Speaker 1: I'm Carol Masser and I'm Tim Sentovic. The cover story
Speaker 1: of Bloomberg Business Week this week the five things to
Speaker 1: get right before the Next pandemic. Every infectious disease expert
Speaker 1: knew something like the novel coronavirus was coming sooner or later,
Speaker 1: just as they know today that COVID nineteen won't be
Speaker 1: the last pandemic. That is so true to him. The
Speaker 1: world cannot eliminate emerging diseases. In the twenty one century alone.
Speaker 1: Humanity has contended with outbreaks of stars in two thousand
Speaker 1: three h one and one in two thousand nine, mers Ebola,
Speaker 1: and now, of course COVID. But what we can do
Speaker 1: is prepare for the next one, and we can do
Speaker 1: it now, because there will be another pandemic, and then
Speaker 1: another one after that. Of course, pandemic response as well,
Speaker 1: they require foresight. To that end. Prioritizing just a handful
Speaker 1: of initiatives could help stave off the disaster inflicted on
Speaker 1: the world this round. A five point planned stop the
Speaker 1: next pandemic. The fight against COVID isn't over, but we're
Speaker 1: already learning lessons for the next epidemiological crisis and the
Speaker 1: one after that. By Robert Langreth. In January, a lengthy
Speaker 1: proposal showed up at the offices of the Biomedical Advanced
Speaker 1: Research and Development Authority in Washington. Running a hundred and
Speaker 1: twelve pages, the document described a strategy for stopping future pandemics.
Speaker 1: It outlined a number of vaccine technologies to pursue, including messenger,
Speaker 1: RNA and adinavirus vectors, and recommended that a team of
Speaker 1: one hundred and eighties scientists, doctors, and other experts be
Speaker 1: created to carry out the plan. There were intricate technical details,
Speaker 1: an org chart, and an estimated cost five million dollars
Speaker 1: over ten years. Congress created BARDA, a division of the U.
Speaker 1: S Department of Health and Human Services, in two thousand
Speaker 1: and six, for precisely this kind of thing. It's charged
Speaker 1: with developing and procuring drugs and vaccines, and ensuring that
Speaker 1: the country is researching countermeasures to combat bio terrorism and
Speaker 1: chemical warfare, as well as pandemic influenza and other emerging
Speaker 1: infectious threats. The agency has historically been small, though, and
Speaker 1: the proposal, which came from the pharmaceutical company Glaxo Smith Klein,
Speaker 1: would have entailed one of its more ambitious efforts Following
Speaker 1: the massive fourteen Ebola outbreak in West Africa, which killed
Speaker 1: more than eleven thousand people, Glaxo researchers wanted to identify
Speaker 1: virus is likely to cause major epidemics and tackle several
Speaker 1: of them at once. The idea was to just make
Speaker 1: vaccines against all the viruses, says Monsef Sloughi, who was
Speaker 1: then chairman of the company's vaccines unit and later served
Speaker 1: as chief science adviser to the Trump administration's Operation warp Speed.
Speaker 1: Glaxo owned an underutilized lab and a decommissioned biotech plant
Speaker 1: in Rockville, Maryland, and it was already relocating vaccine researchers
Speaker 1: there as part of a corporate reorganization. Under its bar
Speaker 1: toa proposal, the mo MANY would have provided scientific staff
Speaker 1: and facilities at the Rockville site, while government agencies and
Speaker 1: nonprofits funded vaccine development for multiple platform technologies through early
Speaker 1: human trials and manufacturing. That way, if an outbreak happened,
Speaker 1: Glaxo would have prototype vaccines ready for final stage trials.
