Unboxing the System

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The way we make science is simultaneously saving and dooming us

Roughly eighteen months after COVID-19 vaccines first made it to market, it’s easy to forget how unlikely it is that they were developed at all. When the COVID-19 pandemic began, no vaccine had been brought to market in under 10 years, and most had taken two-plus decades to develop. More daunting, by March 2020, only two effective vaccines—for human papillomavirus (which took 25 years) and rotavirus (which took 33 years) had been brought to market in the past four decades.

Vaccines take decades to develop…except in 2020.

With all that in mind, it’s worth applauding the insane sprint that brought us a vaccine in the middle of a pandemic, something that had never been done before, nor even attempted, given how long the road to a vaccine was and how quickly pandemics spread. That means, of course, celebrating the efforts of Pifzer, Moderna, Johnson & Johnson, AstraZeneca, and other pharmaceutical companies—and that’s not something that most people feel comfortable doing. After all, pharmaceutical companies are in the business of maximizing profits at the expense of people’s pain. Right? Well, yeah. And COVID-19 has illustrated why that profit motive isn’t just morally unpleasant but actively undermining humanity’s capacity to protect itself from pandemics.

Future threats aren’t good business

In May 2020, when I was in the early days of research for The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure (have you heard it’s now available and that you should buy a copy?), I spoke with Nat Moorman, a virologist at the University of North Carolina. Moorman had spent his career studying human cytomegalovirus but had like so many in his field been dragged into coronavirus research as the COVID-19 pandemic unfolded. It was a heady time, with the vaccine race barely out of the gate and the world following each development with baited breath. “What would you have paid me for a COVID-19 vaccine a year ago,” Moorman mused to me at the time, before answering his own question. “Nothing.” He was right, of course: before the pandemic, there was no financial incentive to develop a vaccine or therapeutics that could protect the human race from viruses that didn’t yet exist, despite the fact that more pandemic-ready pathogens have emerged in the past twenty years compared to the entirety of the 20th century and that everyone knew another one was sooner or later going to appear.

That financial disincentive to plan for the future is only half of the story. The other half is that when a health crisis like COVID-19 hits, the market incentives to respond can reach absurd lengths. Case in point: despite the fact that there are at least five highly-effective COVID-19 vaccines currently on the market, there are also as of today—wait for it—about three hundred and fifty COVID-19 vaccines in development.

What the hell. Nobody needs 350 more COVID vaccines.

Let that sink in. The market already has more COVID-19 vaccine options than we need (though, as I pointed out in a previous newsletter, far from enough doses for people living in lower-income settings). And yet, three hundred and fifty pharmaceutical companies, biotechs, and research labs around the world think it makes good financial sense to develop even more. The worst part is, they’re probably right: the market rewards scientific discoveries that fit into the current paradigm. That’s because even if a new COVID vaccine is useless, developing one has become a benchmark for scientific success that signals to investors that your group is worth pouring dollars into.

This is why a small but growing contingent of scientists and legal experts are calling for an open science approach to discovery. I wrote about this in my Globe & Mail op-ed, but briefly what open science means is that discoveries aren’t patented. Just as important, though, is that other proprietary aspects of producing cures are shared. This includes, for example, the recipe for the lipid bubble that Pfizer and Moderna use to transport their vaccines into human cells, the techniques that vaccine manufacturing plants use to produce doses, and the vaccine storage process used to ensure that doses aren’t destroyed in transit. The point of opening up this knowledge is to remove the financial roadblocks that have stalled out the search for life-saving discoveries that can’t promise to produce revenue.

This includes cures for diseases like malaria and Dengue fever, which kill hundreds of thousands of people in low-income countries each year. But what should concern us all is that it has also fully stamped out efforts to develop vaccines to protect us against one of the twenty-six viral families that haven’t yet spawned pandemic-causing pathogens but have the potential to infect humans. It’s a collective action problem: everyone knows that it’s just a matter of time until that happens, and nobody wants another pandemic. But in our current system of for-profit discovery? None of that matters.

