The big hole in America’s plan to fight Covid-19 variants

Several vaccine makers supplying the U.S. have made recent efforts to expand their manufacturing capacity, some with government assistance. The Biden administration used the Defense Production Act to secure some Pfizer supplies and claimed credit for engineering Johnson & Johnson’s deal with Merck for vaccine-production help later this year. Moderna this week announced a long-term deal with a contract manufacturer.

“The question is how much of this do the companies do at their own risk versus how much does the government support?” said Nicole Lurie, who led the Department of Health and Human Services’ emergency preparedness efforts during the Obama presidency. Lurie is now a strategic advisor at the Coalition for Epidemic Preparedness Initiatives, one of the organizations leading the global vaccine equity effort known as the COVAX Facility.

U.S. authorities have already doled out billions of dollars to secure hundreds of millions of doses of the first vaccines from Pfizer, Moderna, J&J, AstraZeneca and Novavax. These manufacturers have promised a combined 700 million doses to the U.S. this year — a gargantuan task that nevertheless they promise they can largely accomplish by this summer.

From then, the road forward gets hazy. Scientists still do not know how long protection from vaccines lasts and whether certain strains can overcome any immune protection from the initial vaccines. Booster shots could become a regular occurrence. And each of these manufacturers will need to continue producing initial doses in addition to any boosters.

“The good news is that the existing vaccines generate neutralizing antibodies that work against the variants,” said a senior administration official. “We need more data to determine the durability of that response. It’s likely — it’s anticipated — that that response will wane over time.”

The official added that there are three possible ways forward: Boost immunity with another dose of existing vaccines, boost with a vaccine aimed at variants, or combine those into what’s known as a bivalent vaccine.

Biden officials are betting on vaccinating the vast majority of Americans before variants spread so widely in the United States that new shots are needed — but that ship has sailed in other countries, such as South Africa, that are scrambling for shots that protect against variants like B.1.351 and P.1.

“I think that as soon there’s a variant vaccine that’s made it through the appropriate trials, it may be prudent just to switch over to that vaccine, certainly in countries where the variant is prevalent,” said Lurie.

All this could pose one of the biggest tests of vaccine diplomacy for U.S. officials. While the Trump administration largely bucked global cooperation on Covid-19, adopting an ‘America First’ approach to securing vaccines, the Biden team has made early moves to rejoin the international fray, returning to the World Health Organization and becoming a participant in the COVAX Facility vaccine equity effort.

But there is a careful balance for Biden to strike between racing to protect Americans in a matter of weeks, as promised, and pitching into the global effort to defeat the virus before variants become the world’s biggest problem.

“I’m talking to you all about how we have even access to more vaccines than we need to take care of every American. And we’re helping other poor countries — countries around the world that don’t have the money, the time, the expertise,” Biden said in an April 6 speech celebrating that 150 million shots had been administered in the U.S. “Because until this vaccine is available to the world and we’re beating back the vaccine — the virus in other countries, we’re not really completely safe.”