Planet Money - Moonshot in the arm

Episode Date: November 5, 2021

COVID-19 prompted the quickest vaccine development in history. An inside look at how the government and pharmaceutical companies joined forces to make it happen.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

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It's March 2020. Dr. Robert Kadlec, known by his colleagues as Dr. Bob, finds himself in the middle of the COVID crisis. And that's because last year, Dr. Bob, former Air Force physician and bioweapons expert under George W. Bush, he is now the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, meaning that now that there is a pandemic, it's on Dr. Bob to deal with it. Remember what it was like a year and a half ago? There were not enough gloves, not enough masks, not enough PPE. There were no proven medicines for COVID, no vaccines. So Dr. Bob's

portfolio of responsibilities was pretty large. So briefly, it's being prepared. Being prepared. The stockpile. The stockpile. All the vaccines. All the vaccines. So you're kind of a pandemic guy. All the vaccines. All the vaccines. So you're kind of the pandemic guy. Yeah, that's a good way of putting it. Dr. Bob is the kind of person who turns to history for ideas. So he does what Dr. Bob does, and he starts to dig into the archives.

There, he finds a technical manual from 1962, where researchers had tested what materials could be turned into an impromptu mask. There were things like using toilet paper folded over, using t-shirts, and a variety of other products. And in this manual, he finds some pretty good evidence that, yes, cloth masks are effective. Dr. Bob's like, great, cloth masks, let's do this. He calls up Hanes, and he convinces them to pivot from making underwear to making masks. They make an agreement and he launches America Strong, Keep Healthy and Live On, which is a cloth mask initiative. Now, the color was somewhat controversial.

The color was controversial. What color were they? Well, they were white because, you know, what you didn't want to have something is somebody would have this mask and would never wash it. And so the idea that it was white would show dirt. Right. And then people would be self-conscious and they would wash their mask. Function over fashion. That is so Dr. Bob.

So he takes a slice out of his tiny budget to order 650 million white cotton masks from Hanes. They cost about 71 cents per mask. Shipping was about 62 cents with the Postal Service so that we could conceivably mail them to every residence in the United States. But you might have noticed you never got a pack of these America Strong masks in the mail. That's because they weren't sent. And even though the CDC liked the plan, so did Dr. That's because they weren't sent. And even though the CDC liked the plan, so did Dr. Fauci, so did FEMA. When it came time to brief it to the audience at the White House task force,

I didn't get even to the first slide. It was interrupted and stopped. What went wrong? Well, I'd like to know, I'd like to know too. Dr. Bob asks around, but he never gets a formal answer. Instead, he just hears trivial, gossipy comments about his mask. No one would wear them. No one wanted to use the postal service. Why were they white?

You know, they look like underwear. That one's a little true. We never had the full debate. And it was pulled off the agenda and never to be surfaced again. There have been some studies since that suggest that his idea could have saved tens of thousands of lives. Yeah, that's the one thing that keeps me awake at night, even today. With that not going forward, it was time to come up with another idea. Another idea. Because if Dr. Bob can't slow the spread with masks, then he really has only one other option. He better get some vaccines made, and he better do it fast.

Hello and welcome to Planet Money. I'm Amanda Aronchik. And I'm Alexi Horowitz-Ghazi. Now that we have a few different COVID-19 vaccines, it might seem inevitable that it would happen this way. But a year and a half ago, when Dr. Bob first embarked on his mission, it felt impossible. Today on the show, Dr. Bob's next idea. Operation Warp Speed. This is the story behind the story of how the vaccines were made in record time. And one little quick warning.

This show is going to be a weird, trippy flashback, like, was this last year? Was this a thousand years ago? There is no way to know for sure. It's April 2020, just a couple of days after Dr. Bob Kadlec's mask idea gets shot down, and he is feeling desperate. He is the government's pandemic guy, appointed by President Trump, responsible for making sure we have the medicines and vaccines we need. But he has got nothing. The medicine cabinet is bare.

