine is found and we're mass producing it. The
following is from an editorial in the March 27 2020 issue of the journal
Science:













*"There is an unprecedented race to develop a vaccine against severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2). With at least 44 vaccines
in early-stage development, what outcome can we expect? Will the first
vaccine to cross the finish line be the safest and most effective? Or will
it be the most well-funded vaccines that first become available, or perhaps
those using vaccine technologies with the fewest regulatory hurdles? The
answer could be a vaccine that ticks all these boxes. If we want to
maximize the chances for success, however, and have enough doses to end the
coronavirus disease 2019 (COVID-19) pandemic, current piecemeal efforts
won't be enough. If ever there was a case for a coordinated global vaccine
development effort using a “big science” approach, it is now.There is a
strong track record for publicly funded, large-scale scientific endeavors
that bring together global expertise and resources toward a common goal.
The Manhattan Project brought about nuclear weapons quickly (although with
terrible implications for humanity) through an approach that led to
countless changes in how scientists from many countries work together. The
Human Genome Project and CERN (the European Organization for Nuclear
Research) engaged scientists from around the world to drive basic research
from their home labs through local and virtual teamwork. Taking this big,
coordinated approach to developing a SARS-CoV-2 vaccine will not only
potentially save hundreds of thousands of lives, but will also help the
world be better prepared for the next pandemic.An initiative of this scale
won't be easy. Extraordinary sharing of information and resources will be
critical, including data on the virus, the various vaccine candidates,
vaccine adjuvants, cell lines, and manufacturing advances. Allowing
different efforts to follow their own leads during the early stages will
take advantage of healthy competition that is vital to the scientific
endeavor. We must then decide which vaccine candidates warrant further
exploration purely on the basis of scientific merit. This will require
drawing on work already supported by many government agencies, independent
organizations like the Coalition for Epidemic Preparedness Innovations, and
pharmaceutical and biotech companies to ensure that no potentially
important candidate vaccines are missed. Only then can we start to narrow
in on those candidates to be advanced through all clinical trial phases.
This shortlist also needs to be based on which candidates can be developed,
approved, and manufactured most efficiently.Trials need to be carried out
in parallel, not sequentially, using adaptive trial designs, optimized for
speed and tested in different populations—rich and developing countries,
from children to the elderly—so that we can ultimately protect everyone.
Because the virus is spreading quickly, testing will be needed in
communities where we can get answers fast—that means running trials
anywhere in the world, not just in preset testing locations. Working with
regulators early in the process will increase the likelihood of rapid
approvals, and then once approved, a coordinated effort will ensure that
sufficient quantities are available to all who need the vaccine, not just
to the highest bidder.All of this will require substantial funding, which
is the big ask of big science. Late-stage clinical trials are not cheap,
nor is vaccine manufacturing. Although new modular manufacturing methods
may speed up the process and cut costs, a single vaccine facility can cost
half a billion dollars. Distribution comes at a cost, too. So, to guarantee
sufficient production of SARS-CoV-2 vaccines, incentives are needed to
engage manufacturers for large-scale capacity. As for dissemination, those
organizations with experience in global vaccine distribution, like Gavi,
will be at the ready.Ideally, this effort would be led by a team with a
scientific advisory mechanism of the highest quality that could operate
under the auspices of the World Health Organization (WHO), for example. But
none of this will be possible without political will and a global
commitment from leaders of the G7 and G20 countries and multilateral
organizations, like the WHO and the World Bank. A pandemic of this
magnitude, affecting so many lives, livelihoods, and economies, demands
this.In many ways, COVID-19 is more like the Manhattan Project than other
big science efforts, not just because it involves the application of
science and not just in terms of scale, but because it is a global security
issue. In the race to develop a SARS-CoV-2 vaccine, everyone must win."*

John K Clark
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