SUNDAY, MARCH 27 , 2022. THE WASHINGTON POST EZ BD B5
in 2021, found that poor public confidence in
government undermined adherence to miti-
gation measures, such as wearing masks,
complying with stay-at-home orders and vac-
cination mandates. More recently, a study
showed Americans’ continued low trust in
government translated into more infections
and deaths.
As at other stages in the pandemic, it could
be up to us individually to take precautions
and prepare for what’s to come. I personally
have encouraged family and friends to order
more rapid antigen coronavirus tests, which,
for the moment, are being offered free by the
federal government. My family has already
bought additional high-quality masks, even
though mask mandates have been lifted. With
studies piling up on the lingering effect of
infection from the virus, and long covid, I do
not plan to let down my guard. Magical
ease threats taught me to expect this vicious
cycle of complacency followed by hyper-re-
sponsiveness. For example, in August 2016,
the CDC warned Congress that federal funds
to combat Zika, a mosquito-born virus that
was causing debilitating birth defects, had
dried up. If Congress didn’t act soon, the CDC
said, there wouldn’t be money to sustain
efforts and fight off new outbreaks. The
long-awaited funding was finally approved in
September, seven months after President Ba-
rack Obama requested the funding. By that
time, more than 23,000 cases had been report-
ed in the continental United States and Puerto
Rico, including 2,000 pregnant women.
Public trust in government was already
hanging by a very tenuous thread even before
the pandemic. That flagging trust has, in turn,
hurt our coronavirus response. The latest
Global Health Security Index report, released
ings with world leaders, while flinging around
technical terms like “reactogenicity” without
explanation. It makes a few errors of fact — at
one point confusing the alpha and delta vari-
ants, for instance — and chapters on vaccine
equity are too shallow to be satisfying contri-
butions to discussions on that important is-
sue.
Yet Bourla’s character and enthusiasm —
when they emerge — lift his narrative. For
instance, an account of his parents’ narrow
escape from the Greek port city of Thessaloní-
ki during the Holocaust is moving in itself, but
in noting the fate of Jewish family members
less fortunate, he also reflects on those we
have lost, the value of human life and how it
can be bettered, and his voice shines off the
page.
“Moonshot” might inspire others to devote
themselves to the hard work of making effec-
tive vaccines — heaven knows we need them
for diseases including tuberculosis, malaria
and beyond. And none of us should forget:
mRNA vaccines are an astonishing technical
and logistical achievement, a marvel of the
modern age. Time is life, and science will win.
raced to get vaccines into people before the
virus reached them. According to “Moonshot,”
Britain was the beneficiary of the Trump
administration’s failure to promptly distrib-
ute its own doses of the vaccine, gaining 3
million extra shots. Future doctoral theses will
be required to estimate how many lives were
saved.
Similarly, a close collaboration with Israel
provided some of the best data on how the
vaccines performed in the real world in which
immunity can wane, and against a nimble
virus that continues to churn out variants. The
book is correct that Pfizer’s vaccine, like the
others, stands up remarkably well when it
comes to preventing the worst consequences
of infection. In 2020, the goal was to produce a
vaccine that would provide as good or better
protection than immunity following infection,
so we need not face the virus completely
unprepared. We are fortunate that we have
multiple vaccines in our arsenal. “Moonshot”
is studiously silent about these competitors,
which were produced on a schedule almost as
rapid as that of Pfizer.
We can expect the best accounts of the race
to vaccines will be written by outsiders, and for
these authors “Moonshot” will be a reference.
For sure, the book is flawed; it seems uneven
and unsure of its target audience, mixing up
accounts of logistics with starry-eyed meet-
Circle” (the executive meeting room where top
leadership sat in a circle of comfortable chairs
rather than at a conference table) and corpo-
rate mantras such as “Time Is Life” or “Science
Will Win.” Some readers will be inspired while
others find their toes curling at the manage-
ment-speak, but the slogans suggest the effort
required to inspire a diverse team. Among that
team are Ugur Sahin and Özlem Türeci, the
married couple at BioNTech who spent years
of preliminary work developing the mRNA
vaccine technology used in Pfizer’s vaccine.
Bourla is rightly fulsome in his praise of
BioNTech — he could arguably be more ful-
some yet.
Some of the most interesting parts of the
book describe events after Pfizer’s vaccine
began to be rolled out in different countries.
One of the single boldest and, in retrospect,
best decisions of the pandemic was that of the
British government to massively ramp up its
vaccination efforts in January 2021. The coun-
try had been eager to move past the virus and
declare it endemic (sound familiar?) but was
instead slammed by the alpha variant.
