Nicole Lurie is a physician who served as the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services during the administration of President Barack Obama. She currently serves as COVID response lead and strategic advisor to Richard Hatchett, CEO of The Coalition for Epidemic Preparedness Innovations (CEPI), which, along with Gavi and the World Health Organization (WHO), has launched the COVAX facility in an effort to ensure equitable access to COVID-19 vaccines. The goal of the facility is to secure two billion vaccine doses for participating countries by the end of 2021. HVP Editor Kristen Jill Abboud recently discussed CEPI’s role in vaccine development and access, and how the process of rapidly developing SARS-CoV-2 vaccines may facilitate preparations for future pandemics.
An edited version of the conversation appears below.
What has been the most difficult part of developing vaccines in the midst of the COVID-19 pandemic?
There are many, many steps involved from the beginning of an outbreak and the decision to develop a vaccine, to actually getting a vaccine into people. And although there are groups that specialize in each part of vaccine development, there is nobody in the world who can do the entire process, so pulling together all that expertise and making sure things don’t fall through the cracks is critical. The biggest obstacle often hasn’t been a scientific one, but rather the lack of go-to entities with responsibility for some of the steps in this process—in some cases, CEPI has stepped in to fill some of these gaps. And, of course, we’ve worked with Gavi and WHO to set up COVAX.
The situation is a little clearer in the U.S., where the government is able to fund all of the development, manufacturing, and procurement, but there are a lot of other issues as well, such as establishing a global supply chain and clinical trials networks. There will also be a lot of challenges in getting a vaccine to the public quickly, particularly if it is one that requires an ultra-cold chain. It isn’t easy and we are still going to have a lot of innovation.
How was CEPI able to quickly pivot to begin working on COVID-19 vaccines?
I think for us it was incredibly helpful to have had contracts with developers already working on MERS [Middle East Respiratory Syndrome] vaccines, which meant there were prototypes for coronavirus vaccines already in development, and also to have had developers start work on vaccine platforms for Disease X, which SARS-CoV-2 certainly qualifies as. Another thing that was really helpful was that the contracts we had in place with vaccine manufacturers were flexible and allowed us to pivot, so we didn’t have to go back and re-execute contracts for us to be able to start this work. That actually allowed us to work very, very quickly in getting research started, and we were able to move quickly to issue a call for proposals and support additional, new developers as well.
Early on, we also realized that there was no global entity that was responsible for manufacturing vaccines at scale, and so that’s how COVAX
came into being. The financing for this global endeavor has turned out to be a gigantic gap. Fortunately, we recognized that early enough and so we’ve been able to deal with it, but as I repeatedly say: “You shouldn’t be passing the tip cup in the middle of a pandemic.” CEPI was able to step in and lean forward, but there are still substantial challenges to address with regard to global access.
We also did a pretty deep dive in understanding what the challenges and gaps were in the experience of developing Ebola vaccines. There was a lot to learn from that process. One thing it showed was that you could really accelerate things by doing multiple steps in parallel rather than in sequence, and we’ve certainly done that with COVID vaccine development.
Does COVAX represent the new model for ensuring global access to vaccines for pandemic pathogens?
In the U.S., the government pays for the research, the development, the trials, makes advanced procurement commitments, and delivers vaccines. That’s not the way the rest of the world is set up. I think COVAX was born out of necessity, as was the ACT accelerator
, and while I think these efforts are on track to becoming the new model, I think we’ll want to make some further adjustments before we declare this ‘the new model.’ I think what we’re going to see coming out of COVID is a lot of countries wanting to have onshore manufacturing capacity to be able to manufacture vaccines, and as a result, I think we will see a lot more movement toward countries developing their own capabilities to address some of the bottlenecks in vaccine development and supply. That will lead to other challenges, such as supply chain competition, which will need to be resolved as we go. But my hope is that those capabilities are put toward globalism instead of nationalism. I think it would be far preferable to not have multiple countries operating in separate silos from one another and the rest of the world, but rather for there to be more global collaboration and interaction.
What is your biggest fear given the politicization of COVID-19 vaccine development?
My biggest fear right now is around vaccine confidence. All of the controversy and discourse and the missteps with Emergency Use Authorization that have happened so far have so eroded confidence in the scientific agencies—the CDC [U.S. Centers for Disease Control and Prevention] and the FDA [U.S. Food and Drug Administration]—that it would be tragic if we ended up with a really great vaccine and people didn’t get vaccinated.
Interview by Kristen Jill Abboud