What if we don’t find a cure or vaccine for this quickly?

WASHINGTON » President Trump said Sunday that we should have a vaccine for COVID-19 by the end of this year. We all hope he’s right. America is the cando nation with the most dynamic, innovative economy in human history. So most Americans just assume that we’ll 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,” an effort to deliver a vaccine with 300 million doses by January. The president is to be commended for clearing bureaucratic obstacles to vaccine development. But like putting a man on the moon, he’s 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. 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.

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,” says Scott Gottlieb, former commissioner of the Food and Drug Administration. “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.”

Gottlieb says we’ll 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 with a robust surveillance system 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, recently approved for emergency use in severely ill COVID-19 patients.

“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. They want something that treats their illness quickly. But we may not have that kind of a treatment for some time.

So, what do we do? Roy argues that 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. “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?” 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.”