It’s a sad state of affairs, and there are at least some signs that the approach to discovery might be shifting. Until it does, at least we can look forward to the arrival of hundreds more COVID-19 vaccines into the marketplace.

Happy shopping.

As many COVID-19 vaccine brands as toothpastes. This is the future we’re looking at.

Meanwhile, in Dan Werb news…

It’s been a fun few weeks since the launch of The Invisible Siege and I’m so happy it’s out in the world. Lots has been going on but some highlights are (in no particular order):

I was so thrilled to launch the book (virtually) at Warwick’s in San Diego, a beautiful independent bookstore that is also the U.S.’s oldest family-owned bookstore in the country, which is no small feat. If you missed the launch, which included a great discussion with Davey Smith (head of infectious diseases at UC San Diego, and a key scientists profiled in The Invisible Siege), you can watch it here. 

So much hand waving so you know it was a good time.

The very august Walrus Magazine published an excerpt from The Invisible Siege that covers two points in humanity history when new coronaviruses emerged to threaten our species. What happened next? Read on…

Last week I also published an op-ed in TIME under the headline “To End COVID, We Have to Admit That We’ve Failed”. If you’ve reading these newsletters you know that I’m fascinated by how scientific failures become sturdy foundations for life-saving advances. Check it out. Hint: it’s a good news story.

Grab yours now!

Thanks for reading. If you haven’t yet, please pick up your copy of The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure. I’m not generally filled with confidence about the creations I send out into the world, but this one’s special.

And if you are reading the book and liking it, please tell people about it, and—if you’d be so kind—consider writing a review on Amazon or Goodreads. You have no idea how much that kind of thing helps get the word out.

As always, if you enjoyed this newsletter and haven’t yet, please consider subscribing and telling people in your life that you think would enjoy it.

See you next time.

It’s never too late to bend the arc

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Also: PUB DAY!!!!

One of the more curious side effects of the pandemic has been on our relationship to time. In conversations with friends, I’ve often heard the same thing: a pandemic day feels like an entirely different amount of time compared to pre-pandemic days. Hours have stretched themselves to absurd lengths, days have become seasons, months years, and the years themselves; well, best not to even think about them, lengthened as they’ve been into stifled lives, accompanied by pulsing boredom and anxiety. As restrictions get lifted in many countries, it’s as if we have to re-learn what a day—a real day, out in the world—feels like again. It’s euphoric and scary and feels, maybe more than anything, like a gift from the universe.

But that experience of pandemic time isn’t the only reason it’s been on my mind. Early in the writing of The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure (did I mention it is out today and you can order it here?), when most of my conversations, it seemed, were with virologists, I was struck by how limited my idea of time really was. More than that, I realized that there were two universes of time that I would have to contend with in the book: human time and viral time. Human time is, by this point, instinctive for us: we’ve trained our internal clocks to the rising and setting sun, and even have a vague awareness of how long a decade or century might be. But viral time…that’s something else entirely.

Coronaviruses, it turns out, replicate every three minutes, an absurdly short cycle that compresses what we think of life down to the blink of an eye. But trying to understand a virus through the strange dance of a single virion is like trying to understand what makes a beach by looking at a single grain of sand: everything important is obscured. Viral time isn’t just about a three-minute replication cycle. It’s about the long churning evolution, spurred on by mutations that accrue in each new virion, that happens over hundreds, thousands, and millions of years. And that’s what we’ve been contending with over this entire pandemic: a virus that represents, by some estimates, the product of 300 million years of evolution.

Earth 300 million years ago. No humans, but lots of coronaviruses.

Yes; you read that right. And for those of you up on your human evolution, you’ll know that homo sapiens, our beloved species, only emerged 300,000 years ago. Coronaviruses didn’t arise to meddle with humanity. Our species was born into a coronavirus world. This family of viruses, the Coronaviridae, had been preying on humanity’s ancestors for hundreds of millions of years before our species evolved. No wonder, then, that coronaviruses are so expertly attuned to our biology: they had time—eons of viral time—to practice. But if there’s anything that this pandemic has taught us, it’s that our species has been able to make up the coronavirus’s running head start to the point that the end of this battle is in sight.

