Finish off Covid19. Hurry.
Time is of the essence. The Cosmopolitan Globalists offer a blueprint for ending the pandemic.
By Owen Lewis and the Cosmopolitan Globalists
The world must be vaccinated. There is no time to lose.
SARS-CoV-2 is the greatest menace to public health since the Spanish Flu. It will continue to be a menace until it is eradicated. By this, the Cosmopolitan Globalists mean completely eradicated, gone, disappeared, extinguished. No government, anywhere, can afford to treat this as some kind of flu, nor can any government pursue herd immunity by any strategy save vaccination. Herd immunity absent vaccination is not only a failed policy, but a murderous one. The danger is not limited to the countries that try it.
Covid19 is far more serious than the flu. It is not at all comparable. It is a true killer. To judge from the damage to their hearts, lungs, and brains, many survivors will be permanently crippled. Mutations that make the disease more contagious—or more lethal, or both—are not an abstract possibility; they are happening already. More are inevitable if the disease continues to spread unchecked. Time is of the essence.
The new mRNA vaccines are more effective, in the short run, than traditional vaccines. But they may not be as effective in the long run because they are, by comparison, more narrowly targeted on the virus’s spike protein. There are fifty or so mutations that could render these new vaccines useless by changing the shape or the structure of the spike protein.
The race to vaccinate is a race against time. Too many governments—even in the rich, developed world—do not seem to understand this. France’s vaccination rollout, for example, has been a disgrace, proceeding at a pace appropriate to a moderate outbreak of adolescent acne. France’s health minister has suggested, with a straight face, that the government is dawdling to avoid alarming French anti-vaxxers.
The Cosmopolitan Globalists are appalled. How could any serious government allow the views of a conspiracy-addled death cult even to enter its policy considerations? This from a government that has proudly proclaimed France to be a bulwark against obscurantism and a champion of the Enlightenment? Macron’s government should have fallen the day these words escaped the health minister’s mouth. The world has had enough of catering to insanity—enough.
The emergency is not confined to the risks posed by Covid-19 and its new mutations. Every day the pandemic rages unchecked brings economic and social devastation. The French Economic Observatory estimates that two months of lockdown cost France 120 billion euros in lost revenue—that is to say, every single day of delay costs two billion euros. Lives and revenues are hardly all that is lost. Lost, too, are essential civil liberties, days of education, professional development, businesses, savings, the public’s mental and physical health. Every day lost is a catastrophe. France is now headed for a third lockdown.
In April, French budget minister Gérald Darmanin said, “Our country has not seen such a deficit since World War Two.” It has been obvious since he said this that a vaccine would arrive, that distributing it would require a massive logistical effort, and that every day of delay would be so costly—not only in deaths—that nothing could be a higher priority than preparing the rollout, and no cost should be spared to do it properly.
But the French government did not prepare for it. Vaccination centers are already running out of needles. The online system for scheduling appointments is preposterous: The elderly, who are most at risk, could not possibly understand or navigate it—and what’s more, even if they could, it doesn’t work. There is more anti-vaccination sentiment in France than in any other developed country. This has been known since the beginning of the pandemic. The sentiment is much more of a danger to France than ISIS, but there has been no public education campaign to combat it, nor any serious attempts to stigmatize it. Instead, the government is catering to it as if it were one among many perfectly respectable points of view.
No failure of French governance since the fall of France has been as consequential—nor as similar. Yet despite the enthusiasm of French citizens for taking to the streets to express even the most minor displeasure, France seems in the face of the virus resigned, passive, and fatalistic.
The same weaknesses that led to the catastrophe of 1940 are on display: a hopelessly divided political elite, an inadequate understanding of the threat, wishful thinking in place of rigor, a leadership pitifully reluctant to take the initiative. French culture, then as now, is defeatist. The French were and are disgusted with their leaders, who are widely viewed as venal and corrupt; this pessimism has permeated society so thoroughly that the public seems to believe this war cannot be won and it is pointless to try. The anti-vaxxers are actively and enthusiastically collaborating with the enemy, yet they experience no shame. This time, it would be warranted for an outraged public to take to the streets. Yet when it is really a matter of life and death, no one bestirs himself.
