When will I receive the Covid vaccine? Operation Warp Speed ​​and US Health-Care System

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Moncef Slaoui was hired by the Trump administration in May to lead a Manhattan Project-style effort to drastically cut the time needed to develop a coronavirus vaccine and produce hundreds of millions of doses for the American people.

The renowned immunologist and former head of the vaccines division at GlaxoSmithKline Plc is somewhat of a celebrity in the pharmaceutical world. He took on the role of chief scientific advisor to Operation Warp Speed ​​with two conditions: “Full powers and no interference.”

Slaoui, 61, sees the rapid development of several vaccines and the manufacture of millions of doses as an unprecedented success. However, a slow and confusing implementation has frustrated millions of Americans and prompted the Biden government to promise to accelerate the pace. Slaoui said he has been concerned about the failure to get more shots.

“A vaccine is useless if it stays on the shelf,” he said.

Speaking to Bloomberg after resigning earlier this month as an advisor to the U.S. pandemic response at the request of the Biden government, Slaoui reflected on a fractured health care system that he suggests is responsible for problems with dose administration.

Your comments have been edited for clarity and readability:

Bloomberg: What do you think of the Biden administration’s goal of vaccination of 100 million doses in 100 days?

Moncef Slaoui: 100 million doses in 100 days is frankly below the plans we had. At that time, we had 100 million people vaccinated. That means two doses. At least in terms of manufacturing and supply, there will certainly be 200 million doses produced by the end of March or mid-April. So if the ambition is to use only half of them, that is the ambition. I hope that goal is achieved and exceeded.

Bloomberg: Why is the gap between the doses of vaccine delivered and the doses administered so large? Of the 39.8 doses administered in the United States, only 19.8 million injections have been administered so far, according to Bloomberg’s Vaccine Tracker.

Slaoui: Having lived in Europe and now in the United States, clearly health systems are dramatically different, as opposites. The point in the United States is that the system is so fragmented, there are so many health providers, so many health insurers, so many systems, so many jurisdictions and people are moving far more between them than people do in Europe. It is really difficult to convey a coherent message to people and it is difficult to mobilize everyone at the same time in the health system to do something.

The way we did that, and it clearly turned out to be a problem, was to say, because we cannot align all of these systems, we will work with them, empower them. We were part of an administration whose worldview was based on less centralization.

Bloomberg: Why hasn’t the Trump administration’s approach to working across states proved successful?

Slaoui: What remained a surprise to me, frankly, is that we are looking for health administration officials in many jurisdictions and states. We spent two to three hours with them in person and countless hours over the phone. We explain, we will have vaccines. There will be a limited number of doses. There will be a prioritization process and we will allocate doses for each state based on the population. And then each state and health care system must tell us where to send them.

Every week, a health care system in New York or California would say: send 200 doses to this CEP, 300 to the other and 500 or 1,000 to this hospital and so on. How is it possible that the health system speaks with such precision that it wants 200 here, 500 there, 700 here, and then when we rule with 99.9% correctness, it ends up that they don’t even immunize people?

The assumption was that these sites would be ready to immunize and, frankly, they didn’t tell us, we don’t have the resources for that. So it remains an enigma for me.

Bloomberg: What could Operation Warp Speed ​​have done differently to achieve its goal of delivering 20 million doses by the end of 2020?

Slaoui: I am not denying the fact that this has by far been less than our goal. That we missed it. In terms of discovering vaccines, developing and manufacturing them, we went faster than ever. But a vaccine is useless if it stays on the shelf. Of course, it needs to end in people’s arms.

Perhaps having a hundred stadiums where people could come and be immunized would have helped. Or use 200,000 military personnel to immunize people in tents. Maybe that’s how you do it. The approach we have in our plan is that as soon as we passed Phase 1a, that restricted population, we would go to pharmacies. There is a pharmacy less than 10 miles from 90% of Americans. As we reach these populations, which is happening now, the rate of immunization will increase. We are currently reaching one million people a day and will continue to increase based on the previous plan.

Bloomberg: On a previous Bloomberg interview, you said that Pfizer Inc. turned to the US government for get priority access to raw materials so you can deliver 100 million doses by the second quarter of this year. Did the US government trigger the Defense Production Law for that purpose? And what would that mean for the relationship between the U.S. government and Pfizer?