Care to spend some of your human time with a book?

There’s another reason I’ve been thinking so much about time, one that hits much closer to home. If you’ve been reading these newsletters, you probably know that today is publication day for The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure. And if you’ve been enjoying them, please click on the link above and get yourself a copy of the book. Reviewers have so far described it as “page-turning,” (Publishers Weekly) and replete with “vivid storytelling” (David George Haskell, author of The Forest Unseen). Richard Preston, one of my literary heroes and the author of bestselling book The Hot Zone wrote, “I learned so much that I didn’t know before—above all, I met the subtle warriors of the laboratory who are working to save all of us from the horror of new pandemics.” That was pretty nice.

If you like reading and you’re interested in an optimistic counter-narrative about what went right before and during the pandemic (and you’ve come this far, so evidently you do), then please consider buying a copy of the book.

It’s finally here. <3

If you want to help with getting the word out, the absolute best things you can do is order the book, post about it online, and when you read it and love it, write a review on Amazon, Goodreads, or your personal diary (I’ll know). It’s no secret that selling books is hard. So let me be the first to say: thank you!  

Meanwhile, in Dan Werb news…

(Virtual) book launch!!!! Wednesday March 9th @ 4pm PST / 7pm EST!

I’m so thrilled to be launching the book at Warwick’s, a gem of a bookstore in San Diego/La Jolla. I had an amazing time with the City of Omens launch in 2019 and looking forward to returning. I’m also thrilled to have Davey Smith joining me. Davey is the head of Infectious Diseases at the University of California San Diego, an Operation Warp Speed scientist who tangled with Trump, and one of the main characters profiled in The Invisible Siege.

RSVP at this link – I can’t wait to see you there! https://www.warwicks.com/event/werb-2022

RSVP for the launch here: https://www.facebook.com/events/316583127107356

Q&A about The Invisible Siege

I did a short Q&A about The Invisible Siege that you can check out here; it covers some of the themes explored in the book, including why I dedicated it to “those who were not saved”.

Op-Ed on Open Science

Last weekend, I also published an op-ed in the Globe & Mail about open science, a model of discovery that seeks to create cures based on global need, rather than on the profit motive. The op-ed delves into some of the missed opportunities for open science before the pandemic, and why it’s more needed now than ever.

Miscellany

There’s also going to be an excerpt of the book going live later today – check my twitter feed for updates.

And, as always, if you enjoyed this newsletter and haven’t yet, please consider subscribing and telling people in your life that you think would enjoy it.

See you next time, when I’ll cover the lessons—right and wrong—that we’ve learned through this pandemic, and how we can develop a foundation for scientific discovery that anticipates that last great mystery: the future.

Time is an arrow

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With a week until publication day, I act out the classic phrase ‘Asked and answered’.

With one week to go to the publication day for THE INVISIBLE SIEGE: THE RISE OF CORONAVIRUSES AND THE SEARCH FOR A CURE, I am bubbling with excitement at getting this lovely book out into the world. (Guess what? You can pre-order here.) I figured I’d take this moment to answer some of the questions I’ve been fielding over the past two years from reporters, friends, and people that hear that I’m an epidemiologist and wrote a book about COVID-19. So without further ado, here’s my AMA, but with the added twist that I’ll be doing all of the questioning and answering this time around.

Artist’s conception of the Dan Werb v Dan Werb AMA. The resemblance is uncanny.

Your last book was about cartels, sex workers, drugs, and violence at the US-Mexico border. What made you want to write a book about COVID?

My last book, City of Omens, was rooted in the border city of Tijuana and was as much about that place as the experiences of the people who lived there. Writing about the scientific discoveries that are helping us overcome the COVID pandemic has been a totally different experience. Instead of walking through public encampments made of old tires in between police raids, I travelled down the rabbit hole of the viral universe, where cells are monstrously huge and DNA is a holy script within which lurks the secrets of the universe. It’s been a wild ride of a different kind.

