Analysis & Comment

Opinion | The World Is Desperate for More Covid Vaccines

The Covid-19 pandemic has been mismanaged for months. Now vaccines are here —  but in very short supply. Most Americans will wait months to get immunized, and poorer countries are scrambling to find any vaccines at all.

There is another way. President-elect Joe Biden can solve the U.S. and worldwide vaccine shortages by using a strategy inspired by the one our country used to address the AIDS crisis. Mr. Biden can marshal the federal government’s resources to manufacture additional vaccine supplies and combine that move with vigorous efforts to boost distribution.

Nearly two decades ago, Anthony Fauci, who was then almost 20 years into his role as the director of the National Institute of Allergy and Infectious Diseases, helped persuade President George W. Bush to establish the President’s Emergency Plan for AIDS Relief. The goal of Pepfar, as it’s called, was to ensure that people in countries with limited resources could get medication to treat H.I.V. Pepfar has received consistent bipartisan support and is recognized as one of the most successful global health initiatives ever implemented, responsible for saving an estimated 18 million lives to date, according to the U.S. government.

Mr. Biden can help address today’s urgent global health challenge by establishing the President’s Emergency Plan for Vaccine Access and Relief, or Pepvar, and rapidly building facilities to manufacture vaccines and their constituent components at scale. Manufacturing could be coordinated using a model similar to the one used by the Department of Energy’s national laboratories, in which a government-owned facility is operated by a private organization experienced in the relevant sector.

The promise and possibility of Pepvar are rooted in the type of Covid-19 vaccines now being distributed in the United States. The Pfizer-BioNTech and Moderna shots use genetic material called mRNA, and their technology is based on teaching human cells to make proteins that trigger a strong and protective immune response to a virus or other pathogen. The other leading Covid vaccine candidates use different technologies, like engineered adenovirus and inactivated coronavirus.

Planned production of these highly effective mRNA vaccines will cover about 1.5 billion people in 2021. The other 6.2 billion people on Earth will have to rely on vaccines using other technologies, which have not been shown as effective or lack peer-reviewed studies of their safety and efficacy.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

It is possible to make mRNA vaccines more widely available. They are easier and faster to manufacture than most other vaccine technologies. The inadequate supply results from a shortage of capacity for making and assembling specific vaccine components. Instead of relying on Pfizer’s and Moderna’s maxed-out supply chains, the U.S. could build more manufacturing capacity via public-private partnerships.

The Moderna vaccine is a particularly attractive candidate for rapid scaling, since it can be kept at normal freezer and refrigerator temperatures, which makes it easier to store and transport. While these storage requirements may limit its use in some settings, increased supplies of the Moderna vaccine could go a long way to meet urgent needs. And since it was developed in partnership with the National Institutes of Health, the government may be able to take advantage of its existing relationship with Moderna. Critically, adding government-owned factory capacity to produce mRNA vaccines would help the U.S. fight other pandemics after the Covid-19 crisis is over.

Pepvar’s first goal should be supporting the production of enough doses to vaccinate the entire world within a year. It is estimated that building such capacity for an mRNA vaccine like Moderna’s would cost less than $4 billion — that’s significantly less than the U.S. government already spends each day on Covid-19 relief — with the cost about $2 per dose. Of course, making the vaccines is just the first step: Pepvar must also provide countries, including our own, with the resources needed to distribute and deliver the vaccines with great urgency.

After all, viruses know no borders. Protecting Americans from Covid-19 requires protecting all people from the disease. We will not end the pandemic until everyone, across the world, can receive highly effective vaccines. And the U.S. can help the world more quickly this time. Pepfar was launched seven years after effective H.I.V. treatments were available in rich countries.

As Mr. Bush said of Pepfar in 2003, “Seldom has history offered a greater opportunity to do so much for so many.” That opportunity stands before us again.

James Krellenstein (@jbkrell) is the executive director and a co-founder of PrEP4All, an activist think tank dedicated to increasing access to H.I.V. and Covid-19 treatments. Peter Staley (@peterstaley) is a co-founder of PrEP4All and an AIDS activist. Wafaa El-Sadr is a professor of epidemiology and medicine at Columbia University.

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