Geopolitics Enters the COVID Era
Geopolitics Enters the COVID Era
One piece of news dominated all the rest yesterday (which is saying something considering Azerbaijan shot down a Russian helicopter, Ethiopia is descending into civil war, and Donald Trump still thinks he won the presidency). Pfizer and BioNTech announced that initial data indicated their jointly-developed COVID-19 vaccine is 90 percent effective. We should caveat that this is only initial evidence. Data from the full Phase 3 trial has not yet been submitted for peer-review. Pfizer and BioNTech are hoping to have sufficient safety data for a potential Emergency Use Authorization by the third week of November. Despite the necessary caveats, the Pfizer/BioNTech announcement represents the first real light visible at the end of the COVID-19 tunnel. The light is particularly bright considering the U.S. Food and Drug Administration was hoping for a vaccine that demonstrated efficacy of over 50 percent. Even the usually mild-mannered Dr. Anthony Fauci allowed himself to exclaim that the initial results were “just extraordinary.”
Assuming the Pfizer/BioNTech Phase 3 trial continues without a hitch and its data is affirmed by the scientific community, the immediate next question is how to make and distribute sufficient quantities of the vaccine to the world. It will not be an easy task. Entire new supply chains are going to have to be developed from scratch in order to transport the vaccine. There are two key issues at play: the vaccine requires two doses and it can only be stored for a maximum of 10 days at approximately 94 degrees below zero before its efficacy begins to diminish. According to one CDC doctor, the vaccine can only exist in a normal refrigerator for about 24 hours. Most pharmacies and doctors’ offices do not have ultra-low-temperature freezers on hand, to say nothing of the challenge of keeping the vaccine sufficiently cold during transport. UPS is building a “massive freezer farm” (which sounds like something out of The Matrix) in Louisville, Kentucky, with a reported capacity of 600 deep freezers each capable of holding 48,000 vials of vaccine, to prepare for the challenge. There is something truly “2020” about having to turn portions of Kentucky into Antarctica in order to get through this global nightmare.
You may be asking yourself, “wait a second, why does this vaccine have to be so cold?” The answer is the Pfizer/BioNTech vaccine is an mRNA vaccine. Without getting too technical, an mRNA vaccine does not expose your body to an inert or attenuated virus in order to generate antibodies like conventional vaccines. Instead, an mRNA vaccine works by essentially teaching your cells how to build a disease-specific antigen inside the body. That is part of what makes mRNA vaccines so much faster and cheaper to produce than traditional vaccines. Whip up some RNA in a laboratory and you can be on your way, rather than having to use chicken eggs or other mammalian cells. It is also the reason cold storage is so essential. RNA is prone to rapid degradation and Pfizer/BioNTech apparently could not figure out how to make the vaccine effective and capable of withstanding even normally cold temperatures. (If you are feeling nerdy and want to learn more about mRNA vaccines and how awesome human ingenuity is, here is a good primer.)
President-elect Joe Biden has already announced a plan to set up a “Pandemic Testing Board,” which he has likened to Franklin Delano Roosevelt’s “War Production Board (WPB).” The comparison is pretty amazing when you stop and think about it: the WPB was set up because the U.S. had been dragged into a World War it wasn’t ready for and it needed military equipment as quickly as possible. Biden is setting up a similar federal government agency just for testing. That’s before accounting for any freezer farms or nation-wide investment in ultra-cold storage facilities at hospitals and clinics. Biden’s plan also promises $25 billion in vaccine manufacturing and distribution and considering what we now know about Pfizer/BioNTech’s vaccine, $25 billion might be too low a figure. Keep in mind also that Pfizer/BioNTech is not the only COVID-19 vaccine in production – Moderna, Astra-Zeneca, and Johnson & Johnson all currently have vaccines in Phase 3 trials.
Complicating matters further, as usual, is geopolitics. The pharmaceutical supply chain was one of the very first to see serious disruption as a result of the COVID-19 pandemic because China was one of the first countries to shut down. That exposed just how dependent global pharmaceutical supply chains are on China. 13.4 percent of U.S. drug imports, for instance, originated in China in 2018, and China’s role as a primary supplier of active pharmaceutical ingredients (APIs) is even larger. Recall the shortages of personal protective equipment that dominated headlines in April and May in the U.S. China also dominated that market too and its desperate need for PPE, as it was hit hard by COVID-19 first, eventually led to shortages globally. In quick succession followed outright geopolitical competition over PPE, a new sinister form of rivalry called “vaccine nationalism,” and even the use of PPE and promises of future vaccines to further nakedly strategic goals.
Back in 2000, multiple countries and manufacturers formed the Developing Countries Vaccine Manufacturers Network (DCVMN). The goal was to make sure that the developing world had access to vaccines despite the high concentration of vaccine production in a handful of countries. Can anyone imagine such an organization being formed in today’s politically charged climate? Countries like Mexico and Argentina intend not to rely on anyone else for vaccine production and instead already have a deal to produce the vaccine for other Latin American countries. China recently announced it was supporting Indonesia’s efforts to become a center for vaccine production in Southeast Asia. Indian Prime Minister Narendra Modi continues to promise India will pursue “self-reliance” in all things – but especially in terms of the pharmaceutical and biotechnology industries. The EU’s new stated goal is “health sovereignty.” At one point early on in the crisis, the U.S. was essentially trying to buy a German firm so the U.S. could get first and exclusive access to a vaccine before anyone.
None of this is to take anything away from the Pfizer/BioNTech announcement, or of the development of any of the other vaccines that will follow. It is simply to point out that we are making new types of vaccines with cutting edge technology that will require new, complex, and costly infrastructure to ensure effective transport. As a result of geopolitical competition, this will also mean the rapid building of completely new supply chains, each supplying separate spheres of political influence. COVID-19 is apolitical: it kills us all no matter who we vote for or pray to or look like. If only the same could be said of the vaccine. We’d all be a lot better off. Unfortunately, whether and how fast and from whom you get the vaccine has become the definition of geopolitical – and a harbinger of things to come.