Over that bleak winter, Britain saw greater
pandemic mortality than the United States
has experienced at any stage, but the toll could
have been even worse were it not for an
accelerated campaign conducted during a
desperate lockdown: Public health authorities
how Pfizer managed such an absurdly rapid
turnaround. Unfortunately, Bourla, who took
on the duties of chief executive in 2019, sheds
little light here. According to “Moonshot,” the
trick was mostly to tell people to do things
more quickly. There is obviously more to it
than that, but pretty much all the book de-
scribes is adequately funded development
steps alongside each other in parallel. A bold
decision to be sure but not the stuff of startling
innovation. As Bourla observes: “it would be
painful to take a $2 billion write-off in my
second year as CEO if the project failed. But I
also knew it would not take the company
down, and it was the right thing to do.” This
contains two truths; it was very much the right
thing to do, and a company the size of Pfizer
could take the risk. Many of the challenges
were in the logistics of getting doses into
people once the vaccine was developed.
There is a hint of difficult and necessarily
bold decisions about where to run clinical
trials and which vaccine candidates to take
forward. These choices were obviously made
well, or Bourla would not be in a position to
write such a book, but there’s scant informa-
tion on how they were made. In place of such
detail, we read about management innova-
tions such as decisions taken in the “Purpose
VACCINE FROM B1
thinking that infection holds no biological
impact could prove disastrous for us all.
Trust in the government’s ability to respond
to this and the next pandemic won’t improve if
we continue on this path of complacency
followed by a flurry of panicked action —
waiting for a crisis to occur instead of thinking
ahead and planning and funding accordingly.
The risk is too high, and we have much to lose.
The gains we had made collectively to sup-
press this virus by vaccinating, testing and
mask-wearing is in jeopardy. We learned so
much these past two years. We can’t afford to
make the same mistakes.
Twitter: @syramadad
Syra Madad is on the faculty at Boston University’s
Center for Emerging Infectious Diseases Policy &
Research and a fellow at the Harvard Belfer Center
for Science and International Affairs.
MOONSHOT
Inside Pfizer’s
Nine-Month
Race to Make
the Impossible
Possible
By Albert Bourla
Harper
Business.
2 16 pp. $29.99
MATT ROURKE/ASSOCIATED PRESS
William Hanage is an associate professor of
epidemiology and co-director of the Center for
Communicable Disease Dynamics at the Harvard
T. H. Chan School of Public Health.
C
ongress’s inability to provide continued
funding for the country’s pandemic re-
sponse gives me deja vu. In December
2019, I and other experts warned that a
program protecting us from a deadly pandem-
ic was about to expire. Three days later, news
broke about a cluster of cases of pneumonia of
unknown cause, which would turn out to be
the novel coronavirus. Despite the warnings,
it wasn’t until the following March that
Congress appropriated funds to respond to
the coronavirus. By then, some states had
implemented stay-at-home orders to prevent
further spread of the coronavirus.
You would think that two years after that
misstep, our leaders would understand how
costly it is in lives and dollars to dither when a
threat seems far off, only to scramble into
action when it arrives at your doorstep. But
the unfortunate cycle of panic and neglect that
has marked our response to previous patho-
gens remains unchanged. As we saw with
anthrax in 2001, H1N1 in 2009, Ebola in 2014,
Zika in 2016, as the threat abates, so does the
funding.
The latest example of this pattern comes as
administration officials are warning that they
desperately need funding to buy tests, treat-
ments, vaccines and other supplies to combat
the coronavirus. The White House said it has
run out of money to buy a second booster shot
for all Americans if it turns out to be needed,
and has said shipments of monoclonal anti-
body treatments to states may have to be
slashed. Some coronavirus surveillance ef-
forts also will be shelved, leaving the United
States potentially blind yet again from incom-
ing variant threats.
Despite this dire warning, a funding pack-
age collapsed in Congress this month amid
partisan feuding.
We are in a much better place right now,
compared with January, when cases peaked at
nearly 1 million per day. But we know that
immunity wanes, and less than half of the
eligible U.S. population is boosted. The pan-
demic is not over globally or nationally.
Several European countries are already seeing
increasing caseloads because of the BA.2
subvariant of omicron. Coronavirus surges in
Europe often presage surges in the United
States. Already, a third of the Centers for
Disease Control and Prevention’s wastewater
testing sites are showing an uptick in virus. If
this is not a warning, I don’t know what is.
My experience responding to previous dis-
Congress isn’t acting on covid. So I’m stocking up on masks and tests again.
We still haven’t
learned from
our mistakes
earlier in the
pandemic, says
epidemiologist
Syra Madad
SHAWN THEW/EPA-EFE/SHUTTERSTOCK
Coronavirus tests
have been relatively
easy to get lately,
such as t hese
distributed by
Montgomery
County, Md. But
they may become
scarce again if
Congress doesn’t
agree to continue to
fund pandemic
preparedness.
A peek into
Pfizer’s pursuit
of a vaccine
A syringe is prepared with coronavirus
vaccine in December 2021.