Beyond hurtling into the world of virology, I was also motivated by a much more base desire: putting some boundaries on my anxiety about the pandemic. Like everyone early on, I had little idea of where things might go. But I leaned on my epidemiologic training, and on the concept of the “Epidemic Triangle’ to make sense of how the pandemic might evolve (see my early New York Times piece about it). From there, the thread just kept drawing me deeper and deeper into the stories of scientists that had been aware of the pandemic threat for decades and who had been quietly working to counter it.

That headline has not aged well but the opinion piece is evergreen.

What do you know about the pandemic that I don’t?

The hardest part of the pandemic for many of us hasn’t been figuring out what we don’t know, but how to make sense of what we do. The pandemic is as much about navigating information overload than it is about adhering to public health restrictions. My epidemiologic training didn’t prepare me for anything to do with coronaviruses or give me access to any rarefied knowledge. In fact, one of the first things that happened during the pandemic was that PubMed—the world’s largest repository of peer-reviewed scientific knowledge—made every single study on coronaviruses free to access by anyone. The floodgates were opened and it’s been like drinking from a firehose since then.

NPR tells it like it is.

Since the pandemic started, there have been roughly 250,000 peer-reviewed studies published. That’s over 10,000 per month and almost 350 per day. For perspective, scientific studies on HIV—a pandemic-level virus that has been preying on humanity for over four decades, is almost always deadly, and which currently infects 38 million people worldwide—only number 400,000, despite studies on HIV/AIDS dating back to the 1980s.

So we’ve all been on remarkably equal footing as far as accessing scientific knowledge goes. Where I might have an edge, though, is in sifting through these endless reams of scientific data and withholding, as best I can, my emotional reaction to new developments before they’re verified. It’s a funny way of doing business: daily, the pandemic produces surprises for us that we need to react to, but scientific research moves at a far slower pace, even at its quickest. So what do I know? That the story we’re hearing about the pandemic right now is going to almost definitely be proven wrong in a few months. And it’s been the same since the damn thing started.

When is this shit going to end?

Full disclosure: when I first started writing The Invisible Siege in March 2020, I was sure that by the time it came out in March 2022, nobody would even remember what a coronavirus was. So I’m possibly not the best person to be asking this question of. We do have some important points of information that can help us chart a path, though.

First, Omicron is milder and more transmissible than any other SARS-CoV-2 variant; in fact, it might be the most contagious virus in human history, with a reproductive ratio of 216 secondary cases for each initial infection. Measles, which was long considered the most contagious, maxes out at a paltry 15 secondary infections for each infection. This thing can move, and its transmission efficiency makes it unlikely that another variant will significantly improve upon it (though it’s not impossible). That at least may bring some stability to the pandemic.

Second, though they’ve required re-upping in the face of variants, the vaccines are still holding. That is a huge win, and at this point it seems more likely than not that we aren’t going to lose the vaccines as a tool to control the pandemic.

Third, we also have a number of broad-based antiviral therapies that are effective at minimizing COVID-19 illness. They’re not going anywhere, no matter what kinds of variants come along.

All of these data points suggest that we’re closer to minimizing the pandemic’s impact on our lives and finding a new kind of normal than we are to launching into another two years of heightened restrictions, stay at home orders, and anxiety.

But there’s an important caveat here. When I say ‘we,’ I mean those of us who live in wealthy countries that have access to vaccines and medicines. In large swathes of the world, Omicron is running rampant and overloading health systems. As I and many others have said repeatedly, the fastest way to end the pandemic is to vaccinate the world. And the lack of vaccine equity remains the biggest drag on our capacity to end the pandemic for everyone because it gives the virus a chance to continue replicating and mutating freely among vulnerable populations.  

Sobering stats from Our World in Data

Please tell me your book has good news in it – anything, really – so that I can sleep at night.

I wanted to write this book as an optimistic counternarrative about what has gone right in our response to the pandemic. The Invisible Siege tells the story of the scientists that have powered the discoveries that have saved us from the virus. It’s an incredibly hopeful story about people sticking to their vision in the face of long odds. It’s also a story about why we might just be entering into an age in which we end all pandemics forever. To my mind, that’s the most hopeful story around.

You’ve been asking all of these questions. I have a few of my own. How can I ask you?

