Slow Vaccine Campaign Remains a ‘Puzzle’ to Ex-Warp Speed Chief

Moncef Slaoui was tapped 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 GlaxoSmithKline Plc’s vaccines division is a bit a celebrity in the pharmaceutical world. He took on the role of chief scientific adviser to Operation Warp Speed with two conditions: "Full empowerment, and no interference."

Slaoui, 61, sees the rapid development of multiple vaccines and manufacturing of millions of doses as an unprecedented success. However, a slow and confusing rollout has frustrated millions of Americans and led the Biden administration to vow to accelerate the pace. Slaoui said that he has been troubled by the failure to get more shots into arms. 

"A vaccine is useless if it stays on a shelf," he said.  

Speaking with Bloomberg after he resigned earlier this month as an adviser to the U.S. pandemic response at the request of the Biden administration, Slaoui reflected on a fractured health-care system he suggests is responsible for the problems administering doses.

His remarks have been edited for clarity and readability:

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

Moncef Slaoui: 100 million doses in 100 days is frankly below the plans we had. We had 100 million people vaccinated by that time. That means two doses. At least in terms of manufacturing and supply, absolutely there will be 200 million doses produced by the end of March or the middle of April. So, if the ambition is to only use half of them, then that's the ambition. I hope that goal is met, and far surpassed.

Bloomberg:  Why has the gap between vaccine doses distributed and doses administered been so wide? Out of 39.8 doses delivered in the U.S., only 19.8 million shots have thus far been administered, according to Bloomberg’s Vaccine Tracker.

Slaoui: Having lived in Europe and now the U.S., clearly the health systems are so dramatically different, like opposites. The issue in the U.S. 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 so much more between them than people move around in Europe. It’s really hard to deliver a coherent message to people, and it’s hard to mobilize everyone at once in the health-care system to do something.

The way we went about it, and clearly it turned out to be a problem, was to say, because we cannot align all these systems let’s work through them, empower them. We were part of an administration whose view of the world was based on less centralization. 

Bloomberg: Why didn’t the Trump administration's approach to working through the states prove to be successful?

Slaoui: What's remained a surprise to me, frankly, is that we went to health administration officials in many jurisdictions and states. We spent two to three hours with them in person and countless hours on calls. We explained, we're going to have vaccines. There will be a limited number of doses. There will be a prioritization process, and we’re going to allocate doses to each state on the basis of the population. And then each state and health system must tell us where to ship them.

Every week, a health system in New York or California would say, send 200 doses to this zip code, 300 to that other one, and 500 or one thousand to this hospital, and so on. How is it possible that the health system would say with such precision that they want 200 here, 500 there, 700 here, and then when we ship them with 99.9% accuracy, it turns out they can’t even immunize people?

The assumption was that these places would be ready to immunize, and frankly, we were not told, we don’t have the resources to do it. So that remains a puzzle to me.

Bloomberg: What could Operation Warp Speed have done differently to reach its goal of getting 20 million doses distributed by the end of 2020?

Slaoui: I’m not negating the fact that this has been, by far, less than our objective. That we missed it. In terms of discovering vaccines, developing them, and manufacturing them, we went faster than ever before. But a vaccine is useless if it stays on the shelf. It’s clear it needs to end in the arm of people.

Maybe having a hundred stadiums where people could come and be immunized would have helped. Or using 200,000 army personnel to come and immunize people in tents. Maybe that's the way you do it. The approach we have in our plan is that as soon as we get past Phase 1a, that restricted population, we would go into the pharmacies. There is a pharmacy within 10 miles of 90% of Americans. As we get to those populations, which is happening now, the rate of immunization is going to go up. Right now, we’re reaching a million people a day, and it will continue to go up based on the previous plan.

Bloomberg: In a previous interview with Bloomberg, you said that Pfizer Inc. had turned to the U.S. government to get priority access to  raw materials so it could deliver 100 million doses by the second quarter of this year. Did the U.S. government trigger the Defense Production Act to that end? And what would that mean for the relationship between the U.S. government and Pfizer?

Slaoui: Pfizer is getting whatever they asked for. We've used a DPA 18 different times to accelerate manufacturing. With the DPA comes the opportunity to have priority access to whatever materials you need. The consequence of that is the government has much clearer visibility on what Pfizer is doing with those materials. There's an obligation to use those products acquired through a DPA for manufacturing vaccines for the U.S. And that really creates much more transparency around Pfizer's plants than there was before.

Bloomberg: Anthony Fauci said he felt “somewhat” liberated now that he was no longer working for the Trump administration. How are you reflecting on your time working for the White House?

Slaoui:  On the day I interviewed to take the role, I put forward two conditions: Full empowerment and no interference. I remember saying, “I don't know the bureaucracy, I don't know how this world works and I'm not going to learn how it works. I'm just going to focus on the objective and run with it.” And they said, “Perfect, that's what we want.”

When the President would say, “Do you think you can have this data before Election Day?” I always said, Mr. President, there's no way to know. Whoever tells you it's possible doesn't know what they're talking about. And whoever tells you it isn't possible doesn't know what they're talking about. If there was interference, I would raise my hand and resign.

I know Tony very well, I respect him, and I empathize with him. I would say to the system, please just let science dictate what needs to be done.

©2021 Bloomberg L.P.

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