The case for Operation Warp Speed 2.0
Omicron's blitz around the world has underscored the need for a new arsenal of COVID vaccines and therapeutics, experts say — and that may require an effort akin to Operation Warp Speed 2.0.
Why it matters: The virus will continue to evolve, potentially in a way that further escapes vaccine protection, and the best way to prevent more global disruptions to everyday life is to have tools ready to combat whatever comes next.
The big picture: As much havoc as it caused, the world got somewhat lucky with the Omicron variant: It causes less severe disease than other variants — likely because it doesn't replicate as well in the lungs — and existing immune protection works well against hospitalization and death.
- But its transmissibility, ability to evade some immune protection and the ineffectiveness of some existing treatments against it have laid bare how much trouble the world would be in if an equally transmissible but deadlier variant came along.
What they're saying: "As the virus moves forward, our vaccine has been stagnant. And so the virus is going to continue changing, and we can't have a stagnant vaccine," said Rick Bright, former Biomedical Advanced Research and Development Authority director and a member of President Biden’s coronavirus transition team.
- "We need Operation Warp Speed — that kind of efficiency and focused coordinated effort on therapeutics, surveillance and other areas to address COVID," said Zeke Emanuel, another member of the transition team.
State of play: Pfizer and Moderna have said they are working on Omicron-specific versions of their COVID vaccines. Pfizer has said theirs will be ready in March, and Moderna has said they’ll have data available around the same time.
- But relying on Omicron-specific vaccines is risky, experts say, because there's no guarantee they'll work against the next variant, or even provide strong protection against other existing variants.
- "One of the problems with making the primary vaccination against the latest variant is that you might not get as broad of a response as against the ancestral strain," NIAID director Anthony Fauci told Axios in an interview, cautioning that we still need more data before making any big decisions about where to go next.
- "Although with the mRNA, that's a spectacular success story, I don't think we should rest on our laurels, and we should look at how do we get a platform and... design that might give a broader and more durable protection," Fauci added.
The catch: It's impossible to predict what the next problematic variant will be. That likely requires investment in multiple vaccine candidates and technologies, including ones that target different variants or different parts of the virus.
- The existing vaccines could be retooled to be variant-specific or to target more than one variant at the same time, but the holy grail would be a long-lasting vaccine with broad enough protection that it’s essentially variant-proof.
- However, although there's some promising science in this area, a "pancoronavirus" vaccine doesn't yet exist.
- Some experts say we also need new vaccines that are delivered differently, such as orally or via absorption through the skin, and that don't require cold-chain storage. These could help immensely with global vaccination.
- "If you took five of these new approaches, five or six, I would plan on maybe a $5–10 billion effort to accelerate, develop, scale and evaluate those to seriously broaden our arsenal against this virus," Bright said.
Between the lines: Although the original Operation Warp Speed focused largely on vaccines, experts say that if we do it again, there needs to be just as much, if not more, investment in therapeutics — especially given the reality of stubbornly low vaccination rates in the U.S.
- Only one of the existing monoclonal antibodies in the U.S. works against Omicron, per the NIH. Two new antivirals were recently authorized, but there's a severely limited supply of Pfizer's, which performed best in clinical trials.
- Regardless, it's important to have multiple antivirals. Although they generally work well against different variants, the virus can mutate to become resistant to them.
- "We cannot be confident that this silver bullet we have with two small-molecule, oral antivirals are going to hold out for long," Bright said. "They may work on multiple variants, but we should not underestimate how the virus can become resistant to those drugs."
- The administration is working to find next generation antivirals, and is identifying candidates they're interested in funding the development of and potentially purchasing in advance, a senior Biden administration official said.
Yes, but: There are "scientific questions that need to be answered before you do a Manhattan Project, Warp Speed thing where you essentially make hundreds of thousands or even millions of doses of something," Fauci said.
What we're watching: There are enormous potential costs to being caught off guard by the next variant, which dwarfs the billions of dollars experts say should be put toward preparedness.
- But that money will have to come from somewhere, meaning Congress would likely have to authorize new funding for it.