The incompetence of Macron’s government has been just as costly, in per capita deaths and to France’s economy, as any folly of Donald Trump’s. The majority of Americans, at least, expected more—and were well aware that Trump had failed them.
A blueprint for vaccinating the world
The pandemic is the most urgent issue confronting humanity. Vaccine nationalism is scientifically insane on the face of it: So long as the virus is allowed to mutate—anywhere—it remains a threat everyone. Delays in rolling out the vaccine—anywhere—are unforgivable.
Thus the Cosmopolitan Globalist presents the first in a series of articles offering a blueprint for vaccinating the world. We show that it is feasible and far less costly than failure.
This is a global emergency. Vaccinating the world must be the highest priority of every government. Governments that fail to address this crisis with alacrity and competence ipso facto demonstrate their illegitimacy. Recalcitrant or incompetent governments should be toppled—peacefully and democratically, where possible, and where that is not possible, consider democracy as a form of government.
For scientific and strategic reasons, we will argue, vaccinating the world must be the new Biden Administration’s key foreign policy priority. It is the only way to restore shattered global confidence in the United States’ leadership and competence. The US cannot afford to let national governments fight separate, local battles against the virus. The world is a global trade network of interdependent societies. Shutdowns and travel restrictions are equivalent in their effects to harsh economic sanctions, or a siege—and a siege is a weapon of war. If poorer nations are immiserated by shutdowns and travel restrictions for years as they wait for the vaccine, we should not be surprised if regimes change, nor should we be surprised if they are replaced by hostile regimes. Every day of delayed vaccination is another day of cruel sanctions. The world is rapidly hurtling back into darkness and poverty.
This endangers the developed world directly: The virus mutates. It endangers the developed world economically: It damages the economies of the developing and developed world alike. It endangers the developed world strategically: If you don’t like refugees and rogue states, relieve the misery of your southern neighbors. It endangers the developed world morally: If we do nothing as the developing world dies, it will destroy—and should destroy—any remaining legitimacy that obtains to the postwar order.
The solution
The solution is simple. The United States must finance and coordinate vaccination programs around the world. The implementation will be complicated, which is precisely why there must be a single coordinating power.
We now have seven effective vaccines, and more en route. Not every vaccine is ideal for every country. Even if vaccines were free, many countries lack the financial and organizational resources to mount a rapid vaccination campaign. Political and business considerations—or, as in France, cultural ones—may lead to the misallocation of resources.
Despite the past four years, the United States remains the only country that could credibly lead this effort. The World Health Organization’s reputation has been damaged. Chinese companies are not known as reliable producers of safe, high-quality medical products. Private efforts by heroic figures such as Bill Gates are admirable, but even Bill Gates’ resources are nowhere near those of the United States.
Today, we look at the strengths and weaknesses of the vaccines and therapies now available, which suggest how they should be distributed. In coming issues, we will examine the manufacturing and logistics challenges we must surmount. We also explain how the US government—or any government eager to fill its shoes—must coordinate the distribution of vaccines.
Together, these articles are a blueprint for vaccinating the world. This is the only way to end this nightmare. Nothing short of this will suffice. The longer this continues, the more difficult it will be for the world to recover, socially and economically, and the greater will be the risk to the world’s remaining social cohesion and peace.
This is the biggest emergency we confront. Wherever you live, we urge you to insist your government address this crisis with utmost seriousness. If it doesn’t, topple it.
The vaccines
The only good news about Covid19 is that the world now has access to eight vaccines, of which seven are good enough. Each has strengths and weaknesses. In the aggregate, they are sufficient, given effective coordination and serious commitments from national governments, to control the crisis.
They have been developed with unprecedented speed. Previous vaccines have taken ten years or more to develop, with the mumps vaccine, produced in four years in the early 1960s, holding the record to date.
Modern technology has allowed us to develop these vaccines faster than many thought possible. Eight of them, based on three different technologies, are ready to begin saving lives. Three were developed in the West, by Pfizer, Moderna, and Oxford/AstraZeneca. Russia and India have developed a vaccine apiece. China has come up with three. The latter five received approval before safety and efficacy could be fully gathered and reviewed, although China has now fully approved the Sinopharm vaccine. All are now being deployed. Other vaccines are near approval; all of these are currently available.