If you’ve got your own questions for me, I would love to hear them! Please send me an email at [email protected] and I will see if I can answer them for you.

Meanwhile, in Dan Werb news…

You know you want to…

There is no news aside from the news that I am shamelessly promoting The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure. If you’re enjoying these newsletters and curious about the book, why not grab your own copy? That way you can brag to your friends and family that you were first.

I’ll have some more exciting details to share next week, but in the meantime thanks for reading, thanks for supporting, and see you next time.

Failure is the sturdiest foundation

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How our inability to end one pandemic is saving us from another

In my last newsletter, I covered some of the issues around chasing the end of the pandemic with vaccines. Basically, it boils down to what Ralph Baric—the world’s greatest coronavirus researcher—describes as an inevitable flood of SARS-CoV-2 variants that will elude vaccines faster than we can produce and distribute new ones. Those variants emerge in places where the virus is replicating plentifully (the cool scientific term is ‘transmission cycles’), and they will continue to do so until there are no more pockets of susceptible hosts (read: non-immune humans) to infect and mutate within. Phew. If you want to read about Baric’s forty-year journey from outsider coronavirologist to one of the most consequential scientists alive, it’s all in my upcoming book The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure.

Ralph Baric, coronavirus legend

That grim scenario wouldn’t hold, though, if the whole world got vaccinated. But between the pitifully low lack of access to vaccines in low- and middle-income countries and the hyped up anti-vax movement, we’re not going to get close to global herd immunity, which is what’s needed to stop the pandemic. So. What are the options?

Fury-inducing statistics courtesy of the New York Times

Hope. And no, that’s not a joke.

Well, this is where there is, actually some good news. And it’s not just about this pandemic: it’s good news about whatever future coronavirus pathogen next threatens humanity (and yes, there will undoubtedly be more). And like so many scientific successes, this one is rooted in abject failure.

Decades after its discovery, HIV remains one of the world’s most dangerous viruses. But, as we’ve all heard many times, it has been transformed from a killer into a chronic condition. What’s remarkable, though, is that this was all done without a vaccine. The HIV virus is so elusive (it turns the body’s own immune cells against itself) and so slippery (it mutates at a clip that makes SARS-CoV-2 look like its standing still) that every attempt to create a vaccine—and there have been many over the past forty years—have failed. And still, humanity somehow found a way to control the spread of HIV.

That we were able to do so in the absence of a vaccine is one of modern science’s greatest achievements. So how did it happen? The trick was, basically, to assume that the virus was going to burrow its way into human hosts, and that the focus should be on disrupting it once it did. In practical terms, that meant forgetting about vaccines and focusing on antiviral treatments that could stop the virus replicating. It’s a bit like trying to stop the snow from falling (and forgive the simile; I’m writing this from Toronto, where there’s been record snowfall), which is something nature decides, not us. That doesn’t mean, though, that we have to throw ourselves at the mercy of the elements. We can equip ourselves with multiple tools—a warm jacket, waterproof boots, and a shovel—to make sure that when the snow hits, we stay warm and protected.

Toronto. Nuff said. Fred Lum/Globe & Mail

So it goes with antivirals. They won’t help your immune system kill viruses before they find a reservoir inside your body, but they will protect us from the worst of an infection by hindering a virus’s capacity to replicate. In the case of HIV, a combination of antiviral medications (known collectively as highly active antiretroviral therapy) has become so effective that HIV-positive people who take them can have so little virus in their bloodstream that it can no longer be detected, let alone make them sick. It’s an incredible feat—the control of a deadly pandemic-level pathogen without a vaccine—but that’s only the beginning. Because HIV medications reduce the amount of virus in a person’s bloodstream to undetectable levels, they also make it essentially impossible for someone infected with HIV and on treatment to infect other people: there just simply isn’t enough virus in their bloodstream to be a threat. This technique—using medications designed to control AIDS-related illness to stop the spread of a vaccine-dodging pathogen—is known as Treatment as Prevention, and it’s revolutionized the way we think about elusive pathogens.