Speaker 1: A team from the company spent months refining the proposal,
Speaker 1: according to a person familiar with the effort, and had
Speaker 1: reason to believe it might get funded. BARDA officials met
Speaker 1: with Glaxo scientists on multiple occasions, toured the Rockville facility,
Speaker 1: and urged the company to submit a formal proposal, the
Speaker 1: person recalls after it was submitted, BARTA quietly considered it
Speaker 1: for several months. Finally, in late seen, the agency suggested
Speaker 1: that Glaxo come up with a scaled down plan focused
Speaker 1: mainly on influenza. That proposal never got funded, either, leaving
Speaker 1: the world without a key weapon against emerging viruses when
Speaker 1: the pathogen that causes COVID nineteen was Discoveredvaccines have since
Speaker 1: been developed using mr NA and a dinavirus vector approaches
Speaker 1: similar to those originally suggested by Glaxo. Many of the
Speaker 1: vaccines benefited from grants from BARDA during the pandemic and
Speaker 1: from government sponsored basic research beforehand. Still, the failure to
Speaker 1: put more extensive infrastructure in place ahead of time was
Speaker 1: a lost opportunity to build up capacity that could be
Speaker 1: bolstering its vaccine supply right now. It was a failure
Speaker 1: even a refusal to fully plan ahead, a blunder that
Speaker 1: ranks with the White House decision to disband the dedicated
Speaker 1: pandemic Response Unit at the National Security Council in May,
Speaker 1: and the inability of the Centers for Disease Control and
Speaker 1: Prevention to quickly develop a COVID test for wide distribution.
Speaker 1: In late every infectious disease expert knew something like the
Speaker 1: novel coronavirus was coming sooner or later, just as they
Speaker 1: know today that COVID won't be the last pandemic. As
Speaker 1: depressing as the current situation is, though, the next one,
Speaker 1: and there will be a next one, doesn't have to
Speaker 1: be this bad. Shortly before his inauguration, President Biden proposed
Speaker 1: spending twenty billion dollars to speed up vaccination rollouts. That's
Speaker 1: a start, but a complete plan, one that can protect
Speaker 1: the US from mass death, catastrophic economic damage, and let's
Speaker 1: hope incompetent political leaders who squander the public's trust will
Speaker 1: have to be more comprehensive. It will likely involve at
Speaker 1: least five separate areas of research and investment. Most of all,
Speaker 1: it will require careful preparation one pathogen surveillance. The world
Speaker 1: can't eliminate emerging diseases. Too many people live near animals,
Speaker 1: and there's too much international air travel. In the twenty
Speaker 1: first century alone, humanity has contended with outbreaks of stars
Speaker 1: in two thousand three h one and one in two
Speaker 1: thousand nine, mers in Ebola, and now COVID. Candidates to
Speaker 1: sicken the world in the future include highly virulent philoviruses,
Speaker 1: which include the Ebola and Marburg viruses, rapidly spreading mosquito
Speaker 1: born flavoviruses such as those that cause zica and dinge fever,
Speaker 1: and bat born paramix viruses like NIPA and hendra. All
Speaker 1: of these are scary. Marburg and Ebola can lead to
Speaker 1: severe vomiting, diarrhea and bleeding, Hendra anipa to deadly brain swelling.
Speaker 1: More a whereisome Still, we tend to wait for outbreaks
Speaker 1: to kill a few dozen people before we do anything
Speaker 1: about them. Our current strategy is we really do let
Speaker 1: them happen, says Peter Dashak, a veteran virus hunter at
Speaker 1: Eco Health Alliance in New York, a nonprofit research group.
Speaker 1: Dash AC suggests we approach emerging viruses the way we
Speaker 1: approach terrorist networks. Track them so we can intervene before
Speaker 1: they reach havoc. Dash Ak, who spent years looking for
Speaker 1: bat coronaviruses in China and elsewhere, estimates there are about
Speaker 1: one point seven million unknown mammal viruses, many of which
Speaker 1: could spill over into humans with just a few mutations.
Speaker 1: He and his collaborators calculate that it would cost a
Speaker 1: little more than one billion dollars to identify two thirds
Speaker 1: of these pathogens by sampling wild animal populations around the world.