So he texts some of his closest colleagues and he says, can you please come meet with me? I've got this idea. Plus, I can offer you an incentive. Well, I think there were about three or four pizzas. They were from We The Pizza on Capitol Hill. They deliver and they take American Express. Five of Dr. Bob's buddies bite. They show up to his windowless office on the sixth floor of the Hubert H. Humphrey building for some pizza and brainstorming. This group knows that in the past, pharmaceutical companies haven't wanted to make vaccines for

emerging diseases, new outbreaks, because who knows how many people will need it? What if the outbreak just goes away? That's what happened with SARS and MERS and Zika. There was no one on the commercial side that was willing to invest the money for something that may or may not occur ever again. For the pharma companies, it's too unpredictable a market. They can't guarantee that they'll make a profit. So the big companies don't want to invest in something so risky, and the small companies don't necessarily have the money or experience to navigate all the hoops. So what about the government? The government can't manufacture vaccines.

Now, we have tried historically, and in doing so, we have failed magnificently. In the past, the government has tried to be a maker of vaccines, to have labs and their own factories. But Dr. Bob says it was just too hard and too expensive for them to do well. They went through a variety of different analyses, some economic, some scientific and technical, and in the end realized that the wherewithal, the experience and expertise to make these things do not reside in the government. He says Big Pharma won't go alone and the government can't go alone. Then in walks COVID-19 and now Dr. Bob has to find a way to get everyone to work together so something can get made like

right, right now. Now again, Dr. Bob has turned to history to find a solution. He's standing in front of his buddies and he takes a black marker and he writes up on the whiteboard, Manhattan Project. We have spent more than $2 billion on the greatest scientific gamble in history. This is President Harry Truman talking about the Manhattan Project, which was a secret program launched during the Second World War to create an atomic bomb. Both science and industry worked together under the direction of the United States Army, which achieved a unique success in an amazingly short time. Obviously, we weren't making a bomb. We were trying to develop vaccines and therapeutics, but it was this idea that it would be a partnership with the U.S. government and the private sector to accelerate the speed of science and have a product at the end of that, in this case, a vaccine.

So they need to accelerate the speed of science. But how? Dr. Bob and his colleagues discuss what the process usually takes. First, there's academic research, where they try to figure out exactly what it is they're making. Then there are preclinical trials, where they test it on mice and monkeys. That's followed by phase one trials, basically asking, is this thing safe? And then phase two trials, where they take a few more people and they see, OK, what's the right dosage? Finally, phase three trials. That's where they're going to get a ton of people and make sure this thing really works. And if it does, now they get it all approved by the FDA. Less than 10 percent of new drugs get that approval because at any point, a vaccine or drug could fail. There's even a part of this whole journey that's known affectionately as the valley of death.

The way things have been done in the past will not work for a respiratory virus that is quickly spreading around the world. Up until now, the fastest timeline for a new vaccine was four years. Thankfully, Dr. Bob knows someone at the FDA, Dr. Peter Marks. They patch him into the pizza party. Peter Marks, you know, came on the line and we pitched him about this idea of accelerating the FDA approval cycle. Together, they come up with a bold solution. What if they were to run all the parts of the FDA process, the animal trials, the human trials, the data analysis, all roughly at the same time.

It's basically taking a string, as linear as it is when you hold it end to end and folding it on itself, to take the processes that are typically done sequentially and doing them in parallel. Dr. Bob loves this idea. And what if we could also manufacture the vaccine candidates while we're testing them? Now, in normal times, pharmaceutical companies wait until after the FDA gives approval to start manufacturing. Setting up a vaccine factory takes months or even years and millions of dollars. So doctors Bob, Peter, and company come up with another idea. What if the government pays companies to start manufacturing vaccines before they are approved? Yeah, your product may not get through the wickets, may not get through FDA approval, but we're going to pay you to develop this product, to manufacture it at scale.

So that was going to be a role of the U.S. government was to assume the risk of manufacturing at risk. If a company manufactures a vaccine and it's found to not be safe or it doesn't work, they will dump it. But they won't have to eat the cost of making it. So Peter has ideas about how to make the FDA process move faster without compromising safety. And Dr. Bob has ideas about how to get the government and private companies to work together. They start to hatch a clear plan. It was kind of like the Reese's Peanut Butter Cup experience. I had the chocolate, he had the peanut butter, and together we were in business.

