Late last week, for a brief moment the pandemic felt like it might be on the way to being under control. Yes, daily Covid-19 death counts were at near-record levels. But the vaccination rate was ticking above a million shots a day, Dr. Fauci was back behind the White House lectern, and the new president had a new plan for beating back the virus.
Then Monday came, and reality hit.
First came the news that
(ticker: MRK) was giving up on the two Covid-19 vaccines it had been testing. Then
(MRNA) said its vaccine appears less effective against a new strain of the virus that causes Covid-19.
dropped 1.2% Monday morning. And though it was flat by the afternoon, the reality of the remaining fight against Covid-19 seemed even more stark.
In recent weeks, the rollout of the currently-authorized Covid-19 vaccines has dominated discussions around the virus. Even with hundreds of thousands of people getting sick in the U.S. each day, the pandemic has begun to feel all-but-over; just a matter of getting a few hundred million shots in arms.
Johnson & Johnson’s
(JNJ) single-dose Covid-19 vaccine was the cavalry just over the hill, ready to inoculate 100 million people in the U.S. by the spring, pending trial data that’s expected any day now.
But cracks in that hopeful vision had already begun to reveal themselves. After weeks of assurances that the current vaccines would protect against a new strain that originated in the UK., Fauci warned Thursday that a variant first identified in South Africa might be able to slip past the immune defenses erected by the vaccines, to some degree.
Now, the implications of that warning are clear. Moderna said Monday that its vaccine appears less effective against the South African strain, and that it will develop a booster shot of its vaccine to protect against it. That raises the specter of an infinitely more complex vaccine rollout, adding the variable of extra booster doses to an already-challenging effort to vaccinate an entire population.
Hours before Moderna’s announcement,
(MRK), perhaps the most successful vaccine developer in the industry, said it had failed in its effort develop a Covid-19 vaccine. The company said it was ending its work on two Covid-19 vaccines after disappointing early trials.
The news puts additional pressure on the results of the Phase 3 trial of the Johnson & Johnson vaccine. Analysts had already expected Johnson & Johnson’s data to move the stock market, depending on how the trial turns out. Experts are looking for the vaccine to demonstrate efficacy of at least 80% with a single dose.
If the Johnson & Johnson vaccine disappoints, there are others in the immediate pipeline, including a vaccine from
(NVAX), also currently in Phase 3 trials. But the Merck programs, though in an early phase of development, had been a comforting fallback from an experienced vaccine maker with a history of developing and manufacturing huge numbers of doses. It seemed a sort of pharmacological safety net in case of unpleasant surprises.
Coming a month after news that another more traditional vaccine from major vaccine makers
(GSK) had run into delays in early trials in elderly patients, that safety net is feeling a little frayed.
All at once, it feels that much more important for the Johnson & Johnson vaccine to work as well as expected.
The Moderna news, meanwhile, is a reminder that vaccination may not be the light switch that turns off the pandemic.
Two weeks ago, Pfizer’s chief scientific officer told Barron’s that he expected mutations of Covid-19 to cause all of the current vaccines to lose activity within a year or two. Moderna’s announcement this morning suggests even greater urgency.
In a not-yet-peer-reviewed paper posted Monday, Moderna scientists found “reduced but still significant neutralization” of the South African Covid-19 strain lab tests using blood taken from individuals who had been vaccinated with the Moderna vaccine. The company said that, “out of an abundance of caution,” it would test a new booster shot of its vaccine designed to protect against the South African strain. It will also try using a third dose of its original vaccine as a boost. The company said the new booster shot would be tested in a Phase 1 study in the U.S.
The idea of attempting to deliver Covid-19 booster shots, nonetheless in a country already struggling to reach its initial vaccination goals, is enough to keep local public health officials up at night, if they’ve been sleeping at all anyhow.
This U.S. has administered 21.8 million vaccine doses to 18.5 million people since December, according to the Centers for Disease Control and Prevention. A number of doses are going to waste as states, counties, and the federal government struggle with huge logistical challenges, the product of decades of underinvestment in the nation’s public health infrastructure.
Speaking to Barron’s two weeks ago. Dr. Ashish Jha, dean of the School of Public Health at Brown University, offered one key piece of advice to smooth the rollout: “We can come up with the most elegant plan in the world, but our national ability to execute on these things is just not fantastic,” he said. “Simplicity, man. There’s nothing like simplicity.”
You know what’s not simple? Trying to balance administering booster shots to health-care workers, 90-year-olds, and other vulnerable populations while still racing to get prime doses into the arms of 45-year-olds.
That’s not to say that everything is grim. Vaccination does seem to work in the real world, as the experience in Israel seems to be showing.
But the path ahead looks a bit rockier this afternoon than it did when the sun rose this morning.
Write to Josh Nathan-Kazis at firstname.lastname@example.org