Speaker 1: Doing this would give scientists clues about which viruses pose
Speaker 1: the greatest risk to humans, allowing communities situated in potential
Speaker 1: hotspots to focus on reducing spillover risk and helping governments
Speaker 1: and research institutions allocate resources for further study. If we
Speaker 1: had a better handle on what was happening pathogenically, we
Speaker 1: could work to identify the outbreaks that have the most
Speaker 1: potential to become severe, says Caitlin Rivers, an epidemiologist at
Speaker 1: the Johns Hopkins Center for Health Security. Imagine a kind
Speaker 1: of national weather service for pandemics that would predict the
Speaker 1: course of emerging pathogens. These official forecasts would be more
Speaker 1: authoritative than the hodgepodge of competing disease models out there now,
Speaker 1: making it easier for governments to undertake potentially unpopular mitigation measures,
Speaker 1: such as closing borders or ordering lockdowns before an outbreak
Speaker 1: takes hold during the COVID pandemic. The opposite happened in
Speaker 1: late February, right before its hospitals were overrun. Milan's city
Speaker 1: government unveiled a campaign called Milan Does Not Stop, which
Speaker 1: encouraged people to visit tourist attractions and go out to dinner.
Speaker 1: In the US, many local leaders hesitated before imposing harsh
Speaker 1: social distancing measures. Had restrictions come only one week earlier,
Speaker 1: according to research from Columbia, thirty two thousand lives would
Speaker 1: have been saved by early May. It's about giving decision
Speaker 1: makers enough confidence so they feel comfortable acting, Rivers says,
Speaker 1: and an epidemic forecasting center would be a relative bargain,
Speaker 1: costing the US only one million to one hundred fifty
Speaker 1: million dollars a year. She estimates. The Biden administration is
Speaker 1: planning to create one two, repairing and augmenting the w
Speaker 1: h O. Pandemic surveillance and response almost by definition, are
Speaker 1: global efforts, which means it's time to consider a new
Speaker 1: global partnership to oversee them. The World Health Organization's structural
Speaker 1: shortcomings have been well documented. The main international body charged
Speaker 1: with fighting disease, it's been criticized by the U S
Speaker 1: and others for being overly deferential to China and for
Speaker 1: being slow to declare the outbreak a global emergency. The
Speaker 1: agency responds that it has to remain diplomatic while collecting
Speaker 1: information and that it can't force member states to reply
Speaker 1: to it. Still, the spat led the US to announce
Speaker 1: last year that it was withdrawing further weakening the body
Speaker 1: at a key moment. This dispute, like so many aspects
Speaker 1: of the COVID catastrophe, was predictable. The current pandemic response
Speaker 1: system relies on transparency. Governments are supposed to alert the
Speaker 1: international community at the first sign of danger, but of course,
Speaker 1: leaders worried about damaging their national economies or their personal
Speaker 1: political prospects often clam up at the crucial moment and
Speaker 1: withhold data the rest of the world needs. China was
Speaker 1: slow to admit the magnitude of the problem in Wuhan
Speaker 1: early last year, and didn't immediately let international health experts
Speaker 1: into the city to assess the threat. In the U S,
Speaker 1: President Trump confronted the looming crisis by dismissing it repeatedly,
Speaker 1: assuring Americans that COVID would simply go away. One day.
Speaker 1: It's like a miracle. It will disappear, he said on
Speaker 1: February twenty seventh, just as the virus was taking off.
Speaker 1: Thomas Boiki, who heads the Global Health Program at the
Speaker 1: Council on Foreign Relations, points out that none of this
Speaker 1: is new. This is a repeated problem. He says, China
Speaker 1: was slow to acknowledge the tsar's outbreak in two thousand three,
Speaker 1: and in twenty fourteen, officials in West Africa took months
Speaker 1: to recognize that mysterious illnesses in remote areas were being
Speaker 1: caused by the ebolavirus, allowing it to travel from rural
Speaker 1: areas where it probably could have been contained two cities.
Speaker 1: In a recent report, Boiki and his colleagues recommended developing
Speaker 1: a system that bypasses central government bureaucrats and monitors anonymized data,
Speaker 1: such as rising cases of unexplained pneumonia, gathered directly from
Speaker 1: hospitals around the world. It was a locally run project,
Speaker 1: the Seattle Flu Study, that first spotted community spread of
Speaker 1: COVID in the US. In January, an independent panel convened
Speaker 1: by the WHO blasted the current epidemic alert system as slow, cumbersome,
Speaker 1: and indecisive in theory. The who which Biden has said
Speaker 1: the US will rejoin, could be given more teeth, but
Speaker 1: some argue that the world might need a new coalition
Speaker 1: of countries to more effectively coordinate response. Richard Hatchett, chief
Speaker 1: Executive officer for the Coalition for Epidemic Preparedness Innovations c
Speaker 1: e p I, an organization that's worked to accelerate the
Speaker 1: development of COVID vaccines since it's it up in ten,
Speaker 1: has suggested an alliance committed to a less cautious approach
Speaker 1: a biological NATO to defend the world against developing pathogens.
