Until the onset of the COVID-19 pandemic, vaccinology had fallen off a cliff. Not only have drug companies and scientists failed to bring vaccines to market, but the time it took to do so was measured in decades, not years — and certainly not months. All of this has been turned upside down by a sudden global demand for protection from the pathological damage SARS-CoV-2 has inflicted on our bodies. With millions of lives and billions of dollars at stake, a slew of drug companies including Moderna, Pfizer, AstraZeneca and Johnson & Johnson have done the impossible: They have delivered highly effective COVID-19 vaccines in less than one year. It was close to the miracle that science produces. This has been done, not by accident, by private corporations with a fiduciary duty to maximize profits for their shareholders, and a burning desire to be the first to market.
This record-breaking sprint to the finish line provided our species with a massive protection boost in the fight against COVID-19. While the death toll in the United States crossed the one million mark this month, the rapid distribution of COVID-19 vaccines is believed to have saved, in just the first few months, hundreds of thousands of lives across North America and Western Europe. Some observers, having gone through the lean years in vaccinology, have predicted that this astonishing success would usher in a new era of highly effective vaccines to treat everything from malaria to Zika to HIV. The march couldn’t have come at a better time: In the first two decades of the twenty-first century, more new epidemic-causing pathogens spread to humans than in the entire twentieth century. Humanity, on the brink of a new era of epidemics, is – in time – on the cusp of a global age of vaccinology.
Or so it seemed. In the year and a half since the arrival of COVID vaccines, the limitless possibilities and stark limitations of the for-profit scientific discovery system have been exposed. And even for those used to getting frustrated with the ways profit distorts the science industry, the absurdity of what happened amounts to a dystopian nightmare. Frankly, the system that gave us COVID vaccines has shown itself to be alarmingly incapable of developing innovations to protect our species from other emerging threats.
Case in point: Although there are at least five highly effective COVID vaccines currently on the market, there are also approximately 350 other COVID vaccine candidates in development. Let this sink in. Pfizer, Moderna, and the rest of the top winners are actively distributing tens of millions of doses of the vaccine worldwide (although there are few such doses in low-income countries). The market is full of effective vaccines; The last thing anyone needs is more brands to choose from. However, hundreds of pharmaceutical and biotechnology companies and research laboratories have concluded that it makes perfect sense to spend their resources developing more. The worst part is that given the perverse incentives of for-profit science, they are probably right. Since the basic principle of drug companies is to maximize profits, investments in low-risk discoveries — such as gradually improved treatments for chronic diseases like cancer, or another COVID vaccine — are your best bet to make money from, say, developing vaccines against a family of Viruses that can infect humans but have only a slight risk of generating a strain ready for a pandemic in the future.
The result of this absurd situation is that the gears of the scientific industry do not begin to move until a new virus has caused enough death and destruction to be treated. As Nat Moorman, a University of North Carolina virologist said, “What would you have paid me for a COVID-19 vaccine in 2018? Nothing.” There simply hasn’t been a market, although experts have already seen the emergence of two types of pathogenic coronaviruses since the 21st century. This puts our species in a precarious position. Although there is no discussion that humanity faces more spillover events and potential pandemics, there is no way the for-profit system can anticipate these challenges by funding the production of vaccines against viral families that may produce deadly strains. And make no mistake: the next pandemic will happen. In April, a worldwide outbreak of bird flu spread as a new strain began wiping out flocks around the world, threatening a spillover event to humans. Just one month later, 11 countries, including the United States, reported cases of monkeypox (a form of smallpox virus with a 1% mortality rate, spread through skin-to-skin contact), raising the specter of another case. A viral threat to our species even as the COVID-19 pandemic continues.
“While people are praising the speed with which Moderna’s COVID-19 vaccine reached the market, the truth is that the company has already developed a candidate vaccine for the coronavirus.“
Nevertheless, there is hope. Of the 150 known viral families, only 26 can infect humans. In the words of Dr. Barney Graham, a newly retired NIH vaccinologist who helped lead the development of the COVID-19 Moderna vaccine, “This is a limited number. This is a big but traceable and capable thing.” The “doable thing” that Graham advocated is to develop candidate vaccines for a representative strain of each of those 26 viral families. Twenty-six vaccines against 26 families to cover all of our bases against any pandemic strain that arises next. While we may never need most of them, taking on Graham’s project will radically accelerate our progress in fending off any future threat.
This is not just a guess. While people are praising the speed with which Moderna’s COVID-19 vaccine has reached the market, the truth is that the company has already developed a candidate vaccine for the coronavirus – for Middle East respiratory syndrome (MERS), a slow-spreading but deadly cousin of SARS-CoV. -2- In 2017. Obtaining preliminary safety and efficacy data from the MERS vaccine gave Moderna a head start in introducing the COVID vaccine candidate into trials and, eventually, to the public. There was little market incentive for the company to make a vaccine for MERS, and it likely would have only tried it for one big reason: It was funded to do so by the US National Institutes of Health, which is working on Graham’s vision to build representative vaccine candidates to prepare humanity for a pandemic. Viral epidemics of the future, I just happened to ask our moderns to start with the coronavirus. The rest is history.
Pharmaceutical companies and other for-profit actors should not be blamed for achieving their primary goal of making money for their shareholders. But we also cannot give up the space for scientific discovery for a system that can only look back at threats that already exist, and which stimulates investment in treatments that will yield a guaranteed financial return. If we are to get serious about protecting our species in this new pandemic era, we need to make sure that public money is spent to produce vaccines against potential pandemic strains from all the viral families that threaten our species. It’s the only way to make sure that instead of shelves filled with hundreds of brands of COVID-19 vaccines, we have something we can actually use the next time a new pathogen appears.