The conflicts will turn global and domestic, friendly and vicious. The vaccine wars have begun. Who “wins” will determine many billions in profits and the fate of nations. Not to mention yours.

Domestic

There are perhaps 300 vaccines in development for COVID. Two mRNA vaccines using a novel platform from BioNTech and Moderna, have shown in preliminary results what appears to be “95%” effectiveness in preventing major flu-like symptoms. Great news. Now it will be nice to see if it’s accompanied by transparency of results, especially for harder endpoints like hospitalizations.

The mRNA vaccines are expensive to make, administer twice, refrigerate, and distribute. Many more traditionally created vaccines will follow. Which will be best?

Without data, we know little. Most of what’s appeared so far is in the nature of press releases.

And the definition of “best” will demand review of many variable endpoints, including clinical ones like how well they prevent infection versus illness. If you prevent infection, you can eventually move towards eradication of COVID. Then you need look at the traditional clinical variables like hospitalization and death rates; how long the immunity lasts; overall side effects.

Like many medical treatments, results will vary dramatically by population. What works in infants may not work in the elderly. What works in women may not do as well in men. Will vary by country and ethnic group.

You’ll only find out by doing the studies.

Next are the non-clinical variables: cost. Ease of production. Speed of production. Ease of use. Ease of distribution. Short and long term stability.

What do you need to determine these effects? A commission of public health people without major ties to industry would help.

Don’t expect to see it. There’s too much riding on the outcomes for major political and economic actors not to lobby very, very actively. And then there’s the wider world:

International

Who wants a cheap, effective vaccine for COVID? Everybody. Who should get it? Everybody, especially as a disease that spreads this easily will not be controlled until, like polio or measles, vaccines reach every population.

Who will make and distribute it? Anyone who wants major influence in global affairs.

Like us.

The Russians and Chinese are already offering free or cheap vaccines to many nations. The COVAX group through the WHO is trying to make sure effective vaccines will get distributed throughout the world, especially to first responders and groups that might more easily spread the illness.

Our history here is instructive. The president’s “America First” program has seen us try to leave the WHO. It’s seen us develop tests for COVID so ineffective – my molecular biologist brother-in-law explained that the CDC original tests involved mistakes undergraduates don’t make – that we came back of the line for reagents, which meant we did not have usable tests when the epidemic hit hard.

Right now, America has more official cases and deaths from COVID than any nation. Many overseas have written that we are our country is not a mere laughingstock: they pity us. That’s our present “America First.”

How to change that?

Do what we should have done from the virus’ beginning, when the world expected us to run the epidemic response.

A Real Response

If the president decides that it’s okay to admit defeat and finally leave office, we could invoke the Defense Production Act. Finally, we can make enough PPE to protect our frontline workers. We can then organize a truly national public health response, and get standardized reporting as well as trace and track ready and functional.

Next, we can build vaccine capacity for all the world, not just ourselves. We do that by working with COVAX to produce multiple vaccines that can be brought by donkey over the Himalayas or sent by boat to remote jungle villages. We make enough for us and for everybody else, all that we can.

Such actions will bring more than goodwill. That will provide hope to billions and advance health around the world, allowing the global economy to re-expand and aid everyone’s success. Including ours.

We’ll be announcing to others that we’re back, part of the community of nations again, the nation that people looked up to for centuries. That’s the real way to make America first.

Note: Old hand problems have resurfaced; won’t be posting for a while.