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tablish the protocols for all the drug development.
Dolsten says Pfizer is considering collaborating with
the network on its antiviral treatments. “We have
never run an antivirals study against corona virus,”
he says. “The spirit of ACTIV and what we have
learned from all the trials now will be invaluable.”
The third group was tasked with figuring out how
to do the staggering amount of testing it would take
to get these drugs and vaccines to market, includ-
ing finding organizations to monitor droves of volun-
teers and gather the relevant data. “You needed very
quickly to set up clinical- trial networks that can en-
roll thousands of people,” says Collins, “and we don’t
have that capacity ready to go unless you pull things
together including networks that haven’t worked on
infectious disease before.”
The fourth group was a kind of advance guard,
which gathered and disseminated all the informa-
tion that the other groups would need to get going
before human trials began: any animal studies that
had been done, how to gain access to the right sort of
laboratories—those that can work with highly con-
tagious viruses. It also made sure laboratories had
cleared their decks and were ready to go.
While all this was under way, there was still the
problem of diagnostic testing. You can’t fight a virus
if you don’t know who has it. At the time, in mid-
April, the U.S. was performing about 150,000 tests
a day; to effectively monitor the population for the
virus, the NIH estimated it would need 6 million.
RADx required Collins and his colleagues to add
a new skill set to their résumés: venture capitalist.
Collins dispatched Bruce Tromberg, director of the
National Institute of Biomedical Imaging and Bio-
engineering (NIBIB), to help lure in businesses, tech
companies and academic labs with novel testing ap-
proaches, and they created a kind of Shark Tank where
those with ideas would get speedily reviewed by a
team of experts, who would evaluate not just the sci-
ence but also their capacity to scale it. Candidates who
made it through that round spent a week in virtual
intensive collaboration with industry experts, who
tweaked and refined their innovations. Other projects
that were further along were given an influx of cash.
“Within eight months they attracted proposals
from 700 different people and pushed two dozen
of them into the marketplace,” says Alexander, who
was one of the champions of the project when the
White House was skeptical about the benefits of test-
ing. “That’s an incredible engineering and scientific
achievement.” The first over-the- counter home test
approved by the FDA, from Ellume, was developed
using that process.
Has it been enough? Not nearly. Collins wishes
he had included convalescent- plasma studies in
ACTIV, to clarify if the blood of people who had re-
covered from COVID-19 could help those strug-
gling with it. “I take that as a failure of our whole ac-
ademic clinical research effort, and a failure of NIH,
that we didn’t jump in and make sure that this was
organized in a fashion that would give a rigorous an-
swer,” he says. “It may help most with people who
just got infected who haven’t made their own anti-
bodies yet, but we don’t know for sure.” And there
is only one FDA- approved COVID-19 medication,
remdesivir—a repurposed Ebola drug. That’s not
surprising to Collins—it takes three to five years
to develop a new antiviral drug—but it still haunts
2007
GEORGE W. BUSH AWARDS
COLLINS THE PRESIDENTIAL
MEDAL OF FREEDOM
2014
OBAMA VISITS THE NIH’S
VACCINE LAB DURING THE EBOLA CRISIS
2020
TRUMP TAKES QUESTIONS
ABOUT VACCINES
FROM LEFT: STEPHAN ELLERINGMANN—LAIF/REDUX; STEPHEN JAFFE—AFP/GETTY IMAGES; CHIP SOMODEVILLA—GETTY IMAGES; WHITE HOUSE PHOTO/ALAMY; MANDEL NGAN—AFP/GETTY IMAGES
