Oliver Contreras/SIPA USA via AP Images
President Donald Trump speaks during an Operation Warp Speed Vaccine Summit in Eisenhower Executive Office Building at the White House, December 8, 2020, in Washington.
If Donald Trump had one redeeming achievement as president, it was that he blithely welcomed the 2020 pandemic relief packages developed by House Democrats. The CARES Act was the most egalitarian economic policy in American history, and more ideologically conservative Republicans like Sen. Lindsey Graham (R-SC) absolutely hated its generosity to the poor. If an ordinary GOP guy had been in the Oval instead of Trump, we might be in a massive economic depression right now.
Over the long term, probably the most significant part of the CARES Act was a relatively tiny part of it—the $10 billion (or about 0.4 percent of the total, though this was later increased to $18 billion) that was allocated to Operation Warp Speed, which funded the development of the COVID-19 vaccines. This turned out to be a smashing success.
It’s worth emphasizing just how remarkable the mRNA COVID-19 vaccines are. The previous all-time speed record for vaccine development was about four years, and most of them took well over a decade. Going from discovery of a totally novel virus to designing a highly effective new vaccine with hitherto unproven technology to finishing clinical trials and getting emergency approval in less than a year is one of the most remarkable scientific accomplishments in human history. And it was all accomplished with roughly 2 percent of this year’s military budget.
So it’s depressing that we aren’t dedicating similar resources to every other chronic health problem. As Rachel Silverman argues in a paper for the Center for Global Development, there are numerous other public-health challenges, both in the U.S. and around the world, that would be highly amenable to OWS-style efforts.
The basic structure of OWS had two parts: on the one hand, direct funding of studies and trials, and on the other, promises to purchase huge quantities of any vaccine that was successfully produced—what Silverman calls a “push” and “pull” combination. That gave private companies the resources and confidence to charge ahead with vaccine development.
Now, much of the groundwork for mRNA had been laid previously by scientists like Kati Kariko, but this only emphasizes the importance of resources and concentration of effort. Kariko had ironed out most of the kinks in the theory and practice of mRNA technology, but it took her decades, largely because nobody could see any prospect of immediate profit. For most of her career, she bounced around from lab to lab, surviving on scraps, struggling to research or publish anything.
One can criticize private pharmaceutical companies for being so focused on profit (especially for spending more on advertising, which really ought to be banned, than research), but as Silverman points out, it is highly risky for a private company to gamble on a paradigm-breaking new technology. Insofar as America relies on pharma to carry out research and drug production—a lamentable fact but also one unlikely to change—it’s important to get the incentives right.
Silverman outlines several case studies where an OWS-style effort would almost certainly bear fruit. For instance, one would be developing new antimicrobial drugs like penicillin and vancomycin. These drugs are a foundational element of modern medicine—without them, hospitals would be extremely dangerous, pneumonia would become a major killer once more, and organ transplants would be virtually impossible. And that dire situation is looming, as more and more bacteria develop resistance to even the strongest drugs. Yet the traditional drug patent system provides little reason for drug companies to develop new antimicrobials, because any new one will first be used only as a last resort to stave off the development of bacterial resistance as long as possible, and wider usage will likely come only after the patent has expired. Only a few new antimicrobial drugs are currently in the development pipeline. Pharma companies logically prefer drugs like statins that can be given to millions every day for decades.
There are numerous public-health challenges, both in the U.S. and around the world, that would be highly amenable to Operation Warp Speed–style efforts.
Silverman suggests a subscription model instead. Should drug companies develop a new antimicrobial, they would be entitled to an annual payment (from the U.S. and EU) for a decade totaling $4.5 billion, regardless of how much was used, while also producing as much as the government asked for. After ten years, the drug would pass into the public domain so generics manufacturers could stamp it out at cost. Reasonable assumptions suggest such a program would pay for itself 28 times over within three decades.
Another case study has to do with tuberculosis testing. This disease is one of the biggest killers worldwide, in part because even though there is effective treatment for it (at least for the moment), millions of people don’t even know they have it. The problem is worst in India, where possibly as many as 2.2 million people have active TB infections without a diagnosis. That means many deaths due to lack of treatment and lots of people wandering around spreading the disease. We all learned in 2020 that you can’t control a disease if you don’t know who has it.
Tests are available but have “become entrenched in a high-price, low-usage equilibrium” with just one company controlling almost half the world market, Silverman writes. Testing machines cost at least $10,000 up front and a cost of $10–$20 per test—far too expensive to be deployed at scale in a poorer country like India. Silverman suggests wrenching the market into a low-cost, high-usage equilibrium with OWS-style mass purchase offers. If a lateral flow test (like COVID rapid tests) could be sold for $1.50 but only cost $1 to produce (a plausible possibility), India could use them at the needed scale and test companies could still make money.
Developing a cheap TB test wouldn’t directly benefit the U.S. that much, as there isn’t much TB here, but it would be a nice diplomatic feather in our cap, and reduce the chance of drug-proof TB spreading around the world in later years.
At any rate, these examples are only meant to be intuition pumps for future efforts. No doubt a full investigation of global health needs would reveal dozens more promising areas—malaria, HIV, dengue fever, influenza, RSV, and ordinary colds, just for starters. It shouldn’t take a once-in-a-century pandemic to motivate America to do what obviously needs to be done to protect public health.
