Open economy, as the odds are against a quick cure
WASHINGTON — President Trump said Sunday we should have a vaccine for COVID-19 by the end of this year. We all hope he is right. America is the can-do nation with the most dynamic, innovative economy in human history. So most Americans just assume that we’re going to be able to have an effective treatment available in a matter of months — with a vaccine not far behind.
But what if we don’t?
The Trump administration has launched “Operation Warp Speed,” a Manhattan Project-style effort to deliver a vaccine with 300 million doses by January. The president is to be commended for pressing his foot on the accelerator and clearing bureaucratic obstacles to vaccine development. But like putting a man on the moon, he is asking U.S. scientists to do something that has never been done before.
Consider: The biopharmaceutical industry has been working on developing a vaccine for HIV for almost 40 years without success. The same is true for hepatitis C. We still don’t have a cure for the common cold — some colds are caused by a coronavirus. In fact, we have never developed a vaccine for a coronavirus. And it took almost five years to produce a vaccine for Ebola — the fastest a vaccine has ever been developed for a dangerous new virus. To meet Trump’s stated goal, we would have to more than quintuple that record.
There are now about 95 vaccines for this virus under development. The vast majority will fail. Others may actually make it easier to catch the virus or worsen the disease, which has happened with some HIV drugs. “There are very few settings in medicine where you have the potential with a medical product to cause distributed harm, mass casualties,” Scott Gottlieb, former commissioner of the Food and Drug Administration, says. “It’s not a vaccine that you’re going to give to 10,000 people or 10 million people. It’s a vaccine that you’re going to give to the entire world . ... And if it has some latent side effect ... that isn’t apparent for many months and many years, and you’ve just given it to 100 million people, you can cause serious harm over a very large population.”
Gottlieb says we will have a vaccine in large clinical trials by the fall. But the more likely path out of today’s lockdown is the development of an effective therapeutic, coupled to a very robust surveillance system that allows us to ring-fence small outbreaks before they become large outbreaks.
But finding even one effective treatment is also incredibly hard. The most promising therapy under investigation is remdesivir, which was recently approved for emergency use in severely ill COVID-19 patients. A preliminary study found the drug improved recovery time from 15 days to 11 days — a 31% percent decrease — and showed no statistically significant effect on mortality. “The best that can be said about that drug is it shortens your hospital stay by a couple of days,” says Avik Roy, a health care policy expert. “It’s not a cure, it’s a modest improvement on the condition.”
That’s not what most people have in mind when they think of a therapeutic. They want something that treats their illness quickly and sends them back into the world. But the reality is we may not have that kind of a treatment for some time, much less a vaccine that confers immunity.
So, what do we do? Roy argues we may have to restart the economy before we have completely controlled the pandemic — reopening schools and businesses for lower-risk individuals and using contact tracing to slow the spread of the virus. He points out that about 100,000 people die every year in the United States from hospital-borne infections, yet we don’t shut down the entire hospital industry. “Think of all the people who aren’t seeking health care for non-covid illnesses . ... How many of those people are going to die prematurely because they didn’t get the health care they should have gotten in a normal environment?” he asks. “We’ve just thrown 30 million people out of their jobs. How many deaths of despair are going to take place because of the wreckage that we’ve imposed on the economy?”
The search for a vaccine is a moonshot, and it may work. After all, America did put a man on the moon. But we can’t keep the economy in lockdown while we wait. The purpose of the lockdown was not to prevent every American from getting COVID-19, Roy says, but to prevent our health care system from being overwhelmed. “We’ve done that,” he says. “It’s time to stop annihilating the economy.”