They write up a mission statement, come up with a name. Project Peanut Butter Cup? No. They call it Project Warp Speed because Star Trek. Dr. Peter's a huge Trekkie. Aside from the Manhattan Project being their inspiration, they also copy the leadership structure. You might have heard of J. Robert Oppenheimer. He's often remembered as the head of the Manhattan Project. But there were actually two leads.

Oppenheimer was the scientific lead, and Lieutenant General Leslie Groves was the operational lead. Dr. Bob wanted to do the same thing. So it would be a collaboration between the health department and the military. So they don't want to call it Project Warp Speed. The military doesn't do projects anymore. Projects are for the dorks over at NASA. Today's military, they do operations. Now all they have to do is get their idea approved by the White House. But there are not actually a lot of fans at the White House of Dr. Bob and his team. You know, the folks who ordered hundreds of millions of tighty-whities for your face. They were on the outs at that point. This is Brendan Burrell. He's a journalist, and he's the one who introduced me to Dr. Bob Kadlec. Brendan just published a book called The First Shots, and this episode is based on his reporting.

Kadlec's boss was on the verge of getting fired, and so was Kadlec. And this is like a team of basically outcasts from the Trump administration, right? There's fighting going on between the White House and the health department over ventilators and PPE and testing. But this ragtag team of outcasts, they still need President Trump. For the program to work, because it is taking two branches of government, it needed the approval of the White House. And that came in the form of Jared Kushner, who, you know, is the president's son-in-law and, you know, known as the secretary of everything and had been kind of meddling in the pandemic response. And Kushner knew that it was important. And so he kind of provided the cover for it and the protection.

So he took it to Trump, got Trump to say, yeah, this is a good idea. And at that point on, they were left to do their own thing. May 15th, 2020, is the official launch of Operation Warp Speed. Dr. Bob was there. There was a Rose Garden ceremony at the White House, and I was invited to it, interesting enough. And so I got a front row seat. And all I know, it was sweltering heat, and I'm just, and of course, you have to get there early. And I'm just sitting in this chair, like in a puddle of sweat. And I just remember meeting Dr. Slaoui for the first time that day. Dr. Monsef Slaoui had just been hired to be the J. Robert Oppenheimer of this operation.

He's got decades of experience working for one of the largest pharmaceutical companies in the world, GlaxoSmithKline. And he's helped get more than a dozen vaccines to market. Slaoui is also a millionaire and drives a Ferrari. He drove down from Philadelphia where he lived and showed up. And I remember he was in a leather jacket and a shirt, open collar. And it was just like, oh, my God, where's your tie? Unfortunately, he had a sport coat, but somebody had to lend him his tie. There are a few chairs set up in the Rose Garden. And then President Trump emerges from the Oval Office, flanked by Dr. Fauci, Dr. Birx, Defense Secretary Esper.

It's kind of a mashup of doctors and generals. Today, I want to update you on the next stage of this momentous medical initiative. It's called Operation Warp Speed. That means big and it means fast. Trump explains some of the details. They've winnowed down the possible vaccines to 14 candidates. And then he introduces Dr. Slaoui. Thank you, Mr. President.

Good afternoon, everyone. He's now wearing a silky blue tie, although it's a little crooked. I have very recently seen early data from a clinical trial. These data made me feel even more confident that we will be able to deliver a few hundred million doses of vaccine by the end of 2020. And we will do the best we can, the best we can to do that. Thank you. Even though Dr. Slaoui was an expert, even if he knew things the public couldn't know yet, there had been so many mistakes so far. 87,000 Americans were already dead. So when they make this promise, no one believes them.

The Trump administration's end of year goal outpaces what most experts believe is possible. The shortest time anybody's ever found a vaccine against any disease that I'm familiar with is about seven years. This doesn't fit with any timeline that we've ever heard before with regard to vaccines. It is impossible to get that done by the end of the year. There was a lot, a lot of pushback. Journalist Brendan Burrell again. It was so dizzying at that time. I was just starting to report on COVID, and I had heard everything that Tony Fauci had said and what every expert said, which is, you know, it's going to be another 18 months before we have the vaccine at a minimum. And then suddenly this thing called Operation Warp Speed gets announced.