Speaker 1: This group could help countries respond much more rapidly to
Speaker 1: future threats. It's not part of the world against any
Speaker 1: other part of the world, but the world against the viruses.
Speaker 1: Hatchet says. A muscular global health coalition could further provide
Speaker 1: funding to eliminate wet markets where wild animals are sold
Speaker 1: for food, and to discourage jungle deforestation, which pushes animals
Speaker 1: and the virus as they carry into closer proximity with people.
Speaker 1: And it could help train more field workers in far
Speaker 1: flung places instead of relying on the current ad hoc system.
Speaker 1: In which a mix of nonprofits, universities, and volunteers, along
Speaker 1: with the w h O, addresses emerging threats. Infectious diseases
Speaker 1: are like wildfires. You need to stomp them out when
Speaker 1: they are containable, says Anne Ramoyne, an epidemiologist at u
Speaker 1: c l A. In both cases, time is of the essence.
Speaker 1: Remoyne has worked on Ebola for years in the Democratic
Speaker 1: Republic of Congo. There, the megacity of Kinsasha abuts the
Speaker 1: world's second largest rainforest, which teems with virus laden animals.
Speaker 1: She's been trying to build up an infrastructure to respond
Speaker 1: to outbreaks, relying mostly on individual private donors. Sometimes she
Speaker 1: scrounges for basic gear herself, tracking down donated lab equipment
Speaker 1: in the US, then checking dozens of extra bags on
Speaker 1: her flights to Africa. Three Genetic sequencing Tracking and tracing
Speaker 1: a virus has typically been thought of as a labor
Speaker 1: intensive process that involves building lists of patient contacts and
Speaker 1: then calling those people one at a time to see
Speaker 1: who else might have become infected. Gene sequencing, by contrast,
Speaker 1: offers the tantalizing prospect of tracking of viruses spread with
Speaker 1: molecular precision, frequent intensive viral sequencing would help us or
Speaker 1: questions such as how widely a given strain spreads within
Speaker 1: a community like a school, and whether the strain might
Speaker 1: mutate to become resistant to existing vaccines. Thanks to the
Speaker 1: ubiquity of high speed gene sequencing machines, it costs only
Speaker 1: fifty dollars or so to sequence a virus's whole genome.
Speaker 1: This information provides clues for contact tracers about the pathogen's
Speaker 1: path and allows the large scale tracking of mutations. Unfortunately,
Speaker 1: in the US, only about three in one thousand COVID
Speaker 1: patients have had their virus samples sequenced, and much of
Speaker 1: the work has been done in academic labs, which are
Speaker 1: removed from the front line facilities that have access to
Speaker 1: detailed patient data and do the day to day contact tracing.
Speaker 1: One of the current leaders in virus sequencing is the UK.
Speaker 1: It's processed more than two hundred thousand samples, about five
Speaker 1: percent of its caseload. That helped Britain catch the B
Speaker 1: one one seven variant, which epidemiologists say could be more
Speaker 1: transmissible because it was found in dozens of countries. It's
Speaker 1: expected to become the dominant strain in the US. The
Speaker 1: lack of virus sequencing in the country is a huge
Speaker 1: failing of our public health system, says Mark Lipsych, an
Speaker 1: epidemiologist at Harvard. Hopefully this will be a wake up call.
Speaker 1: Biden has recognized the problem, announcing plans to drastically build
Speaker 1: up sequencing capacity and choosing as his science adviser Erik Lander,
Speaker 1: a renowned genomics expert with the Broad Institute of m
Speaker 1: I T and Harvard four. Developing more vaccines faster. Vaccines
Speaker 1: have been the most spectacular success story so far in
Speaker 1: the current pandemic. There are already two highly effective options
Speaker 1: on the U S market, and a third vaccine from
Speaker 1: Johnson and Johnson could be cleared within weeks after the
Speaker 1: company reported Phase three results on January twenty ninth, showing
Speaker 1: that it generated strong protection against severe COVID. Yet there's
Speaker 1: clear opportunity for im movement. We need to have strategies
Speaker 1: that allow us to move even faster, says David Hoe,
Speaker 1: who leads the errand Diamond AIDS Research Center at Columbia.