U=U is the newest clarion call in the long fight to end the AIDS pandemic

Antivirals got lost in the COVID vaccine frenzy, even though they might just be our way out…

There are clear lessons here for the future of COVID-19, and for once they’re uniformly positive. We now have multiple approved antiviral medications—Pfizer’s Paxlovid, Molnupiravir, and Remdesivir—that disrupt different stages of SARS-CoV-2 replication. What’s great about these is that they all target parts of the virus that aren’t prone to mutating, unlike the spike protein, which is the target of all current vaccines and which mutates at roughly three times the rate of rest of the virus.

That means that, even if the vaccines fail against future variants, antiviral medications almost certainly won’t. Multiple studies show that COVID-19 antivirals reduce moderate and severe illness by up to 90%, and that they could even protect hospitalized people from needing a ventilator. There’s even good evidence that they could even protect against infection if taken prior to exposure to virus; say, if someone in your family or social network tested positive. And that starts moving things into the realm of Treatment as Prevention: COVID-19 treatments that can stop people from getting sick while also stopping the spread of the SARS-CoV-2 virus itself.

PBS News Hour gets it.

This is ‘end of the pandemic’ stuff, for two reasons. First, because, as I mentioned, the COVID-19 antivirals target parts of the virus that don’t mutate rapidly, so they’ll likely remain effective over time. Second, because these treatments are cheap and easy to distribute, especially compared to the COVID-19 vaccines, which means that Treatment as Prevention campaigns could be deployed to places around the world where outbreaks are occurring and could stop them in their tracks. It’s an unbelievably effective public health approach, and it brings me unadulterated hope for the future.

I’ll end on one last piece of good news. The parts of the virus that these antiviral medications target haven’t only remained stable across all the SARS-CoV-2 variants. They’re also present in every single coronavirus that has ever been discovered. That means that, no matter what coronavirus pathogen shows up next—and SARS, MERS, and SARS-CoV-2 makes it three in thirty years—we can have a lot of confidence that the antivirals that work against COVID-19 will protect us from the next abomination nature sends our way. Does that spell the end of coronavirus pandemics? It just might.

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Meanwhile, in Dan Werb News:

We are one (!) month away from the publication of The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure. There have been some more really positive reviews filtering up, including in Library Journal (paywalled, but thank you librarians, anyway) and from some goodhearted early readers, which you can see on Goodreads. I’m getting pretty amped to have this book out in the world. As always, you can pre-order it here.

You might just love it.

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Thanks for reading. You can find me at my website and on Twitter. If you want to go deep on my science, check out my one true love: Pubmed. If you haven’t yet signed up for this newsletter, or know someone who would like it, go ahead and do it here.

Walking slowly towards the outgoing tide

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Why COVID-19 vaccines are both better than we could ever imagine and the wrong strategy to end the pandemic.

There’s a great deep dive in this past weekend’s New York Times about the decades-long journey that brought mRNA vaccines from concept to cure. It’s the kind of story that I love (and that my book Invisible Siege: The Rise of Coronaviruses and the Search for a Cure, chronicles extensively): a story about scientists working towards turning an esoteric dream into a reality, even (especially!) when nobody else cared. And what a reality: the COVID-19 vaccines developed by Pfizer and Moderna have now been injected into billions of arms and blanketed the world with some pretty serious protection to disease. That’s something that we take for granted, but it’s worth stopping, breathing deeply, and taking some perspective for a minute on what that really means.

Good hands, as the say in the basic science biz (courtesy of NYT)

While the Omicron wave has made everyone feel miserable, the scientific response to the pandemic has played out far better than anyone dared dream. It starts with those mRNA vaccines. For context, the US Food and Drug Administration (which has final say on whether a drug can be marketed in the US) set the threshold for COVID-19 vaccine effectiveness at 50%. Let that sink in. Fifty percent! That means, of course, that getting a vaccine would be a coin toss: half the people who got a shot would still get as sick as the people who didn’t. The rationale for the FDA was that this was the absolute minimum level of effectiveness to get a population to herd immunity (which is about 70% of a population that is immune to getting sick) through a combination of naturally-acquired immunity (by getting infected with the SARS-CoV-2 virus) and a kick ass inoculation campaign that managed to get close to 100% of the population vaccinated. The upshot is that each percentile increase in the effectiveness of a vaccine makes it that much easier to reach herd immunity and get through the pandemic.