The speed of development has in part been owed to messenger RNA vaccines designed by Moderna and Pfizer. Moderna’s vaccine was ready two days after the publication of the virus’s genetic sequence. Since then, the company has been doing nothing more than test the vaccine for safety and efficacy. Both Moderna and Pfizer vaccines are 95 percent effective—an almost unimaginable success. Early results suggest, too, that the Pfizer vaccine, and thus probably the Moderna vaccine, prevents the vaccinated from spreading the virus.
Messenger RNA vaccines
Traditional vaccines are made in two ways. The first is by taking a piece of the viral shell, or something on it—like Covid-19’s spike protein—and training the immune system to recognize the complete virus. This means growing the virus, harvesting it, and separating out the part of interest. It’s a good system—proteins like the infamous spike protein are easy for the immune system to recognize—but it’s time-consuming.
The second is by using a weakened or dead virus to prepare the immune system for the live version. This approach has drawbacks, too, including the time it takes to of grow and then to weaken or kill the virus. In live-attenuated vaccines, there’s a small risk the weakened pathogen will mutate and regain virulence. This happens, occasionally, with vaccine-derived polio.
The final drawback of these methods is that growing large volumes of live virus creates a small but real risk of lab release.
The mRNA vaccines avoid all of these problems. They’re made rapidly, without animal cells, and they contain no virus—just code for spike protein. The time-consuming process of extraction and the risk of mutation are eliminated.
DNA may be understood as an instruction manual: How to Build and Maintain a Living Thing. The instructions must be conveyed in a usable format to cellular factories, or ribosomes. Messenger RNA is both messenger and message, sending instructions from the DNA to the ribosomes. Upon reading the mRNA, ribosomes produce the encoded protein, allowing the cell to grow or survive.
The Moderna and Pfizer vaccines contain synthesized mRNA that codes for the coronavirus spike protein. Our ribosomes use the mRNA as the template for producing these proteins, which fools our immune system into believing the whole virus is present and teaches it to recognize—and defeat—the real thing.
The technology is ingenious and beautiful, but there is a major liability: These vaccines are fragile. They must be kept extremely cold: Pfizer’s must be stored at -70°C, though once at a distribution center, it can be stored at 2–8°C for five days. Moderna’s is more robust; it can be stored at a standard vaccine freezer temperature, -20°C, for six months, and in refrigerator conditions, 2–8°C, for a month.
A small number of recipients have experienced severe allergic reactions. This is a risk with any vaccine, but the rates with these seem slightly higher than normal. A number of health agencies now advise those with known allergies to the vaccine’s components to avoid them. They can be protected with other vaccines, or perhaps antibody therapies. Anaphylaxis, when it happens, appears rapidly after vaccination and is readily treatable.
Human and monkey adenovirus vaccines
The Russian, Oxford, and Chinese CanSino vaccines represent noteworthy innovations, too. They use modified adenoviruses—common cold viruses—as vectors. There have been many attempts to do this, but until now, only a rabies vaccine for animals has been a success.
To make this kind of vaccine, you take a human adenovirus, eliminate the genes that cause illness, then add the gene that encodes for the SARS-CoV-2 spike protein. By using a virus as a vector, you deliver the vaccine by means of a device that’s already highly proficient at slipping past the body’s defenses and into its cells.
The strength of this kind of vaccine is also its weakness: The immune system learns to recognize not just the spike protein, but the vector. Since human adenoviruses are common everywhere, many people have antibodies against them. This decreases the effectiveness of the vaccine. Immunity to adenoviruses varies widely; what works well in China may not be as effective in Africa, and vice-versa.
Low levels of immune response are endemic in the elderly—the population most at risk—because after a lifetime of exposure to adenoviruses, they have more antibodies. Children have the opposite problem: They’ve had no exposure, so they may have an overly strong immune response, with a higher risk of serious side effects.