Speaker 1: Ho estimates we could have easily shaved four to five
Speaker 1: months from the drug and vaccine timeline had more preparation
Speaker 1: taken place. Early investment in mr NA technology by the
Speaker 1: US government helped Maderna bring its vaccine candidate to human
Speaker 1: trials in a record sixty six days, but it still
Speaker 1: required more than four months of phase one and phase
Speaker 1: two trials to confirm safety and find the right dose
Speaker 1: before the crucial Phase three trial could begin in late July.
Speaker 1: There's no available shortcut around this final stage, which focuses
Speaker 1: on efficacy in humans. But Maderna could have tested candidates
Speaker 1: for known coronavirus as ahead of time. But Maderna could
Speaker 1: have tested candidates for known coronavirus as ahead of time,
Speaker 1: which might have allowed it to start a large Phase
Speaker 1: three trial months earlier. According to CEO Stephan Boncell, fall
Speaker 1: would have looked so different if we had a AXT
Speaker 1: scene in July, he says. Mancell figures it would cost
Speaker 1: two hundred million to three hundred million dollars to bring
Speaker 1: prototype mRNA vaccines for the ten most worrisome virus classes
Speaker 1: through early human trials, so that with a few tweaks
Speaker 1: they'd be ready for large scale testing. It might cost
Speaker 1: another billion or two billion dollars to maintain a spare
Speaker 1: manufacturing plant along with a stockpile of raw materials for
Speaker 1: millions of doses. In January, in a small start towards
Speaker 1: his goal, Maderna announced that it's begun work on a
Speaker 1: vaccine for the NIPA virus, which has killed hundreds in
Speaker 1: multiple outbreaks in Asia. Since Vancell's proposal is similar to
Speaker 1: the concept Glaxo tried to sell Barda back in seventeen.
Speaker 1: A spokeswoman for the Department of Health and Human Services
Speaker 1: says that at the time, Barda's funding from Congress was
Speaker 1: focused on defending against influenza and biological, chemical, and radiological weapons.
Speaker 1: It's now soliciting proposals for coronavirus countermeasures, including vaccines. Some
Speaker 1: people also saw the proposal as too tightly linked to
Speaker 1: one company and in competition with groups such as C
Speaker 1: E p I, which has backing from the Bill and
Speaker 1: Melinda Gates Foundation and others to develop vaccines against emerging threats.
Speaker 1: Glaxo declined to go into detail on why it couldn't
Speaker 1: attract funding, but in a statement, it said it's committed
Speaker 1: to pandemic related research efforts. One tantalizing area for future
Speaker 1: investment vaccines and drugs that offer protection against multiple viruses.
Speaker 1: The existing COVID vaccines spur antibodies against the unique spike
Speaker 1: protein the virus uses to enter cells. Researchers could instead
Speaker 1: create a shot that triggers an immune response against the
Speaker 1: stem of these spikes, which varies much less between strains,
Speaker 1: allowing protection against numerous COVID like illnesses at once. According
Speaker 1: to Venete Minicheri, a coronavirus specialist at the University of
Speaker 1: Texas Medical Branch at Galveston, it's tricky and it might
Speaker 1: not work, but the potential payoff would be immense. In November,
Speaker 1: the National Institutes of Health announced plans to fund research
Speaker 1: into broad acting coronavirus vaccines. Something similar should be done
Speaker 1: with antiviral drugs, says Ralph Barrick, a coronavirus researcher at
Speaker 1: the University of North Carolina who did crucial research before
Speaker 1: the pandemic showing that rimdesseevie, an antiviral developed by Gilead
Speaker 1: Sciences to phidibola, was promising against coronaviruses. Rimdessevie got cleared
Speaker 1: for the u S market on May first, in part
Speaker 1: because it had already been tested extensively in patience during
Speaker 1: a twenty eighteen outbreak in the DRC so only phase
Speaker 1: three trials targeting COVID were required, but Rimdessevier must be
Speaker 1: administered through an i V, which has limited its use
Speaker 1: to hospitalized patients. Mirk is working on a coronavirus drug
Speaker 1: that could be taken as a pill, but unlike Gilead's medicine,
Speaker 1: it hadn't yet started phase one trials at the start
Speaker 1: of the pandemic, putting it on a much slower path efficacy.