The vaccines stay the same, but the virus keeps on getting smarter…

When Pfizer and Moderna shared the results from their mRNA vaccine trials, both were, stunningly, 95% effective against illness. What a relief: it meant that reaching that 70% herd immunity threshold would be way easier (read: would require getting fewer people vaccinated) than if the vaccines were 50% effective. What’s so damn frustrating, though, is that while humanity has been getting itself immune to COVID-19, the SARS-CoV-2 virus hasn’t been standing still. At this point, the vaccines are by and large made to stop the spread of a version of the virus that first spread through Wuhan, China. Since then, three major variants have spread. D614G, the first, was the version of the virus that first went global, replacing the ‘wild-type’ version of the virus that first emerged in Wuhan. Delta was the variant that ultimately outcompeted D614G (with honorable mentions to Alpha, Beta, and Gamma), and Omicron has now shown itself to be far more transmissible than anything that has come before. Each step of the way, the vaccines have seen their effectiveness degrade, and the rapid spread of Omicron (and its accompanying hospitalizations) proof of just howwily coronaviruses are in evolving to overcome our defenses.

Scary-looking variants, courtesy of CTV News

This matters because, as we’re seeing now, vaccines will become less effective over time, necessitating boosters and updated formulations to match the most recent variant. As long as herd immunity is elusive, new variants will inevitably arise, spread, and weaken vaccines.

Vaccines and the end of the pandemic

That brings us to a darker truth that rarely gets coverage: variants are going to keep showing up as long as the world—not a single country, but the entire world—doesn’t have access to vaccines. It’s not enough to protect people in wealthy countries. That might keep us in a sort-of mid-pandemic limbo, with breaks between waves followed by escalating case numbers and deaths, and lockdowns and restrictions, the whole thing continuing ad nauseum. But hoarding vaccines is only going to treat symptoms of the pandemic. If we’re serious about ending the threat of COVID-19, everybody everywhere needs access to a vaccine. That way, herd immunity can be reached across the world, which would then stop the virus from being able to replicate and mutate at will, which would reduce the chances of horrible new variants emerging, which would end the pandemic once and for all.

It’s a simple formula and one of the rare moments when the ethical path (vaccines for everyone) fully lines up with the most selfish one (I want the pandemic to end for me).

While the dream of vaccine equity has a ways to go, there are some really hopeful signs that we might just get there. The mRNA vaccines weren’t designed to be especially cheap or easy to transport globally. But new vaccine candidates like Corbevax (dubbed ‘The World’s COVID-19 Vaccine’) and HexaPro are specifically being developed as inexpensive, easily distributable options for global scale-up. Let’s hope they get there.

Until they do, worry not (there’s already enough anxiety out there). Vaccines are still an incredibly effective way to protect yourself. They just aren’t likely to end the pandemic. In my next newsletter, I’ll tell you about the secret weapon that 19 might just make COVID-19 the last coronavirus pandemic to wreak havoc on humanity. Hint: it doesn’t have anything to do with vaccines…

Meanwhile, in Dan Werb news:

Publishers Weekly named The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure one of the top ten science books of the upcoming season. In their starred review, they called it “a page-turning and unsettling look at the history of coronaviruses”, and that “the light he sheds on scientists whose work has gone largely under the radar makes for a moving account.” Well, damn. That’s nice. You can pre-order the book here.

Join me, won’t you?

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Thanks for reading. You can find me at my website and on Twitter. If you want to go deep on my science, check out my one true love: Pubmed.

THE INVISIBLE SIEGE: THE RISE OF CORONAVIRUSES AND THE SEARCH FOR A CURE

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A story about hope, science, viruses, the pandemic, and the long way through the darkness

Well I damn did it. Behold the last 18 months of my life. The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure. This is the story of how science saved the day, starting in the 1980s and running through to the COVID-19 vaccines and treatments that came online last year. This was such a joy to write in the midst of the pandemic shittiness. As things looked grimmer and grimmer, I spent hundreds of hours talking to scientists who had spent decades studying coronaviruses and making the scientific discoveries that would deliver us vaccines and treatments. There’s so much in this book that is thrilling, earth-shattering, and at times frankly unbelievable. But it is all true, I swear.

