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.

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.