Adenovirus-based vaccines are a gamble. They will be useful in some contexts and less so in others; they could be dangerous to the young and of limited aid to the old. Patchy effectiveness will make it difficult to know whether we’ve succeeded in protecting enough people around the world from infection.
The developers of the Oxford adenovirus-based vaccine avoided these problems by using a chimpanzee adenovirus, ensuring a near-complete lack of pre-existing antibodies. The vaccine was 62 percent effective when the standard two full doses were given, but 90 percent effective when a half dose was followed by a full dose. No one is sure why. Perhaps the longer gap between the first and second doses accounts for it. Studies to determine the most effective method of vaccination are ongoing, but numbers so far range from 62 to 95 percent, making it hard to know how good it is. We know it’s safe and effective, but we aren’t sure how effective.
On the positive side, it’s stable at refrigerator temperatures of 2–8°C for six months, making it much easier to store and transport around the world than the more effective mRNA vaccines.
Sputnik V
Russia launched its Sputnik V vaccination in early December, without offering peer-reviewed public data. It too requires two doses, each made with a different human adenovirus—Ad26 and Ad5. In principle, this militates against the buildup of antibodies against the second dose, improving the vaccine’s effectiveness.
Sputnik V has been plagued with problems beyond the lack of publicly-released data. The trial size and duration have been inadequate, and the manufacturers haven’t been able to provide enough of the second shot, the Ad5, which seems to be tougher to make. Although the official numbers put the vaccine’s effectiveness at 91.4 percent, many Russians are unconvinced, with the majority saying they don’t want it. Independent estimates suggest its efficacy may be much lower, perhaps closer to 60 percent. We just won’t know until better data is available. What’s more, the liquid form of the vaccine must must be frozen and kept cold, below -18.5°C, similar to the storage conditions required by Moderna. There are plans to freeze-dry it, but no data so far shows how this might affect its efficacy.
China’s vaccines
All three of China’s vaccines were approved for emergency use, although only the one produced by Sinopharm has the full approval of the Chinese government.
The Sinopharm vaccine relies on inactivated SARS-CoV-2—a tried-and-true vaccine technology, used to make influenza vaccines and vaccines against pertussis, rabies, and hepatitis A. Although Phase III trial results aren’t available, earlier results indicated that it was safe and stimulated an immune response. Since the final results aren’t public, the purported protection rate of 79.3 percent should be taken with a grain of salt. It’s certainly theoretically plausible and about what you’d expect.
Sinovac makes another vaccine using inactivated coronaviruses. Like the Sinopharm vaccine, there is little data about its effectiveness. Only very limited peer-reviewed safety information has been released. Phase III trials were launched in Brazil, Indonesia, and Turkey; no large trials were conducted in China, however, suggesting China may be using other countries’ citizens as guinea pigs to see if the vaccine is safe for widespread use at home. There is so far no efficacy data, although there have been unsupported claims of 50.4 percent efficacy in Brazil, 91.3 percent in Turkey, and 65.2 in Indonesia.
Finally, CanSino has produced another human adenovirus vector (Ad5) vaccine. Data from its ongoing Phase III trials in various countries has been paltry. Phase II data, however, showed it to have a good safety and immune profile. Unlike the other approved vaccines, CanoSino’s requires only a single shot—perhaps to minimize the odds of antibodies developing against the adenovirus vector. Unfortunately, the same Phase II data indicated that about half the elderly in the trial already had high levels of antibodies against Ad5. So the vaccine will probably be far less effective for them.
The story of the CanSino vaccine in Canada suggests the dark side of China’s vaccine diplomacy. After Canada’s detention of Huawei executive Meng Wanzhou, China refused to send vaccines to Canada for Phase II trials, ending Chinese-Canadian collaboration. This was embarrassing for Canada, but had no permanent impact on its ability to vaccinate its citizens. A less prosperous country could readily be pressured to toe the CCP line this way.
All three Chinese vaccines are stable at refrigerator temperatures of 2–8°C, making them easier to transport. But it may be harder to persuade people to trust these vaccines, given the lack of data about their efficacy. More information is available about their safety profile, but the data is still sub-par.
