Development of new Covid-19 vaccines is proceeding at a furious pace, which is good news for the world. We already have two vaccines in phase 3 trials in the US and Europe; each of these trials which will vaccinate many thousands of people, and then wait to see how many get infected. If the vaccines work, then in a few months’ time we’ll be able to start large-scale production.
But we don’t have to wait. Both of these vaccines (from Moderna and Oxford University/Astra Zeneca) have already been shown, in phase 1 trials, to be safe and probably effective. That’s why the companies are moving ahead and giving each vaccine to 30,000 more people: they are fairly confident that the vaccines are safe. The NY Times reports that 3 other Covid-19 vaccines are also in phase 3 trials: one from BioNTech and Pfizer, and two from Chinese companies, Sinopharm and Sinova Biotech.
So why not start administering millions of doses right now? We should.
In fact, an Indian vaccine manufacturer is already moving ahead with large-scale production. The Serum Institute, run by Indian billionaire Adar Poonawalla, is manufacturing hundreds of millions of doses of the Oxford vaccine, before it gets final approval, investing its own money and taking a chance that the vaccine will work.
Why aren’t we doing the same thing in the U.S. and Europe? As I see it, there are two things holding us back:
1. Money. Making hundreds of millions of doses of a vaccine is expensive, and if the vaccine doesn’t succeed in phase 3 trials, that money will have been wasted. I can see why the private companies running these trials might not be able to proceed with large-scale production. This is where the government can step in: just buy the vaccines in advance! We’re already doing this on a fairly large scale anyway: the US recently announced that it was paying Novavax $1.6 billion to cover all stages of its clinical trials plus the manufacture of 100 million doses, long before the vaccine has been approved.
Given that the U.S. alone has already spent well over $3 trillion (that’s 3000 times a billion, for those who are counting) to bail out the economy, with at least another $1 trillion to come, a few billion dollars more to manufacture vaccines–even if the vaccines don’t work–seems like a great investment.
2. Excessive caution. The normal process for vaccine testing and approval requires 3 phases. In phases 1 and 2, we carefully test for safety and try to determine the best dose. Even though a vaccine might seem effective after these phases, the number of people being tested is small, and we need larger numbers to be confident that the vaccine works. That’s what phase 3 tells us.
So the current phase 3 plans for these vaccines work like this: identify a large number of people (30,000 in at least one of the trials) and give half of them the vaccine, and give the other half a placebo. Then wait for a few months and see how many people get Covid-19. If the vaccine is working, then we’ll see that significantly fewer people in the vaccinated group get sick.
Great. We should definitely do this, and we are.
But we’re in the midst of the worst pandemic since 1918. The careful, step-by-step vaccine approval regimen wasn’t designed for a global emergency, in which every day of delay means that thousands of people die.
We already know that the vaccines in phase 3 trials are safe–otherwise it would be unethical to give the vaccine to 30,000 people, as these trials are doing. (Note: phase 3 trials sometimes uncover safety issues that affect only a small percentage of people–issues that might not appear in smaller phase 1/2 trials. So phase 3 also assesses safety, on a larger scale.) Weighing the risks versus the benefits, I think we should immediately ramp up production, using government funds rather than private money, and then offer these vaccines for free to anyone who wants them.
Of course we’ll have to educate anyone who wants the vaccine that we don’t know for sure if it works. No one will be forced to take it, but I’m guessing that millions of people will be eager to try. And yes, there’s a chance that the vaccines won’t work very well, and maybe this will create greater distrust when we eventually do get a good vaccine. But that’s a risk we ought to take, given the greater harm caused by delays. The evidence for these trial vaccines is already better than for most of the actual treatments we’re giving people–and most importantly, we know they are safe.
So let’s start vaccinating millions of people now, as soon as we can ramp up production. I’ll be first in line to try either the Moderna or the Oxford vaccine, as soon as it’s ready.