Technology That Delivered – The Bulwark

Posted: January 17, 2021 at 9:31 am

Science is coming back to White House.

Over the last four years, particularly during the pandemic, both science and scientists have been under increasing attack. Disease experts like Dr. Anthony Fauci have found themselves dressed down by village idiots like election truther Peter Navarro, and competing for Trumps attention with such COVID-19 authorities as demon-sperm champion Dr. Stella Immanuel.

All this is about to change, a point Biden clearly emphasized on Friday with the announcement that his chief science advisor would be Eric Lander, the visionary geneticist who founded and leads the Broad Institute of Harvard and MIT, and that the position will be elevated for the first time to the cabinet level. This will afford greater prominence and power to the White House-based Office of Science and Technology Policy, which Lander will lead.

One of Landers first tasks, Biden outlined in a letter, will be refreshing national science and technology policy, with a particular focus on the promise of digitization (particularly in public health), the need for sustainability, and the imperative for equity. Biden also emphasized the economic consequences of not maintaining global technological preeminence, highlighting competition from China.

Bidens ask of Landerto develop national science and technology strategy to set us on a strong course for the next 75 yearsis not lacking in ambition. It is especially telling that, in selecting Lander, Biden chose a technology-embracing biologist, domains whose effective integration represents the next scientific frontier.

Americas long national nightmare may soon be overwell, yes that one, but the pandemic as wellthanks to a powerful new technology, mRNA vaccines, that was regarded skeptically by experts a scant two months ago. The dramatic transition from promise to substance captures the transformative potential of emerging technologies, offers encouragement to those who pursue these risky endeavors, and highlights the unreasonable effectiveness of data in validating the arrival of a worthy new approach.

The approach that may serve as deliverance from the coronavirus.

Historically, vaccines against viruses required some physical version of the virus as a starting point. In the case of polio, for instance, the virus was either inactivated (the Salk vaccine) or a weakened (attenuated) strain (the Sabin vaccine). The idea for both is the same: By administering a benign version of the virus, the vaccinated person develops the ability to rapidly mount an immune response against the more dangerous actual virus.

Using traditional methods, the procedure of starting with a disease-causing virus and developing a testable vaccine has historically required years. In contrast, mRNA vaccines use an approach that profoundly accelerates the process of developing immunity by focusing immediately on the specific feature of the virus that the body must learn to respond to: a protein component of the virus surface called a spike. An mRNA vaccine does the equivalent of FedEx-ing this specific information to the body and telling cells to produce just this spike protein so the body can quickly learn to recognize it and respond.

In practice, this allows for an astonishingly fast process. A mere 48 hours after the viruss genetic information was posted by researchers in China in January 2020, mRNA vaccine scientists at Moderna and their collaborators at the National Institutes of Health had figured out the part corresponding to the surface spike they knew (based on previous work) would likely make the best vaccine, and Moderna had started the process of manufacturing it for initial testing. (BioNTech, who developed a similar vaccine with Pfizer, initially selected 20 potential molecules to test, before ultimately landing on the same one Moderna had selected.)

Just two months after the virus was originally identified, Modernas candidate vaccine was ready for human clinical trials. By years end, the FDA had authorized the use of both the Moderna and the BioNTech mRNA vaccines, based on the stunning efficacy each demonstrated in large, well-controlled clinical trials. Many health experts would have accepted a vaccine that protected half of recipients, and been delighted with one protecting two-thirds. Yet these mRNA vaccines, the data suggested, seemed to protect just about everybody.

Three prominent lessons emerge from this experience.

First, were reminded of the radically and rapidly transformative power of emerging technologies. Any sufficiently advanced technology is indistinguishable from magic, Arthur C. Clarke famously observed. The ability to start synthesizing a vaccine against a novel pathogen two days after genetically identifying it, to start clinical studies in two months, and to start inoculating patients in less than a year feels about as magical as it gets.

Second, while the success of transformative technology can feel abrupt and singular, its development tends to be anything but, requiringas in the case of mRNA medicinesyears of incremental development, lots of capital, and champions with the resilience to persist through, and learn from, failure after failure after failure. The success of both Moderna and BioNTech can be attributed in large measure to their ability to integrate new thinking with deep experience and domain expertise. Modernas CEO, for example, is a seasoned pharma manager with deep roots in manufacturing and regulation, for example, while BioNTech was able to leverage Pfizers deep operational capabilities and established ability to execute at global scale.

Finally, and perhaps of particular importance in an era where facts have struggled to retain their salience, the mRNA vaccine success demonstrates the democratizing power of science at its best. When executed responsibly, science offers an objective forum, an established methodology where even the most audacious and visionary ideas can be considered and evaluated, and where compelling results, like the vaccine data, can persuade dubious skeptics.

As Lander takes up Bidens technology policy refresh challenge, he will certainly examine the devastation wrought by the pandemic and ask what we might have done differently. There will be many examples of things that didnt work. But the striking and unanticipated success of mRNA vaccines reminds us to also recognize the innovative triumphsthe audacious dreams that were, against all odds, fulfilled. An idea scrawled on a napkin ten years ago becomes a life-saving medicine, injected into millions of arms100 million in the next 3 months, Biden hopes.

In learning from what went right, Lander and his colleagues will need to consider not only how best to cultivate visionary science, but alsocriticallyhow to accelerate the efficient translation of science into what matters most: practice, and the real-world care of patients.

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Technology That Delivered - The Bulwark

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