India’s vaccine
Data from Covaxin, made by the Indian company Bharat Biotech, has not been peer-reviewed. But Phase II results indicate the vaccine is safe and induces an immune response. No Phase III data on safety or efficacy has yet been published, though the company plans to publish it in March. Like two of the Chinese vaccines, the Indian vaccine uses two doses of inactivated SARS-CoV-2.
The vaccine has been met with some doubt in India. The company’s fact sheet points out that the vaccine has been authorized by the Indian Central Licensing Authority “for restricted use in emergency situation in public interest as an abundant precaution, in clinical trial mode.” Neither the company nor the government has explained exactly what the term “in clinical trial mode” means.
Doctors at the Ram Manohar Lohia Hospital in New Delhi, one of India’s best-known hospitals, do not seem enthusiastic about it. They sent a letter to the hospital’s superintendent requesting they be administered the AstraZeneca vaccine instead. The health ministry has received reports of some 580 adverse reactions to vaccination, but it has not yet clarified which vaccine gave rise to these reports. Of these, only nine cases required hospitalization. As of January 19, according to the Indian government, 631,417 people had been vaccinated.
Though health experts and watchdog groups in India view Covaxin as rushed and perhaps premature, it is based on well-established technology. India has significant expertise in making vaccines. India’s Serum Institute is the largest vaccine manufacturer on the planet. While we can’t wholeheartedly applaud Covaxin’s approval, given the lack of data, we have a good feeling about it. And India hasn’t engaged in the kind of sinister vaccine diplomacy we’ve seen from China and Russia.
Antibody therapy
One more tool is available immediately: antibody therapy. Antibodies, Y-shaped proteins the body makes naturally in response to infection, are tailored to each variety of virus or bacteria. They help the immune system mount an assault the next time it encounters the pathogen. Antibodies do two jobs: they neutralize viruses by binding to them, making them unable to infect cells, and they mark the virus for destruction by other parts of the immune system. A variety of antibodies can stop SARS-CoV-2. These can be mass-produced in a lab to create drugs that should, in principle, provide immediate protection against Covid-19.
The technology is still new and not many antibody drugs have been approved. The downsides: We’re unsure how effective they are; they cost much more than vaccines, running to the hundreds of dollars per dose; and administering an antibody infusion is time- and labor-intensive compared to giving a vaccine. But the trials are encouraging. We may have drugs that provide six months’ to a year’s worth of protection by springtime. These could fill in the gaps of any vaccination campaign, offering protection to people who can’t be vaccinated, such as those with compromised immune systems and vaccine allergies. This might help to contain localized outbreaks more effectively by giving instant immunity instead of the weeks required for vaccines to work.
There will probably be more vaccine approvals in 2021. J&J has an adenovirus vector vaccine that looks good. Novavax has a promising candidate made with nanoparticles from SARS-CoV-2 spike proteins. There are no guarantees, however. We need to significantly increase the use of what we have available now even as we keep these latecomers in mind
All of these vaccines will play important roles in vaccinating the world, with the possible exceptions of Sputnik V and China’s CanSino vaccine. We hope the lack of adequate data on Indian, Chinese, and Russian vaccines will promptly be rectified.
Both mRNA vaccines should be deployed extensively and immediately in developed countries and in major population centers everywhere else. It will be difficult, however, to use them in rural areas of developing countries because they must be stored at such a low temperature.
The Oxford vaccine apart, adenovirus vaccines are not ideal. They will be less effective in the old and perhaps unsuitable for the young, though they are still better than nothing.
The three inactivated virus vaccines developed by China and India will probably be useful in a broad range of circumstances. Though less effective than the mRNA vaccine, they are easier to transport and store. It will be much easier to bring them to rural areas with unstable electricity.
Some of these vaccines are better than others. In a perfect world, we would use only the best and nothing else: the two mRNA vaccines from Moderna and Pfizer. But we need to vaccinate the world as quickly as possible. The future of the human race depends upon achieving global herd immunity, fast. The perfect is the enemy of the good, and if you’re in a hurry, good is good enough.
Hurry.
We will continue this series in the coming days.