Speaker 1: Trial results are expected by April five. Ironing out distribution
Speaker 1: and logistics. Getting tests and vaccines to people isn't rocket science,
Speaker 1: it's not even regular science. But adapting logistics in a
Speaker 1: medical system as large and complicated as that of the
Speaker 1: US can take months of advanced planning and coordination, and
Speaker 1: databases must be developed to keep track of everything. Not
Speaker 1: enough of that work happened in twenty twenty, as the
Speaker 1: Trump administration insisted on having state governments handle testing, acquire
Speaker 1: and distribute personal protective equipment, and implement vaccine distribution protocols.
Speaker 1: This has arguably been in retrospect, the most unfortunate and
Speaker 1: most easily avoided failure a national and international crisis needs
Speaker 1: the full intervention of the federal government, says Peter Hotez,
Speaker 1: a vaccine researcher and dean of the National School of
Speaker 1: Tropical Medicine at Baylor College of Medicine in Houston. It's
Speaker 1: one of the major reasons we've lost four hundred thousand
Speaker 1: American lives because of this bizarre insistence. Biden's plan to
Speaker 1: have the federal government set up mobile clinics and community
Speaker 1: vaccination centers and gymnasiums and stadiums could spur things along.
Speaker 1: It probably should have been the plan from the beginning.
Speaker 1: But once we're through the immediate crisis, the US needs
Speaker 1: to take stock of its supply chains for basic drugs, equipment,
Speaker 1: and testing supplies, and then to provide incentives for companies
Speaker 1: to create more capacity where it's needed. Our federal government
Speaker 1: has no idea what supply chains are vulnerable, says Julie Swan,
Speaker 1: a health system's expert at North Carolina State University. When
Speaker 1: Hurricane Maria slammed into Puerto Rico in it shut down
Speaker 1: power to one of the biggest US makers of saline
Speaker 1: ivy bags, exacerbating an existing shortage of an essential medical item.
Speaker 1: This year to name one of many examples. A shortage
Speaker 1: of plastic pipette tips needed for automated laboratory machines slowed
Speaker 1: down COVID testing, forcing labs into a constant scramble for supplies.
Speaker 1: Not only do we have no effective way to count
Speaker 1: basic medical staples, but we're also unable to keep proper
Speaker 1: track of public health data on patients and testing capacity.
Speaker 1: It's all logged in a hodgepodge of outdated and often
Speaker 1: incompatible federal, state, and local computer systems. Not knowing where
Speaker 1: outbreaks are worst makes it difficult to identify where to
Speaker 1: send supplies. We're flying blind. Swan says, State databases need
Speaker 1: more integration so we know in real time where our
Speaker 1: inventory is. During the current crisis, all of this has
Speaker 1: been harder than it needed to be. That's because pandemic
Speaker 1: response requires foresight, something that was in short supply the
Speaker 1: past few years. Nobody ever expected a thing like this,
Speaker 1: Trump said on March twenty four, in one of his
Speaker 1: many false statements about the virus. Many experts had in
Speaker 1: fact been predicting a pandemic for years, but they couldn't
Speaker 1: persuade anyone to do enough about it. Slowy, the former
Speaker 1: Operation Warp Speed Advisor says, policymakers seem to care about
Speaker 1: fighting epidemics only shortly after they've happened. When the outbreak
Speaker 1: is there, every government is all over you as an industry,
Speaker 1: he says, and then when the outbreak dissolves, everybody looks
Speaker 1: the other way. That's what happened in too much of
Speaker 1: the world after Stars, Mirrors and Ebola, with two million
Speaker 1: dead worldwide and a year's worth of economic devastation, it
Speaker 1: should be harder to look the other way now with
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