One of my favorite stories that I stumbled upon while writing “The Premonition” was of the truly odd and inspiring work done inside the George W. Bush White House between late 2005 and the middle of 2007. Working with a mid-level Centers for Disease Control and Prevention employee named Lisa Koonin, two doctors, Richard Hatchett and Carter Mecher, sought to answer a vexing question: What might society do to protect itself from a new pathogen in the period between the start of a pandemic and the creation of a vaccine? Their work wound up having enormous influence, and the doctors have become known for a peculiar sort of pandemic expertise. Hatchett is now based in London, and runs the Coalition for Epidemic Preparedness Innovations, headquartered in Oslo, which, among other things, helped to fund early production of the new mRNA vaccines. As the omicron variant was emerging, he sat down to answer a few questions about the pandemic and where it might lead. This interview has been edited for clarity.
Michael Lewis: There are early signs that omicron will supplant delta and become the dominant virus, until something comes along to supplant omicron. There are also signs that the existing vaccines might not be as effective at protecting people from the new strain. If all this winds up being true, might we need a vaccine tailored to omicron and—if so—do we wind up chucking all the existing vaccine and return to Go, without collecting $200? Might not this happen over and over again—and we produce billions of doses of vaccines that don't get into people before the virus mutates around them?
Richard Hatchett: We already know that omicron at least partially evades the immune response elicited by several of our vaccines. Might this happen again? My bet is that it will. Look, we’re going to be living with Covid for a long time and our current vaccines are very good, but that doesn’t mean we can’t develop better ones that provide broad protection against a wide range of SARS-CoV-2 variants, and even against other coronaviruses. Developing such vaccines may take years, because there is a lot of basic virology and immunology work we need to do. Fortunately, there are many groups hard at work chipping away at the problem already. We just need to make sure they are and remain well funded. We need to be thinking about where we want to be with respect to this virus not just next month or next quarter but in five or 10 years.
ML: Do high-income countries have sufficient vaccines to vaccinate their populations?
RH: I think they mostly do. There were some countries that got caught out. Japan initially; even Europe was a little bit short of vaccine relative to the U.K., Australia, New Zealand. They have now caught up and have gotten to a limit where they're running into vaccine hesitancy or people that just don't want to be vaccinated as kind of the boundary.
ML: So rich countries don't have a supply problem, they have a demand problem, and lower-middle-income and lower-income countries have a supply problem.
RH: We have had a supply problem, but that has shifted very recently. Lower-middle-income countries were behind the upper-middle-income countries but had greater access to vaccines than low-income countries. The low-income countries were the ones who really fell off the cliff. In the last few months, the number of doses becoming available through Covax has increased. In November, we delivered close to 200 million doses. The first week of December, we delivered 11 million doses in a day. That’s how much supply picked up.
ML: Can you back up just a second and explain what Covax is and how it came about?
RH: Sure. Covax is the mechanism that was set up by CEPI, Gavi, the World Health Organization and Unicef to fund research and development on Covid-19 vaccines, and then to procure, allocate and deliver them. It was set up as a global sharing mechanism, but because the high-income countries have already taken care of themselves, it has now become essentially a mechanism to rebalance supply to low- and middle-income countries.
ML: Is there a precedent for the attempt to vaccinate the entire world so quickly?
RH: This is the first time it's been done at this scale. There are so many things about the pandemic that are unprecedented.