Owen Lewis is a science and space enthusiast and the founder of Fusion is the Future (@is_fusion), dedicated to promoting nuclear fusion as humanity’s best energy source. He is a Christian humanist.
Learned a lot here! Definitely interesting to learn more about Russia and China's vaccines. Tying back to your previous pieces on China, hoping Biden agrees with you and makes the right call in his foreign policy. It's going to be essential to show leadership here. We have a moral duty to resist Chinese hegemony so long as China is controlled by the CCP, which has proven its willingness to enslave and torture its own citizens, and as we see here, subject foreign populations to hastily-developed vaccines that they don't trust to use on their Han majority.
Very informative. I think you’re a little too pessimistic about the adenovirus-vector vaccines. We will hear about the J&J vaccine any day now; if it’s effective at one dose it would be the greatest thing since sliced bread. The AZ vaccine is (as of now a two dose vaccine). Sadly, AZ screwed up their Phase III trial so no one really knows what the most efficacious first dose is.
It is true that the adenovirus vector can probably only be given once, but depending on the durability of protection this might not be a problem. If it protects for a decade or more (which is possible but not certain) there’s no need to worry about whether the vector can only be administered once.
Another advantage to the adenovirus vaccines is that long term (or semi long term) safety data is available. While the mRNA vaccines are literally brand new, J&J uses the exact same technology in its Covid vaccine that it uses in its Ebola vaccine. Around 1 million J&J Ebola vaccines have been delivered in Africa with practically no safety issues. The mRNA vaccines are almost certainly safe, but it’s hard to know for sure.
There’s a third vaccine technology that wasn’t mentioned (unless I missed it)-the protein based vaccines. Novavax has one and so does Sanofi (working in partnership with GSK). Basically they provide immunity by exposing the immune system to synthetically manufactured spike protein. These vaccines tend to be weaker so they are paired with chemicals called adjuvants which make the immune system hyper vigilant. The new Shingles vaccine (Shingrix) is this type of vaccine.
Mutation of the virus is something to worry about but not panic about. Most (not all) produce immunity not by priming the immune system to recognize the entire spike protein but by priming the immune system to recognize a part of the spike protein called the receptor binding domain (the part of spike protein which chemically attached itself to the ACE2 receptor found ubiquitously on cells in the human lung, nasal passages and bowel). The receptor binding domain is probably somewhat less likely to mutate.
What regulatory agencies have gotten wrong is the emphasis on development of symptomatic disease as the primary end point in the trials. I think it makes much more sense to focus on whether the vaccines prevent severe disease, hospitalization or death. After all, if the vaccines turn a deadly disease into the sniffles, that would be pretty good.
Claire is right; the United States is ideally suited to vaccinating the world. In fact our country has played the most important role in vaccine development. While Claire can’t bring herself to admit it, the Trump Administration’s Operation Warp Speed was a brilliant and unparalleled success. Most (not Pfizer) companies in the West with the most promising vaccines took warp speed money.
It also pays to remember that the only reason that the world is blessed with a viable and dynamic pharmaceutical and biotech industry is because American patients pay almost all the freight for R&D. Almost every successful pharmaceutical company in the world undertakes the remarkably risky research needed to produce new medicines because most of their profit comes from prices paid by Americans. If Pharma ha to rely on drug prices paid by Europeans, Canadians, Australians and all the nations in Asia, the business would not be profitable enough to justify the risks. In this sense, Claire, Americans are already footing the Bill for almost all Covid vaccine discovery efforts.
Last year, the House of Representatives passed a Bill which would have severely restricted drug prices. Speaker Pelosi was a fierce advocate of the Bill. In the Senate, a less onerous but still destructive Bill was introduced.
This was one case where gridlock proved to be a great thing. Does anyone think we would have gotten Covid vaccines (not to mention new antibody treatments) so rapidly if the Pharmaceutical industry had tens of billions of dollars in reduced revenues?
As for getting shots in the arm, most American States have failed miserably. So have all European nations (with the possible exception of the UK). The only country getting it right is Israel. As of today, Israel is offering vaccines to citizens aged 40 and up. Maybe our leaders should call Benjamin Netanyahu for advice.