And they're saying they can have a vaccine by the end of the year. Nobody really knew what to believe. At this point, no one even knows for sure if any of the potential vaccines will work. But still, there's this intense race going on to find out. And then talk about flashbacks. The vaccine race hits the summer of 2020. That's after the break. In the summer of 2020, Dr. Bob is still trying to keep himself from getting fired.

And he's also trying to help Operation Warp Speed meet its deadline. 300 million doses ready by January 2021. There are still a bunch of pharma companies in the race. Moderna, unproven vaccine makers. Johnson & Johnson, big company, but more talc than vax. AstraZeneca is having some issues. And then there's Pfizer-BioNTech. Vaccine makers, Johnson & Johnson, big company, but more talc than vax. AstraZeneca is having some issues. And then there's Pfizer-BioNTech.

At this point, Pfizer and Moderna are taking the lead, getting volunteers for phase three, the human trials. Now, Pfizer is enormous, and they decide they don't need money from Operation Warp Speed for R&D. But the government has promised to pay them $2 billion for their shots if they work, essentially providing them with a very big incentive. And then while they're doing all these trials, something happens that has a surprising effect on all this. George Floyd is murdered in Minneapolis. And the reckoning over race that follows touches everything, including the race to find a vaccine. Dr. Francis Collins is the director of the National Institutes of Health. He's actually Dr. Fauci's boss and one of the key players in making Operation Warp Speed happen. I was deeply moved by what had happened in our

country and this just glaring example of how we have not gotten past our long and gruesome history of racism. And it was playing out daily in the presence of COVID-19. People of color were disproportionately getting sick and dying from COVID. And at this point in time, Dr. Collins is overseeing the pharma companies that are in phase three, that are recruiting tens of thousands of people to try out the shots. And he looks at who Moderna has been signing up. They felt this enormous pressure to recruit quickly because it's a public health crisis and people are dying. And if you're trying to recruit quickly, you recruit the people

who are most likely to say yes. And that tends to be white people, especially young, healthy white people. Dr. Collins goes to Moderna's executive team and he's like, what are you going to do about this? And he says that their response was less than satisfying. I mean, it was hand-waving. And this is where I got fairly directive. And I made a little speech about, okay, if that's the strategy you're going to pursue, you may have a vaccine that turns out to be safe and effective for white people, but you will have failed and we will not defend you. So at this moment in the pandemic where it

feels like every second matters, they pump the brakes. They don't want to go forward with the trials because, Dr. Collins says, if the people testing. They don't want to go forward with the trials because, Dr. Collins says, if the people testing the vaccine don't represent the American public, the public won't trust the vaccine. Moderna then recruits more people of color. So at this moment, you make this request to diversify the trials. What happens? Does it slow things down a little? what happens? Does it slow things down a little? It, in fact, did have a modest effect of that sort. But, Dr. Collins says, just by a week or two.

Really, though, Pfizer and Moderna were both doing everything possible to be first. They always denied that it was a race against each other. They kept saying, no, it's just a race against the virus. But really, being first would mean bragging rights forever, plus the first chance at those lucrative international deals. Then, on Sunday, November 8th, 2020, Pfizer gets its first peek at whether its vaccine really works. Their executives gather together at their offices in Greenwich, Connecticut. They're there because the data is about to be unblinded. This means that of those thousands of people participating in human trials, some have gotten COVID. But whether that COVID-positive person got the vaccine or the placebo is still a secret. Here's journalist Brendan Burrell again.

So the company doesn't know what the results are as they're coming in. The company doesn't know. Yeah, I mean, they say it's like going to the dark side of the moon. That's the expression that people use. You have no idea. You've just sunk, you know, half a billion dollars into this thing, and you're not going to find an answer out until it's ready. So there's this independent group known as the Data and Safety Monitoring

Board. They work for the government and they are the people who know. They have the special goggles that allow them to see the results, to see if there's safety problems and they tell the company they have to halt the trial or tell the company this vaccine is so effective or this treatment is so effective, you know, we're going to take the blind off and we're going to share the results with you. Now, the FDA had said, we'll be happy if you can make a vaccine that is 50 percent effective. The Pfizer execs are sitting, waiting patiently to find out how well their vaccine works. They've finished their boxed lunches. So they're waiting around and they start making bets. Maybe it's 60% effective.