What I didn’t know before writing this book – and what I’m so excited to share with readers – is the backstory of the cures that are seeing us through the COVID-19 pandemic. And I don’t just mean vaccines: the antiviral treatments like molnupiravir and remdesivir, which are both protective against COVID-19 disease, have their roots in scientific discoveries that happened decades before SARS-CoV-2 ever emerged. How? Well, it took an amazing amount of sheer will on the part of a really small group of coronavirologists to keep pushing towards their development. How they designed a strategy to counter a virus that didn’t yet exist is one of the great stories of the pandemic, and unlike many of the others, it’s a story of hope and optimism.

Beyond that, this book is about camels, bats, patents, profits, authoritarian governments, minks, mice, and some incredible human beings. I think you will like it, whoever you are. (And yes, before you mention it, I am schooled in the role of bias in informing self-serving opinions.)

You can preorder this beautiful book here: https://www.penguinrandomhouse.com/books/670859/the-invisible-siege-by-dan-werb/

And if you want to hear from me, please sign up for my brand new newsletter: www.danwerb.com/subscribe

I’m so excited to share this with you all ?

Why do science

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A few thoughts on solving urgent problems the long way.

Bust by Chris von Szombathy

How many times have you seen a headline that was something along the lines of, “study shows that getting hit by a rock on the head is bad for your health” and thought to yourself: why did anyone bother? We already know the answer!! See the video below for a great example of what I mean, courtesy of The Onion.

All I can say is: I feel your pain. While I write about a lot of different things, most of my research is focused on one topic: how poverty and substance use intersect to cause people to die. I think a lot about overdose these days, for obvious reasons: over the past five years, over 100,000 people have died of overdose across North America. It’s a staggering number, recently dwarfed by the number of deaths from COVID-19 in the United States ( which at last count was almost at 750,000, which is truly horrific). The difference, though, is that stopping COVID has radically altered society: we’ve by and large changed the way we live in an effort to stop people from dying, while the pandemic has spurred incredible scientific discovery (learn all about that in my upcoming book, The Invisible Siege). But what’s been done to stop people from dying of overdose? Basically nothing.

The disparity between how society has reacted to the two epidemics – COVID-19 and overdose – is shocking. But it’s also revealing about the different ways in which science can be used as a tool for change. With COVID-19, the central scientific problem was pretty straightforward: figure out what the virus was, and then create vaccines and antiviral treatments that could stop it from spreading. The overdose epidemic, though, doesn’t require fancy new discoveries to prevent people from dying: it requires that society treats drug use differently, and crafts policies that change how we collectively treat drug markets.

Because we basically know how to stop people from dying of overdose, ending the overdose epidemic is arguably the harder scientific problem: it can’t be solved through discovery. Instead, scientists need to find a way to challenge accepted orthodoxy that sees drug use treated like a moral failing.

I spend a lot of my days doing exactly that. It’s a lot of incrementalism: running studies that show that arresting people doesn’t actually stop them from using drugs. Or showing that people don’t die of overdoses if they’re allowed to inject in places where they can be supervised by medical professionals. A lot of the work can sometimes feel like stating the obvious using the most absurdly resource-intensive way possible. But the fact is that the scientific method is one of the most bulletproof ways of showing truth to the world, even if that truth feels self-evident.

With the COVID-19 pandemic, the world understood that delays meant death. That’s why vaccine trials were run as quickly as possible while maintaining rigorous protections to ensure safety. That’s evidently not the case with the overdose epidemic. So for those of us doing science to try to stop people from dying of preventable overdoses, we’re trying to do two things at once: make a scientific argument for urgency, and then enact the complicated solutions that we know will stop death. It’s all slightly crazy-making, but all we can do is use the tools that we have to do the work the long way.

Science at its best.