There’s a one-word exit strategy for the devastating Covid-19 pandemic, which is crippling economies around the world: vaccines.
Political leaders and captains of industry know preventing Covid-19 infections is the only way to get the global economy back on its feet, said Richard Hatchett, CEO of an organization tailor-made to help spur the critical work of making vaccines. They also know, he said, that vaccine development will not be cheap.
Hatchett heads CEPI — the Oslo, Norway-based Coalition for Epidemic Preparedness Innovations. By the third week of January, CEPI had already signed funding agreements with three groups racing to develop vaccines. Since then, its portfolio has grown to eight, with more on the way.
STAT asked Hatchett about the work in early February. Late last week, we spoke with him again to see how the effort is progressing. The interview has been lightly edited for clarity and length.
Bring us up to speed on where things stand with the work you’re doing. You tweeted that the organization had raised $430 million toward your $2 billion goal, which feels like a long way off still.
We have eight vaccines that we’re supporting at this point. We actually have a couple more that we will be announcing soon. We’ve got obviously the partnership with GSK [GlaxoSmithKline] about the use of their adjuvants, which is great. Norway recently announced it is providing roughly $220 million. So we’re actually up, I believe, to around $660 million toward the $2 billion goal.
Kudos to Norway and everybody else who has contributed. But it feels like the world is not yet fully grasping that you don’t get vaccine unless people pony up.
I’m actually fairly sanguine that we will receive the funding that we need, because I do think that political leaders do understand that vaccine is the exit strategy. And, you know, every other attempt to get back to normality leaves very significant risk. So the quicker we can get a vaccine, the quicker we can put this pandemic and its consequences hopefully behind us. And the longer it takes to get to a vaccine, the deeper those consequences are going to be.
I’m also not clear why some of the major vaccine manufacturers, the people who have significant production capacity, are still on the sidelines. [Sanofi, Pfizer and Johnson & Johnson are working on Covid-19 vaccines; Merck and GSK to date are not.]
You’ve seen J&J and Sanofi have signed up for work with BARDA [the Biomedical Advanced Research and Development Authority], which will develop vaccines. In the first instance, those are vaccines to address U.S. requirements. But you know, if they succeed in developing vaccines, those vaccines can also be manufactured outside the United States and they can contribute to a global solution.
I don’t want to betray anybody’s confidence, but I’ve talked to all of the major manufacturers and they’re all really interested in helping. And I think you will see them play a very important role ultimately in the global response.
I will say that many of those manufacturers had over many years, whether it was with Zika or Ebola or dengue, had a series of experiences that somewhat disincentivized their participation in developing vaccines against epidemic diseases. This is different. This is an extraordinary historical event of unbelievable proportions. And I don’t think that the kinds of considerations that make them not want to jump into Ebola vaccine development are operative here.
This case is not only different because of the substantial need, but it’s clear that there is going to be a market for this. People are going to need to be vaccinated against this pathogen into the foreseeable future, wouldn’t you think?
I do. When it first emerged, there were different camps talking about whether it would self-extinguish or whether it would be contained or whether it would become endemic. I haven’t really heard anybody arguing anything other than that it is likely to become an endemic virus that we deal with forever. The long-term commercial calculus would tend toward making this a reasonable thing to invest in developing.
The challenge is we’re in a pandemic and we need vaccine super fast — as fast as we can possibly get it in very large quantities. We’re going to probably — I’ll speculate here — vaccinate a very large percentage of the world’s population in a very short period of time. That probably will take two or three or four years. But in a compressed period of time, we’re going to want to vaccinate 5, 6, even 7 billion people.
My own sense is that this will be a lot easier for companies if there are very substantial purchase commitments. One way to conceive of that would be a global advanced purchase commitment over several years to buy an awful lot of vaccine. And probably in the order of billions of doses over several years, that could be from multiple manufacturers. But I do think the world needs to think about it.
It also needs to think about how we’re going to allocate vaccine fairly. This is a case of enlightened self-interest. Countries can’t really protect themselves or protect their economic interests until the pandemic goes away. And that means getting vaccine to as many people globally as possible. And I don’t think you can just leave that to market mechanisms or even necessarily to tiered pricing. Because, you know, the vaccine supply is going to be limited initially. So there’s going to have to be some kind of prioritization of vaccine.
Bill Gates was talking recently about the need to build vaccine production capacity now, on spec. The problem with that is we don’t know what vaccine platforms are going to work. How do you anticipate that? Or do you think a lot of platforms are going to work with this?
I think you have to assume that a lot of platforms are going to fail because that’s just our experience with vaccine development.
I think — we’ve been quite candid with our donors about this — if we want vaccines as fast as we possibly can and we don’t want to compromise safety, i.e. we want to have a rational clinical development program, we’re going to have to take an awful lot of financial risk, which means doing exactly what Mr. Gates was describing. It means investing in manufacturing capacity for everything — right now — and scaling it up — right now — and even beginning full-scale manufacturing before we know if the vaccine even works.
And that means a huge commitment of resources. That’s well beyond the $2 billion that I’ve been talking about. That’s talking tens of billions of dollars if you include the cost of manufacturing hundreds of millions or billions of doses.
And that’s the reality that political leaders need to understand. They also need to weigh that reality. I mean they shouldn’t balk at that. They’re financing trillion-dollar rescue packages for the economy. The fastest path out of this is having lots of vaccine as fast as possible. And if that means making a $30 billion bet, then it means making a $30 billion bet.
CEPI is funding the Moderna-NIAID vaccine, which has already started clinical trials. When we last spoke, you talked about the fact that any vaccine that CEPI funds needs to be available to the global community. I have a hard time imagining the U.S. government allowing anything out of the United States until it felt that American needs had been met. How do you enforce that contract stipulation?
That’s a pressure that any government, anywhere, of any political persuasion is going to face, to be fair. And the solution that we are pursuing with all of our partners is to focus on how can we globalize the manufacturing capacity. How can we replicate manufacturing in multiple locations around the world?
That’s a core part of our strategy to really improve global access to the vaccines. Because you’re going to face the same pressures in India, in China, in Belgium. Everywhere the vaccine is manufactured, political leaders are going to feel the same pressure. It’s going to be a real challenge.
One thing that I would offer is that right now, no government knows who the winners and losers are going to be. And no government can be certain that they’re going to have access to vaccines. Securing access to vaccine for your health care workforce and your most vulnerable populations as part of a globally brokered fair allocation system may be an attractive deal right now. Otherwise, you’re taking your chances. And over time, as the winners and losers begin to emerge, I think the opportunity to have such conversations will be more restricted.