Maybe 70%? That'd be pretty good. But they really have no clue. Here we go. Yeah, hello everybody. Hi Bill. Hi Catherine. Pfizer made sure there was a video team there to capture the moment. Everyone is staring at a phone on the conference table. And then there is the world's longest pause.

Good news! We made it! And then the question on everyone's mind? How effective is it? The efficacy was more than 90%. Oh my god! They break out the champagne. I love you! Yeah, it was like stunning, right? Dr. Bob remembers when he heard the results. It was like unbelievable. It was like, you know, wait, there's got to be a mistake here or something. And then knowing, you know, within weeks later, Moderna is to match that. It was just, it was like, oh my God. It was was like almost you couldn't even dream it possible.

It had been just seven months since he wrote The Manhattan Project on his office whiteboard. I got to tell you, though, it was like, yay. Now let's focus on moving. You know, what's next? Technically, Operation Warp Speed did not meet its stated goal. The promise was 300 million doses by January 2021. And instead, by that date, they had distributed 50 million. But in a lot of ways, Operation Warp Speed had been monumental. The program that began in Dr. Bob's office managed to solve a fundamental failure in the vaccine market. They'd collapsed the approval process and they'd helped develop several shockingly effective vaccines. And they did it develop several shockingly effective vaccines.

And they did it three years faster than ever before. The Biden administration didn't end up keeping Dr. Bob around. But they did keep Operation Warp Speed. They gave it a new name, one that only a Democrat could love, the Countermeasures Acceleration Group. one that only a Democrat could love, the Countermeasures Acceleration Group. And we should note Dr. Monsef Slaoui was also dismissed by the Biden administration, and he later faced a sexual harassment charge at his old job. He apologized and resigned.

As for the rest of us, we did get to enjoy Dr. Bob's yay moment for a little bit. But now the what's next is kind of looming over everything. How many boosters will we need? Will we share the vaccines with the countries that need it most? Journalist Brendan Burrell says there are still lots of questions around profit and ownership and patents swirling around. Did we, with Operation Warp Speed, just rush a bunch of vaccines that would have otherwise been made by, like, say, Pfizer, doing it on taxpayer money, and then sending all of that taxpayer money to Big Pharma? You know, I think Big Pharma certainly got a good deal out of all of this. Um, the question of how these profits should be distributed and who owes who for what patent. Certainly all of this was built on some very basic research, some of it coming out of the National Institutes of Health,

some of it coming out of academic institutions. And I think some of that's going to get sorted out in the courts. I mean, hopefully some of this money will go back to basic research that will prepare us for the next pandemic. The next pandemic? Too soon, Brendan. Too soon. There is so much more to this story, and you can read about it in the book that this episode is based on. It's called The First Shots, written by Brendan Burrell, and it is a great read. If you somehow missed Planet Money Summer School and want to now bask in its golden glow, it is available in its own podcast feed. Search Planet Money

Summer School and get all the episodes from seasons one and two. We'd love to hear from you. Email us at planetmoneyatnpr.org. We're also on Instagram, Twitter, Facebook, and TikTok at Planet Money. Today's show was produced by Dave Blanchard and Corey Bridges. It was mastered by Isaac Rodriguez and edited by Jess Jang. Planet Money's supervising producer is Alex Goldmark. Louise Story and Ebony Reed are our consulting senior editors. Special thanks to Gabrielle Tenenbaum and the team who made Mission Possible, The Race for a Vaccine, which was produced by Pfizer, The Documentary Group, and National Geographic. I'm Amanda Aronchik.

And I'm Alexi Horowitz-Ghazi. This is NPR. Thanks for listening. And a special thanks to our funder, the Alfred P. Sloan Foundation, for helping to support this podcast.